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Choroid Plexus Volume and Permeability at Brain MRI within the Alzheimer Disease Clinical Spectrum
Choi JD, Moon Y, Kim HJ, Yim Y, Lee S, Moon WJ.. Radiology, 2022-05-17
Topic: Amyloid, tau and blood-test diagnosis
Background Mounting evidence suggests that the choroid plexus (CP) plays an important role in the pathophysiology of Alzheimer disease (AD), but its imaging profile in cognitive impairment remains unclear. Purpose To evaluate CP volume, permeability, and susceptibility by using MRI in patients at various stages of cognitive impairment. Materials and Methods This retrospective study evaluated patients with cognitive symptoms who underwent 3.0-T MRI of the brain, including dynamic contrast-enhanced (DCE) imaging and quantitative susceptibility mapping (QSM), between January 2013 and May 2020. CP volume was automatically segmented using three-dimensional T1-weighted sequences; the volume transfer constant (ie, K trans ) and fractional plasma volume (ie, V p ) were determined using DCE MRI, and susceptibility was assessed using QSM. The effects of CP volume, expressed as the ratio to intracranial volume, on cognition were evaluated using multivariable linear regression adjusted for age, sex, education, apolipoprotein E ε4 allele status, and volumetric measures. Results A total of 532 patients with cognitive symptoms (mean age, 72 years ± 9 [SD]; 388 women) were included: 78 with subjective cognitive impairment (SCI), 158 with early mild cognitive impairment (MCI), 149 with late MCI, and 147 with AD. Among these, 132 patients underwent DCE MRI and QSM. CP volume was greater in patients at more severe stages (ratio of intracranial volume × 10 3 : 0.9 ± 0.3 for SCI, 1.0 ± 0.3 for early MCI, 1.1 ± 0.3 for late MCI, and 1.3 ± 0.4 for AD; P K trans ( r = -0.19; P = .03) and V p ( r = -0.20; P = .02) were negatively associated with CP volume; susceptibility was not ( r = 0.15; P = .10). CP volume was negatively associated with memory ( B = -0.67; standard error of the mean [SEM], 0.21; P = .01), executive function ( B = -0.90; SEM, 0.31; P = .01), and global cognition ( B = -0.82; SEM, 0.32; P = .01). Conclusion Among patients with cognitive symptoms, larger choroid plexus volume was associated with severity of cognitive impairment in the Alzheimer disease spectrum. Published under a CC BY 4.0 license. Online supplemental material is available for this article . See also the editorial by Chiang in this issue.
Key findings
- Background Mounting evidence suggests that the choroid plexus (CP) plays an important role in the pathophysiology of Alzheimer disease (AD), but its imaging profile in cognitive impairment remains unclear.
- Results A total of 532 patients with cognitive symptoms (mean age, 72 years ± 9 [SD]; 388 women) were included: 78 with subjective cognitive impairment (SCI), 158 with early mild cognitive impairment (MCI), 149 with late MCI, and 147 with AD.
- CP volume was greater in patients at more severe stages (ratio of intracranial volume × 10 3 : 0.9 ± 0.3 for SCI, 1.0 ± 0.3 for early MCI, 1.1 ± 0.3 for late MCI, and 1.3 ± 0.4 for AD; P < .001).
- CP volume was negatively associated with memory ( B = -0.67; standard error of the mean [SEM], 0.21; P = .01), executive function ( B = -0.90; SEM, 0.31; P = .01), and global cognition ( B = -0.82; SEM, 0.32; P = .01).
- Conclusion Among patients with cognitive symptoms, larger choroid plexus volume was associated with severity of cognitive impairment in the Alzheimer disease spectrum.
Why it matters
In 532 patients with cognitive symptoms, greater choroid plexus volume was found in those with more severe impairment, and some patients also had permeability and susceptibility measurements. This is a retrospective observational study, so it shows an association only and cannot prove that the choroid plexus causes Alzheimer's or that targeting it would help.
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Study details
- Participants532
- Evidence strengthLow
How this study scored 56/100
Published in a peer-reviewed journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Radiology) |
| Journal's citation record | 3 / 4 | Radiology: journal h-index 431 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2022 — within 6 year(s) of the newest study here |
| Sample size | 2 / 4 | 532 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 264 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 44.0 citations a year over 6 year(s) since 2022 |
| Impact for its field and year | 5 / 6 | Cited 29.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 6 other studies in this library |
| Still being cited | 4 / 4 | Cited 228 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Won‐Jin Moon: h-index 40 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Seoul National University: institution h-index 1,053 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 8 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 35579521) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 56 / 100 | — |
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APA 7th
Choi, J. D., Moon, Y., Kim, H. J., Yim, Y., Lee, S., & Moon, W. J. (2022). Choroid Plexus Volume and Permeability at Brain MRI within the Alzheimer Disease Clinical Spectrum. Radiology. https://doi.org/10.1148/radiol.212400
Vancouver
Choi JD, Moon Y, Kim HJ, Yim Y, Lee S, Moon WJ. Choroid Plexus Volume and Permeability at Brain MRI within the Alzheimer Disease Clinical Spectrum. Radiology. 2022. doi:10.1148/radiol.212400. PMID: 35579521.
BibTeX
@article{choi2022-35579521,
author = {Choi, J. D. and Moon, Y. and Kim, H. J. and Yim, Y. and Lee, S. and Moon, W. J.},
title = {{Choroid Plexus Volume and Permeability at Brain MRI within the Alzheimer Disease Clinical Spectrum}},
journal = {Radiology},
year = {2022},
doi = {10.1148/radiol.212400},
pmid = {35579521},
url = {https://doi.org/10.1148/radiol.212400}
}
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