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Glymphatic System Visualized With Intrathecal Gadoterate Meglumine Administered via External Ventricular Drain
Christopher Wong1, Imran Siddiqi1, Louis Reier2
1Neurological Surgery, Riverside University Health System Medical Center, Moreno Valley, USA.
Cureus
|June 1, 2026
Summary
Traumatic brain injury disrupts the brain's glymphatic system, impairing waste clearance. Intrathecal contrast MRI shows altered glymphatic flow in patients with intracranial injury, highlighting potential diagnostic applications.
Area of Science:
- Neuroscience
- Radiology
- Biomedical Engineering
Background:
- The glymphatic system clears brain waste; its disruption is implicated in acute intracranial pathologies.
- Injury-induced glymphatic dysfunction may worsen outcomes like cerebral edema and intracranial pressure.
- Understanding glymphatic dynamics post-injury is crucial for managing brain conditions.
Purpose of the Study:
- To evaluate glymphatic system dynamics after acute intracranial injury.
- To assess the impact of intracranial pathology on glymphatic flow using intrathecal contrast-enhanced MRI.
- To explore the feasibility of intrathecal gadoterate meglumine administration via external ventricular drain for glymphatic imaging.
Main Methods:
- Retrospective study of six patients with intracranial pathology requiring external ventricular drain (EVD) placement.
- Intrathecal (IT) administration of gadoterate meglumine followed by serial brain MRI scans at 4, 12, or 36 hours.
- Analysis of MRI signal intensity in various brain regions to assess glymphatic tracer distribution and clearance.
Main Results:
- Intrathecal contrast administration was well-tolerated procedurally.
- MRI revealed variable glymphatic function, with reduced tracer enhancement in injured areas.
- Neurological decline correlated with reduced glymphatic tracer propagation; EVD placement showed enhanced transport.
Conclusions:
- The glymphatic system is disrupted by acute brain injury, impacting intracranial homeostasis.
- IT contrast-enhanced MRI visualizes glymphatic dynamics and regional pathology.
- Further prospective studies are needed to confirm safety and clinical utility for glymphatic function evaluation.
