Differential Pathophysiological Roles of Centrum Semiovale Perivascular Spaces in Cerebral Amyloid Angiopathy and Deep Perforator Arteriopathy: A Biomarker Synthesis

Highlights

• Centrum semiovale perivascular spaces (CSO PVS) are significantly associated with cerebrospinal fluid (CSF) Aβ42/40 ratios in cerebral amyloid angiopathy (CAA), but not in deep perforator arteriopathy (DPA).
• The burden of visible CSO PVS in CAA reflects impaired perivascular drainage of amyloid-β, whereas in DPA, it likely results from arterial stiffening and altered fluid dynamics.
• CSF Aβ40 levels do not correlate with PVS counts in either CSVD subtype, suggesting the Aβ42/40 ratio is a more specific marker of vascular amyloid entrapment.
• Subtype-specific interpretation of neuroimaging markers is essential for precise diagnosis and management of cerebral small vessel diseases (CSVD).

Background