Relationship between inferior frontal sulcal hyperintensities on brain MRI, ageing and cerebral small vessel disease

Zhang, Junfang; Lim, Hwee Fang; Chappell, Francesca M; Clancy, Una; Wiseman, Stewart; Valdés-Hernández, Maria del C.; García, Daniela Jaime; Doubal, Fergus; Hewins, Will; Cox, Simon R.; Maniega, Susana Muñoz; Thrippleton, Michael J.; Stringer, Michael; Jardine, Charlotte; McIntyre, Donna; Barclay, G. Robin; Hamilton, I.; Kesseler, Lucy; Murphy, Madeleine; Perri, Carol Di; Wu, Yun-Cheng; Wardlaw, Joanna M.

doi:10.1016/j.neurobiolaging.2021.06.013

Cited by 6 publications

(13 citation statements)

References 46 publications

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“…Interestingly, periarteriolar PVS, 2 cortical perivenous spaces, mlymphatics, and waste CSF draining at the cribriform plate 5 are all visible on routine MRI (Figure). Perivenous spaces and mlymphatics are better seen after intravenous gadolinium, since the gadolinium passes via CSF and interstitium to the perivenous and mlymphatic channels but can be seen on noncontrast fluid attenuated inversion recovery (FLAIR; waste including proteins elevates fluid signal) 6 and some T2-weighted sequences.…”

Section: Brain Fluid Pathways: a Short Summarymentioning

confidence: 99%

“…E , Axial FLAIR MRI (without intravenous or intrathecal contrast injection), inferior frontal fossa, showing increased CSF signal in inferior frontal sulci immediately superior to the cribriform plate: even very small amounts of protein or cellular debris increase FLAIR CSF signal at this key cranial fluid drainage point. 5…”

Section: Brain Fluid Pathways: a Short Summarymentioning

confidence: 99%

“…1 Inferior frontal sulci CSF signal (debris) increases on FLAIR with age and PVS (Figure [E]). 5 Glymphatic system activity may increase during sleep, promoting waste clearance in rodents, 1 perhaps explaining the importance of sleep for brain health; in humans, there is limited evidence of PVS associating with poor sleep habits, while pathological sleep (eg, obstructive sleep apnea) increases stroke and small vessel disease. 10 Thus, increased numbers and size of PVS on MRI indicate impaired fluid and waste clearance and worsening brain health.…”

Section: Relevance To Cerebrovascular Diseasementioning

confidence: 99%

“…D, Heavily T2-weighted coronal MRI of sagittal sinus near vertex without intravenous gadolinium shows mlymphatics (long yellow arrows) alongside the sagittal sinus (white arrow). E, Axial FLAIR MRI (without intravenous or intrathecal contrast injection), inferior frontal fossa, showing increased CSF signal in inferior frontal sulci immediately superior to the cribriform plate: even very small amounts of protein or cellular debris increase FLAIR CSF signal at this key cranial fluid drainage point 5.…”

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confidence: 99%

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Not Just Blood: Brain Fluid Systems and Their Relevance to Cerebrovascular Diseases

Liebeskind

2022

Stroke

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troke research has largely focused on blood supply to the brain, particularly via large arteries leading from the heart, the muscular intracranial large arteries, large cerebral veins and venous sinuses, and more recently perforating arterioles, capillaries, and venules. However, these blood vessels only serve part of the brain's fluid management, nutrient delivery, and waste clearance system. The other, and until recently largely neglected, aspect of brain fluid and waste management is the system that flushes the brain, draining interstitial and cerebrospinal fluid (CSF) and waste from the cranial cavity. Details of this non-blood-vessel brain circulation are incomplete, but there is now enough clinical relevance for it to be the focus of this Advances in Stroke: Diagnosis and Imaging, particularly as key elements are now visible on routine magnetic resonance imaging (MRI).

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Section: Brain Fluid Pathways: a Short Summarymentioning

confidence: 99%

Section: Brain Fluid Pathways: a Short Summarymentioning

confidence: 99%

Section: Relevance To Cerebrovascular Diseasementioning

confidence: 99%

mentioning

confidence: 99%

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Not Just Blood: Brain Fluid Systems and Their Relevance to Cerebrovascular Diseases

Liebeskind

2022

Stroke

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“…After an earlier summary by Stuckey et al, 4 a current study by Zhang et al analyzed inferior frontal sulcal hyperintensities (IFSHs) on FLAIR and came to the conclusion that IFSHs were associated with increasing age and independently associated with higher perivascular spaces score in the centrum semiovale in stroke patients, while additional associations, including vascular risk factors, require further verification. 4,5 In the literature since 2004, FLAIR hyperintensity of CSF spaces as delayed gadolinium enhancement is regarded as a marker to characterize early blood-brain barrier (BBB) disruption in acute focal brain ischemia which again was found to be predicted by reperfusion as the strongest independent factor. 6 Due to this relation with reperfusion and its risk of hemorrhagic transformation, this observation was termed hyperintense acute reperfusion marker (HARM).…”

Section: Introductionmentioning

confidence: 99%

HARM revisited: Etiology of subarachnoid hyperintensities in brain FLAIR MRI

Althaus

Kasel

Ludolph

et al. 2022

International Journal of Stroke

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Background: The hyperintense acute reperfusion marker (HARM) describes a phenomenon with a hyperintense signal in the subarachnoid space in Fluid-Attenuated Inversion Recovery (FLAIR) magnetic resonance imaging (MRI) sequences, presumably based on blood–brain barrier breakdown in acute stroke with reperfusion. However, this imaging phenomenon was described in other medical conditions. Aim: Determination of the prevalence and associated clinical findings of this phenomenon in a large sample of patients with different neurological conditions. Methods: This is retrospective, single-center, observational study of 23,948 cerebral MRIs acquired in a Neurological University Clinic over 5 years. The prevalence of HARM, the underlying diagnosis, and damage pattern were examined by chart analysis; MRI was analyzed regarding the type of acute lesions, extent of microangiopathic lesions, and whether gadolinium-based contrast agent (GBCA) was given. Results: Among the MRI data, 84 images (0.35%) from 61 patients were HARM-positive without a subarachnoid signal abnormality in any other sequence. Etiologies were heterogeneous; 35 patients had a cerebrovascular disease (CVD; 19 patients received recanalization therapy), 12 patients had an inflammatory central nervous system (CNS) disease and 14 patients had epilepsy. GBCA was applied to 64% of the patients. Conclusion: HARM was a rare radiological finding in a range of different neurological pathologies, not limited to stroke, or to previous reperfusion therapy and was not dependent on previous GBCA administration. Our data suggest that the term is too narrow in terms of the concepts of the underlying pathology. We propose to use the term FLAIR Subarachnoid Hyperintensity (“FLASH”) phenomenon which might better reflect the observation that the radiological sign can be associated with a variety of central neurological conditions without a straightforward association with therapy.

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Magnetic Resonance Imaging Studies of Neurodegenerative Disease: From Methods to Translational Research

Huang

Zhang

2022

Neurosci. Bull.

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Relationship between inferior frontal sulcal hyperintensities on brain MRI, ageing and cerebral small vessel disease

Cited by 6 publications

References 46 publications

Not Just Blood: Brain Fluid Systems and Their Relevance to Cerebrovascular Diseases

Not Just Blood: Brain Fluid Systems and Their Relevance to Cerebrovascular Diseases

HARM revisited: Etiology of subarachnoid hyperintensities in brain FLAIR MRI

Magnetic Resonance Imaging Studies of Neurodegenerative Disease: From Methods to Translational Research

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