Current Concepts in Intracranial Interstitial Fluid Transport and the Glymphatic System: Part II—Imaging Techniques and Clinical Applications

淋巴系统 医学 间质液 血管周围间隙 神经影像学 背景(考古学) 脑积水 脑脊液 磁共振弥散成像 神经科学 放射科 磁共振成像 病理 生物 精神科 古生物学
作者
Jesse M. Klostranec,Diana Vucevic,Kartik Bhatia,Hans Kortman,Timo Krings,Kieran Murphy,Karel G. terBrugge,David J. Mikulis
出处
期刊:Radiology [Radiological Society of North America]
卷期号:301 (3): 516-532 被引量:53
标识
DOI:10.1148/radiol.2021204088
摘要

The glymphatic system is a recently discovered network unique to the central nervous system that allows for dynamic exchange of interstitial fluid (ISF) and cerebrospinal fluid (CSF). As detailed in part I, ISF and CSF transport along paravascular channels of the penetrating arteries and possibly veins allow essential clearance of neurotoxic solutes from the interstitium to the CSF efflux pathways. Imaging tests to investigate this neurophysiologic function, although challenging, are being developed and are reviewed herein. These include direct visualization of CSF transport using postcontrast imaging techniques following intravenous or intrathecal administration of contrast material and indirect glymphatic assessment with detection of enlarged perivascular spaces. Application of MRI techniques, including intravoxel incoherent motion, diffusion tensor imaging, and chemical exchange saturation transfer, is also discussed, as are methods for imaging dural lymphatic channels involved with CSF efflux. Subsequently, glymphatic function is considered in the context of proteinopathies associated with neurodegenerative diseases and traumatic brain injury, cytotoxic edema following acute ischemic stroke, and chronic hydrocephalus after subarachnoid hemorrhage. These examples highlight the substantial role of the glymphatic system in neurophysiology and the development of certain neuropathologic abnormalities, stressing the importance of its consideration when interpreting neuroimaging investigations. © RSNA, 2021.
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