Hyperintensity

Glymphatic system

Magnetic resonance imaging

Choroid plexus

Nuclear medicine

Internal medicine

Fluid-attenuated inversion recovery

Medicine

Perivascular space

Cerebrospinal fluid

Organic chemistry

White matter

Chemistry

Radiology

Pathology

Central nervous system

Gadolinium

Investigative Radiology

The "glymphatic system" (GS), a brain-wide network of cerebrospinal fluid microcirculation, supplies a pathway through and out of the central nervous system (CNS); malfunction of the system is implicated in a variety of neurological disorders. In this exploratory study, we analyzed the potential of a new imaging approach that we coined delayed T2-weighted gadolinium-enhanced imaging to visualize the GS in vivo.Heavily T2-weighted fluid-attenuated inversion recovery (hT2w-FLAIR) magnetic resonance imaging was obtained before, and 3 hours and 24 hours after intravenous gadolinium-based contrast agent (GBCA) application in 33 neurologically healthy patients and 7 patients with an impaired blood-brain barrier (BBB) due to cerebral metastases. Signal intensity (SI) was determined in various cerebral fluid spaces, and white matter hyperintensities were quantified by applying the Fazekas scoring system.Delayed hT2w-FLAIR showed GBCA entry into the CNS via the choroid plexus and the ciliary body, with GBCA drainage a...

Glymphatic Pathway of Gadolinium-Based Contrast Agents Through the Brain