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Purpose <p>Visible perivascular spaces of cerebral white matter at magnetic resonance imaging (MRI) were in several studies proposed to be an integral part of brain-wide perivascular clearance pathways, and their enlargement could therefore serve as markers of perivascular clearance dysfunction. We studied whether MRI-visible perivascular spaces in subcortical white matter communicate with subarachnoid cerebrospinal fluid (CSF).</p> Methods <p>MRI-visible perivascular spaces of the basal ganglia served as controls. Intrathecal 0.5 mmol gadobutrol was utilized as CSF tracer, and T1-weighted MRI was performed before, and at multiple time points after (3, 6, 24 and 48&#xa0;h) injection. Perivascular spaces with diameter ≥ 2&#xa0;mm were included in the analysis, and a circular region of interest was placed manually within one perivascular space and in adjacent brain parenchyma of each region.</p> Results <p>The study included 27 symptomatic individuals undergoing clinical work-up of various CSF circulation disorders, but in whom no treatable condition was found. Perivascular spaces of both white matter and basal ganglia enhanced with intrathecal gadobutrol, confirming CSF exchange with perivascular spaces. While perivascular spaces of basal ganglia enhanced most with peak at 6&#xa0;h (233.2% [34.9 to 431.5%]) (<i>p</i> &lt; 0.01), coinciding with peak enhancement in subarachnoid CSF, perivascular spaces of white matter enhanced less and more slowly with peak at 48&#xa0;h (159.1% [37.9 to 280.3%]) (<i>p</i> &lt; 0.01).</p> Conclusions <p>The various degrees of CSF exchange with MRI-visible subcortical perivascular spaces suggest these may be dilated for different reasons, therefore questioning their validity as markers of perivascular clearance function.</p>

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Do enlarged white matter perivascular spaces reflect brain clearance dysfunction? Insights from intrathecal contrast-enhanced MRI

  • 期刊论文

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  • 发表日期：

    2025年12月26日

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  • Vanja Cengija,
  • Per Kristian Eide,
  • Geir Ringstad

摘要

Purpose

Visible perivascular spaces of cerebral white matter at magnetic resonance imaging (MRI) were in several studies proposed to be an integral part of brain-wide perivascular clearance pathways, and their enlargement could therefore serve as markers of perivascular clearance dysfunction. We studied whether MRI-visible perivascular spaces in subcortical white matter communicate with subarachnoid cerebrospinal fluid (CSF).

Methods

MRI-visible perivascular spaces of the basal ganglia served as controls. Intrathecal 0.5 mmol gadobutrol was utilized as CSF tracer, and T1-weighted MRI was performed before, and at multiple time points after (3, 6, 24 and 48 h) injection. Perivascular spaces with diameter ≥ 2 mm were included in the analysis, and a circular region of interest was placed manually within one perivascular space and in adjacent brain parenchyma of each region.

Results

The study included 27 symptomatic individuals undergoing clinical work-up of various CSF circulation disorders, but in whom no treatable condition was found. Perivascular spaces of both white matter and basal ganglia enhanced with intrathecal gadobutrol, confirming CSF exchange with perivascular spaces. While perivascular spaces of basal ganglia enhanced most with peak at 6 h (233.2% [34.9 to 431.5%]) (p < 0.01), coinciding with peak enhancement in subarachnoid CSF, perivascular spaces of white matter enhanced less and more slowly with peak at 48 h (159.1% [37.9 to 280.3%]) (p < 0.01).

Conclusions

The various degrees of CSF exchange with MRI-visible subcortical perivascular spaces suggest these may be dilated for different reasons, therefore questioning their validity as markers of perivascular clearance function.