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Exclusion criteria included states with a suggested impairment of BBB integrity, such as neurodegenerative diseases or suspected glymphatic impairment. BBB disruption was assessed using a pre- and post-contrast three-dimensional T1-weighted volume-isotropic turbo spin-echo sequence. Patterns of GBCA distributions were described. The localization of GBCA-extravasation was correlated with perivascular spaces visualized on the coregistered T2-weighted sequences. Fisher\u2019s exact test and logistic regression were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of 43 patients, 30 (69.8%) exhibited visible BBB disruption. BBB disruption was significantly more often observed after therapeutic DSA (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). GBCA-enhancement patterns indicated a localized pial enhancement in 96.7% of affected patients, with additional parenchymal enhancement along the perivascular spaces in 56.7%. Enhancement was predominantly located in the downstream territories of probed vessels, suggesting a potential association with glymphatic transport. An illustrative case with serial MRI examinations is presented, demonstrating time-dependent GBCA-enhancement patterns.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The study provides\n                      <jats:italic>in vivo<\/jats:italic>\n                      evidence of GBCA transport patterns following iatrogenic BBB disruption, which may correspond to parts of the proposed glymphatic pathways. Our results indicate a sequential progression of contrast enhancement, initially manifesting at the brain surface and subsequently extending along perivascular spaces to the subarachnoid space.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance statement<\/jats:title>\n                    <jats:p>Understanding BBB disruption and glymphatic transport with MRI imaging methods may improve neurovascular disease management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>BBB disruption post-DSA may facilitate GBCA transport via glymphatic pathways, offering novel and hypothesis-generating insights into brain clearance mechanisms.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>GBCA enhancement followed a chronological and spatial pattern, suggesting an organized cerebrospinal-interstitial exchange system relevant for brain clearance.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Findings highlight potential implications for BBB integrity in neurovascular health with prospective implications for diagnostic imaging.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1186\/s41747-025-00672-0","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T12:30:30Z","timestamp":1770208230000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Visualization of gadolinium transport across the blood-brain barrier along perivascular clearance pathways"],"prefix":"10.1186","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2573-5770","authenticated-orcid":false,"given":"Svea","family":"Seehafer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yvonne","family":"Mrosek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars-Patrick","family":"Schmill","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Schekeb","family":"Aludin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olav","family":"Jansen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl Alexander","family":"Gless","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna","family":"R\u00fcmenapp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naomi","family":"Larsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"672_CR1","doi-asserted-by":"publisher","first-page":"147ra111","DOI":"10.1126\/scitranslmed.3003748","volume":"4","author":"JJ Iliff","year":"2012","unstructured":"Iliff JJ, Wang M, Liao Y et al (2012) A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid \u03b2. 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All included patients signed informed broad consent allowing the use of images and clinical data for research.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All included patients signed informed broad consent allowing the use of images and clinical data for research and publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"SA and NL received speaking fees from PHILIPS Healthcare. The other authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"10"}}