DTI-ALPS index heterogeneity in cerebral small vessel disease questions its universal glymphatic role

DTI-ALPS index was lower in arteriolosclerosis than cerebral amyloid angiopathy (p<0.001). It correlated with white matter damage but not perivascular spaces or clinical factors, and in aCSVD tied to cognition, questioning its universal use as a glymphatic surrogate.

• Retrospective study of 134 patients with probable CAA or arteriolosclerosis CSVD who underwent 5.0T MRI.
• DTI-ALPS index was significantly lower in aCSVD versus CAA, and across both groups, it was associated with white matter hyperintensity volume and diffusion metrics of white matter microstructure.
• Associations with perivascular space burden and CAA-specific imaging markers were not statistically significant.

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