Region-specific drivers of CSF mobility measured with MRI in humans

Many neurological diseases are characterized by the accumulation of toxic proteins in the brain. This accumulation has been associated with improper clearance from the parenchyma. Recent discoveries highlighted perivascular spaces, which are cerebrospinal fluid (CSF)-filled spaces, as the channels of brain clearance. The forces driving CSF mobility within perivascular spaces are still debated. Here we present a noninvasive, CSF-specific magnetic resonance imaging technique (CSF-Selective T₂-prepared REadout with Acceleration and Mobility-encoding) that enables detailed in vivo measurement of CSF mobility in humans, down to the level of perivascular spaces located around penetrating vessels, which is close to protein production sites. We find region-specific drivers of CSF mobility and demonstrate that CSF mobility can be increased by entraining vasomotion. Furthermore, we find region-specific CSF mobility alterations in patients with cerebral amyloid angiopathy, a brain disorder associated with clearance impairment. The availability of this technique opens up avenues to investigate the impact of CSF-mediated clearance in neurodegeneration and sleep.