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. 2021 Jan 5;298(3):654–662. doi: 10.1148/radiol.2021200643

Figure 5:

MRI scans show perivenular enhancement after gadobutrol clearance and blood-brain barrier (BBB) closure at 24 hours after treatment in a 61-year-old woman with Alzheimer disease. Precontrast coronal, A, T1-weighted and, B, fluid-attenuated inversion recovery (FLAIR) images, both obtained 24 hours after treatment (at same time point as Fig 3, C), show absence of contrast enhancement in the hippocampus and perivascular space after BBB closure. Postcontrast coronal, C, T1-weighted and, D, FLAIR images, both obtained 24 hours after treatment, show enhancement along the course of the hippocampal sulcal vein (arrows). This enhancement, shown on serial axial T1-weighted sections in, E–H (arrows), was present longitudinally along the course of the hippocampal veins and could be followed posteriorly to the basal vein of Rosenthal (H). I–L, T2* susceptibility-weighted angiography (SWAN) images, corresponding to the same levels as E–H, show blooming susceptibility effects of the hippocampal venous structures (arrows) from the same participant, coinciding with the region of linear enhancement. This perivenous enhancement indicates blood–meningeal barrier permeability and occurred transiently after treatment before complete resolution at all treated sites. M, Same area as in D, zoomed on the right hippocampus, shows perivenous enhancement (arrow). N–Q, Zoomed axial SWAN images (I–L) show the hippocampal venous structures (arrows).

MRI scans show perivenular enhancement after gadobutrol clearance and blood-brain barrier (BBB) closure at 24 hours after treatment in a 61-year-old woman with Alzheimer disease. Precontrast coronal, A, T1-weighted and, B, fluid-attenuated inversion recovery (FLAIR) images, both obtained 24 hours after treatment (at same time point as Fig 3, C), show absence of contrast enhancement in the hippocampus and perivascular space after BBB closure. Postcontrast coronal, C, T1-weighted and, D, FLAIR images, both obtained 24 hours after treatment, show enhancement along the course of the hippocampal sulcal vein (arrows). This enhancement, shown on serial axial T1-weighted sections in, E–H (arrows), was present longitudinally along the course of the hippocampal veins and could be followed posteriorly to the basal vein of Rosenthal (H). I–L, T2* susceptibility-weighted angiography (SWAN) images, corresponding to the same levels as E–H, show blooming susceptibility effects of the hippocampal venous structures (arrows) from the same participant, coinciding with the region of linear enhancement. This perivenous enhancement indicates blood–meningeal barrier permeability and occurred transiently after treatment before complete resolution at all treated sites. M, Same area as in D, zoomed on the right hippocampus, shows perivenous enhancement (arrow). N–Q, Zoomed axial SWAN images (I–L) show the hippocampal venous structures (arrows).