title: Gd-based Contrast Enhancement of the Perivascular Spaces in the Basal Ganglia.
abstract: OBJECTIVE
  In textbooks, the perivascular space (PVS) is described as non-enhancing after the intravenous administration of gadolinium-based contrast agent (IV-GBCA). We noticed that the PVS sometimes has high signal intensity (SI) on heavily T2-weighted 3D-FLAIR (hT2-FL) images obtained 4 h after IV-GBCA. The purpose of this study was to retrospectively evaluate the contrast enhancement of the PVS.
  
  
  METHODS
  In 8 healthy subjects and 19 patients with suspected endolymphatic hydrops, magnetic resonance cisternography (MRC) and hT2-FL images were obtained before and 4 h after a single dose of IV-GBCA. No subjects had renal insufficiency. On axial MRC at the level of the anterior commissure (AC)-posterior commissure (PC) line, 1 cm circular regions of interest (ROIs) were drawn centering on the PVS in the bilateral basal ganglia and thalami. Three-millimeter diameter ROIs were set in the cerebrospinal fluid (CSF) of the bilateral ambient cistern. The ROIs on MRC were copied onto the hT2-FL images and the SI was measured. The SI ratio (SIR) was defined as SIRPVS= SI of PVS/SI of the thalami, and SIRCSF= SI of CSF/SI of the thalami. The average of the bilateral values was used for the calculation. The SIRCSF, SIRPVS, and SI of the thalami were compared between before and 4 h after IV-GBCA.
  
  
  RESULTS
  The SIR was increased significantly from 1.02 ± 0.37 to 2.65 ± 0.82 in the CSF (P < 0.01) and from 1.20 ± 0.35 to 2.13 ± 1.23 in the PVS at 4 h after IV-GBCA (P < 0.01). The SI of the thalami showed no significant difference.
  
  
  CONCLUSIONS
  The enhancement of the PVS at 4 h after IV-GBCA was confirmed even in subjects without renal insufficiency. It is possible that the GBCA in the blood vessels might have permeated into the cerebrospinal fluid (CSF) space and the PVS. This might be a first step in the imaging evaluation of the glymphatic system (waste clearance system) of the brain.
authors.affiliation: Department of Radiology, Nagoya University Graduate School of Medicine.
authors.forename: Shinji
authors.initials: S
authors.lastname: Naganawa
authors.forename: Toshiki
authors.initials: T
authors.lastname: Nakane
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kawai
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Taoka
mesh_terms: D000328:Adult; D000368:Aged; D001479:Basal Ganglia / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006571:Heterocyclic Compounds; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C062402:gadoteridol; D005682:Gadolinium