From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.).
Radiology. 2021 Dec;301(3):516-532. doi: 10.1148/radiol.2021204088. Epub 2021 Oct 26.
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.
脑淋巴系统是中枢神经系统中最近发现的独特网络，允许间质液（ISF）和脑脊液（CSF）的动态交换。如第一部分所述，ISF 和 CSF 通过穿透动脉和可能的静脉的脉管周围通道运输，从而允许将神经毒性溶质从间质中有效地清除到 CSF 流出途径。尽管具有挑战性，但正在开发用于研究这种神经生理功能的影像学检查，并在此进行了综述。这些检查包括在静脉内或鞘内给予造影剂后使用对比后成像技术直接可视化 CSF 转运，以及通过检测血管周围空间扩大进行间接的脑淋巴评估。还讨论了 MRI 技术的应用，包括体素内不相干运动、扩散张量成像和化学交换饱和传递，以及与 CSF 流出相关的硬脑膜淋巴通道成像的方法。随后，在与神经退行性疾病和创伤性脑损伤相关的蛋白病、急性缺血性中风后的细胞毒性水肿以及蛛网膜下腔出血后的慢性脑积水的背景下考虑了脑淋巴功能。这些例子突出了脑淋巴系统在神经生理学和某些神经病理异常发展中的重要作用，强调了在解释神经影像学研究时考虑脑淋巴系统的重要性。 © RSNA，2021 年。
