{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:56:47Z","timestamp":1786121807865,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"abstract":"ABSTRACT<\/jats:title>\n \n Background\/Objective<\/jats:title>\n \n Arterial spin\u2010labeling (\n ASL<\/jats:styled-content>\n )\n MRI<\/jats:styled-content>\n can measure perfusion signal adjacent to\n CSF<\/jats:styled-content>\n spaces and may provide information regarding\n CSF<\/jats:styled-content>\n \u2010adjacent water transport physiology. We developed an automated pipeline to extract cortical\u2010\n CSF<\/jats:styled-content>\n interface (\n IF<\/jats:styled-content>\n ) perfusion for comparison between Alzheimer disease (\n AD<\/jats:styled-content>\n ) and cognitively normal controls.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this retrospective study, participants with AD and cognitively normal controls with ASL and 3D T1\u2010weighted MRI were included. Parenchymal cerebral blood flow (CBF) was evaluated globally (whole brain, gray matter, white matter) and across 12 brain regions. IF\u2010perfusion values were quantified using an automated pipeline with tissue segmentation, registration, partial\u2010volume\u2013aware masking, and arterial\u2010signal exclusion. Multivariable sensitivity analysis was performed, adjusting for age, sex, scanner vendor, and acquisition site. Predictive modeling was performed using LASSO\u2010regularized logistic regression with nested repeated stratified cross\u2010validation, and feature contributions were summarized using SHAP.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 51 patients with AD, age (median: 73\u2009years) and 53 cognitively normal subjects (median age: 69) were included. Global CBF did not differ between groups. However, IF\u2010perfusion values were significantly lower in AD (median 4.4, IQR 3.2\u20134.8) than in controls (median 5.2, IQR 4.5\u20136.3;\n p<\/jats:italic>\n \u2009<\u20090.001). In multivariable analysis, AD remained independently associated with lower IF\u2010perfusion after adjustment for age, sex, scanner vendor, and acquisition site (\u03b2\u2009=\u2009\u22121.88, 95% CI: \u22123.52 to \u22120.25;\n p<\/jats:italic>\n \u2009=\u20090.025). In LASSO\u2010regularized logistic regression model, only IF\u2010perfusion and cuneus\u2010CBF remained as significant contributing features for the prediction of AD\u00a0probability with the highest contribution from IF. The final model showed mean ROC\u2010AUC 0.81 in the training and AUC of 0.78 in the testing dataset.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n ASL\u2010derived IF\u2010perfusion is reduced in AD and may represent a promising imaging marker of altered CSF\u2010adjacent water transport physiology. Further validation against established biomarkers of CSF dynamics and clearance pathways is warranted.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/acn3.70498","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T07:25:23Z","timestamp":1786087523000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Arterial Spin\u2010Labeling\n MRI<\/scp>\n at the Cortical\u2010\n CSF<\/scp>\n Interface: A Novel Biomarker in Alzheimer Disease"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0110-2987","authenticated-orcid":false,"given":"Mona","family":"Asghariahmadabad","sequence":"first","affiliation":[{"name":"Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pouya","family":"Metanat","sequence":"additional","affiliation":[{"name":"Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke W.","family":"Bonham","sequence":"additional","affiliation":[{"name":"Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyson","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering University of Washington Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet","family":"Kurt","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering University of Washington Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5610-6748","authenticated-orcid":false,"given":"Hong","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, Weill Institute for Neurosciences University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Ellingson","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, Weill Institute for Neurosciences University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Zucchelli","sequence":"additional","affiliation":[{"name":"Department of Research and Innovation of Olea Medical La Ciotat France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Casagranda","sequence":"additional","affiliation":[{"name":"Department of Research and Innovation of Olea Medical La Ciotat France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quin","family":"Lu","sequence":"additional","affiliation":[{"name":"GE HealthCare San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas M.","family":"Rauschecker","sequence":"additional","affiliation":[{"name":"Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo","family":"Sugrue","sequence":"additional","affiliation":[{"name":"Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis E.","family":"Savastano","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Hess","sequence":"additional","affiliation":[{"name":"Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4217-8785","authenticated-orcid":false,"given":"Kamalini","family":"Ranasinghe","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, Weill Institute for Neurosciences University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Andrew","family":"Josephson","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, Weill Institute for Neurosciences University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce L.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, Weill Institute for Neurosciences University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer S.","family":"Yokoyama","sequence":"additional","affiliation":[{"name":"Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA"},{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, Weill Institute for Neurosciences University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gil D.","family":"Rabinovici","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, Weill Institute for Neurosciences University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Ljubenkov","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, Weill Institute for Neurosciences University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawren","family":"VandeVrede","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, Weill Institute for Neurosciences University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4194-9488","authenticated-orcid":false,"given":"Kambiz","family":"Nael","sequence":"additional","affiliation":[{"name":"Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.nbd.2022.105776","article-title":"Quantifying Cerebrospinal Fluid Dynamics: A Review of Human Neuroimaging Contributions to CSF Physiology and Neurodegenerative Disease","volume":"170","author":"Mehta N. 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