{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:37:06Z","timestamp":1787963826264,"version":"build-2784847793"},"reference-count":82,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurodegener Dis"],"abstract":"<jats:p>Background: The blood-brain barrier (BBB) is a specialized multicellular interface that maintains the central nervous system\u2019s tightly regulated microenvironment. BBB disruption is increasingly recognized as a key feature of neurodegeneration, documented across disorders including Alzheimer\u2019s disease (AD), Parkinson\u2019s disease (PD), and cerebral small vessel disease (cSVD). While the extent to which BBB breakdown is a cause or consequence of neuronal pathology remains unclear, its pronounced presence in disease states suggests a significant contributory role in progression. Summary: This review provides a neuroradiological overview of advanced MRI approaches for assessing BBB integrity in neurodegenerative diseases. The primary quantitative biomarkers discussed are the volume transfer constant (Ktrans) derived from dynamic contrast-enhanced MRI (DCE), reflecting paracellular gadolinium leakage, and the water exchange rate (k&lt;sub&gt;w&lt;\/sub&gt;) from arterial spin labeling (ASL), capturing trans-endothelial water permeability. Disease-specific BBB signatures across AD, PD, and cSVD are systematically described, alongside complementary indirect markers including diffusion MRI, dynamic susceptibility contrast, and vessel architecture imaging. Current technological advances, including ultra-high-field MRI and AI-assisted post-processing, are discussed in relation to their potential to enhance detection sensitivity. With continued technical refinement and standardization, MRI-based BBB metrics are transitioning from research tools into candidate neurovascular biomarkers with growing potential for early diagnosis, treatment monitoring, and longitudinal follow-up. Key Messages: MRI-based BBB imaging represents an emerging neurovascular biomarker under active investigation for future diagnostic and therapeutic applications. DCE and ASL provide complementary BBB metrics (Ktrans, k&lt;sub&gt;w&lt;\/sub&gt;), illuminating distinct and complementary facets of barrier dysfunction. BBB disruption is a key and early feature across AD, PD, and cSVD, with disease-specific regional patterns that may guide patient stratification and therapeutic monitoring. Ultra-high-field MRI and AI-assisted post-processing are advancing BBB imaging sensitivity; however, multicenter standardization and normative validation remain critical prerequisites for clinical translation.<\/jats:p>","DOI":"10.1159\/000552173","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T14:31:44Z","timestamp":1776781904000},"page":"1-16","source":"Crossref","is-referenced-by-count":1,"title":["Beyond the Leak: Advanced MRI Assessment of the Blood-Brain Barrier in Neurodegeneration"],"prefix":"10.1159","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7681-5044","authenticated-orcid":false,"given":"Daniele","family":"Botta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Bernetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana","family":"Hutuca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Federico","family":"Ojeda Esparza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Sveikata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl Olof","family":"Lovblad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix 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