Imaging of the meningeal lymphatic network in healthy adults: A 7T MRI study - 18/03/23

Doi : 10.1016/j.neurad.2023.03.002

Lakir D. Patel ^a,^{^{1
L.D. Patel and P. Raghavan contributed equally and are co-first authors.}} , Prashant Raghavan ^a,^{^{1
L.D. Patel and P. Raghavan contributed equally and are co-first authors.},}^⁎ , Shiyu Tang ^a,^b , Seongjin Choi ^c , Daniel M. Harrison ^c,^d
^a University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, Maryland, USA
^b University of Maryland School of Medicine, Center for Advanced Imaging Research (CAIR), Baltimore, Maryland, USA
^c University of Maryland School of Medicine, Department of Neurology, Baltimore, Maryland, USA
^d Baltimore VA Medical Center, Baltimore, Maryland, USA

^⁎Corresponding author at: 655 W. Baltimore St., 21201, USA.655 W. Baltimore St.21201USA

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Abstract

Background and purpose

Meningeal lymphatic vessels (MLVs) along the dural venous sinuses are suspected to be important in connecting the glymphatic and peripheral lymphatic system. Understanding the topography of MLVs may clarify the role of the glymphatic system in neurological diseases. The aim of this analysis was to use high resolution pre- and post-contrast FLAIR 7T MRI to identify and characterize the morphology of MLV in a cohort of healthy volunteers.

Materials and methods

MRI examinations of seventeen healthy volunteers enrolled as controls in a larger 7T MRI study were reviewed. Pre- and post-contrast 3-D FLAIR subtractions and MP2RAGE sequences were spatially normalized and reviewed for signal intensity and enhancement patterns within putative MLVs along pre-determined dural and venous structures. Frequency of occurrence of MLVs at the above-described locations and patterns of their enhancement were analyzed.

Results

Putative MLVs are commonly located along the superior sagittal sinus (SSS) and cortical veins. A “fixed enhancement” signal pattern was more frequent at these locations (p<.05). The morphology of MLVs along the SSS qualitatively changes in an antero-posterior direction. Lack of signal was more frequent along the straight and transverse sinuses (p<.05).

Conclusion

Putative MLVs in healthy individuals are concentrated along the SSS and cortical veins. FLAIR signal and enhancement characteristics suggest these structures may transport proteinaceous fluid. Pathways connecting MLVs to cervical lymph nodes however remain unclear.

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