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Brain Glymphatic/Lymphatic Imaging by MRI and PET

Nuclear Medicine and Molecular Imaging 2020년 54권 5호 p.207 ~ 223
이동수, Suh Min-Seok, Sarker Azmal, Choi Yoo-Ri,
소속 상세정보
이동수 ( Lee Dong-Soo ) - Seoul National University College of Medicine Department of Nuclear Medicine
 ( Suh Min-Seok ) - Seoul National University College of Medicine Department of Nuclear Medicine
 ( Sarker Azmal ) - Seoul National University Graduate School of Convergence Science and Technology Department of Molecular Medicine and Biopharmaceutical Sciences
 ( Choi Yoo-Ri ) - Seoul National University College of Medicine Department of Nuclear Medicine

Abstract


Since glymphatic was proposed and meningeal lymphatic was discovered, MRI and even PET were introduced to investigate brain parenchymal interstitial fluid (ISF), cerebrospinal fluid (CSF), and lymphatic outflow in rodents and humans. Previous findings by ex vivo fluorescent microscopic, and in vivo two-photon imaging in rodents were reproduced using intrathecal contrast (gadobutrol and the similar)-enhanced MRI in rodents and further in humans. On dynamic MRI of meningeal lymphatics, in contrast to rodents, humans use mainly dorsal meningeal lymphatic pathways of ISF-CSF-lymphatic efflux. In mice, ISF-CSF exchange was examined thoroughly using an intra-cistern injection of fluorescent tracers during sleep, aging, and neurodegeneration yielding many details. CSF to lymphatic efflux is across arachnoid barrier cells over the dorsal dura in rodents and in humans. Meningeal lymphatic efflux to cervical lymph nodes and systemic circulation is also well-delineated especially in humans onintrathecal contrast MRI. Sleep- or anesthesia-related changes of glymphatic-lymphatic flow and the coupling of ISF-CSF-lymphatic drainage are major confounders ininterpreting brain glymphatic/lymphatic outflow in rodents. PET imaging in humans should be interpreted based on human anatomy and physiology, different in some aspects, using MRI recently. Based on the summary in this review, we propose non-invasive and longer-term intrathecal SPECT/PET or MRI studies to unravel the roles of brain glymphatic/lymphatic in diseases.

키워드

Interstitial fluid; Cerebrospinal fluid; Glymphatic; Meningeal lymphatic; Imaging

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