title: The hyperintense acute reperfusion marker on fluid-attenuated inversion recovery magnetic resonance imaging is caused by gadolinium in the cerebrospinal fluid.
abstract: OBJECTIVE
  The hyperintense acute reperfusion marker (HARM) on fluid-attenuated inversion recovery MRI is believed to be caused by gadolinium-based contrast agents crossing a disrupted blood-brain barrier. However, this hypothesis has never been directly verified in humans.
  
  
  METHODS
  In this study, we analyzed cerebrospinal fluid samples of patients with HARM on imaging regarding the presence and concentration of gadolinium-based contrast agents.
  
  
  RESULTS
  Gadobutrol was found in concentrations of approximately 50 μmol/L. Using phantom MRI experiments, we demonstrate that the detected concentrations are consistent with the observed HARM imaging pattern.
  
  
  CONCLUSIONS
  Our study yields first direct evidence in humans that the imaging phenomenon HARM is indeed caused by leakage of gadolinium-based contrast agents into the cerebrospinal fluid.
authors: Department of Neurology, University Hospital of Erlangen, Erlangen, Germany. martin.koehrmann@uk-erlangen.de
authors: Martin
authors: M
authors: Köhrmann
authors: Tobias
authors: T
authors: Struffert
authors: Thomas
authors: T
authors: Frenzel
authors: Stefan
authors: S
authors: Schwab
authors: Arnd
authors: A
authors: Doerfler
mesh_terms: D000328:Adult; D000368:Aged; D001812:Blood-Brain Barrier / Q000293:injuries* / Q000473:pathology; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D005682:Gadolinium / Q000134:cerebrospinal fluid*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male
chemical_list: D005682:Gadolinium