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Research ArticleHead and Neck Imaging
Open Access

Glymphatic System in Ocular Diseases: Evaluation of MRI Findings

P. Manava, C. Eckrich, F. Luciani, J. Schmidbauer, M.M. Lell and K. Detmar
American Journal of Neuroradiology June 2022, DOI: https://doi.org/10.3174/ajnr.A7552
P. Manava
aFrom the Departments of Radiology and Nuclear Medicine (P.M., C.E., M.M.L., K.D.)
cInstitute of Radiology (P.M., M.M.L.), Friedrich-Alexander University, University of Erlangen-Nuremberg, Erlangen, Germany
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C. Eckrich
aFrom the Departments of Radiology and Nuclear Medicine (P.M., C.E., M.M.L., K.D.)
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F. Luciani
bOphthalmology and Visual Science (F.L., J.S.), Klinikum Nuernberg, Paracelsus Medical University, Nuernberg, Germany
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J. Schmidbauer
bOphthalmology and Visual Science (F.L., J.S.), Klinikum Nuernberg, Paracelsus Medical University, Nuernberg, Germany
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M.M. Lell
aFrom the Departments of Radiology and Nuclear Medicine (P.M., C.E., M.M.L., K.D.)
cInstitute of Radiology (P.M., M.M.L.), Friedrich-Alexander University, University of Erlangen-Nuremberg, Erlangen, Germany
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K. Detmar
aFrom the Departments of Radiology and Nuclear Medicine (P.M., C.E., M.M.L., K.D.)
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  • FIG 1.
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    FIG 1.

    Examples of ROIs in the lateral and central eye chamber and the VB (A), the optical nerve sheath (ONS) (B), the Meckel Cave (MC), and the basal cistern (C) and lateral ventricles (D). Min indicates minimum; Max, maximum.

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    FIG 2.

    Image demonstrating contrast agent kinetics after injection of gadolinium in healthy patients: native scan (A), scan 20 minutes after Gd injection demonstrating the physiologic permeability of Gd in the lateral eye chamber (small arrow) (B), and physiologic, symmetric enhancement in the central eye chamber and the VB in the late scan after 120 minutes (C) (thick arrows).

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    FIG 3.

    Example of a patient with a disorder in the AEC on the right; native scan (A), scan 20 minutes after gadolinium injection demonstrating a higher permeability of Gd in the lateral eye chamber (small arrow) and increased Gd enhancement in the in the central eye chamber on the right (thick arrow) (B), and the VB (arrowhead) in the late scan after 120 minutes in the right eye (C).

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    FIG 4.

    Example of a patient with a disorder in the PEC (retinal). Native scan (A), 20 minutes after gadolinium injection demonstrating a pathologic permeability of Gd at the blood-retinal barrier (small arrows) (B), and accumulation of Gd in the VB after 120 minutes (arrowhead) demonstrating an opposite pathway of Gd (C). The physiologic enhancement in the anterior eye segment can also be seen in C, independent of the pathology of the posterior eye segment.

  • FIG 5.
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    FIG 5.

    Relative SI 20 minutes (white boxplot) and 120 minutes (gray boxplot) after contrast application in the AC central (AC_central_1 = 20 minutes, AC_central_2 = 120 minutes), AC lateral (AC_lateral_1 = 20 minutes, AC_lateral = 120 minutes), and VB (VB_1 = 20 minutes, VB_2 = 120 minutes) in the control group and in patients with disorders in the AECs and PECs.

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    Table 1:

    Patient characteristics

    OP (n = 63)Nonop (n = 32)P Value
    Sex
     Male36 (38%)20 (21%)χ² = .811
     Female27 (28%)12 (13%)
    Weight (mean) (kg)80.31 (SD, 15.19)80.67 (SD, 14.72).912
    Age (mean) (yr)60.87 (SD, 16.18)60.09 (SD, 16.67).825
    Gd (mean) (mL)15.31 (SD, 2.65)14.91 (SD, 3.00).508
    Comorbidity
     Arterial hypertension35 (56%)10 (31%)χ² = .015
     Diabetes mellitus12 (19%)6 (19%)χ² = .89
     Nicotine abuse5 (8%)3 (9%)χ² = .368
     Obesity6 (9%)1 (3%)χ² = .238
     Atherosclerosis16 (17%)4 (13%)χ² = .102
     OSAS2 (3%)1 (3%)χ² = .959
     Rheumatoid arthritis9 (14%)3 (9%)χ² = .449
    • Note:—OP indicates ophthalmologic pathology; Nonop, no ophthalmologic pathology; OSAS, obstructive sleep apnea syndrome.

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    Table 2:

    Relative SI of the control group and patients with a disorder in the AEC and PEC compared with the control groupa

    ROI, GroupsNo.MeanSDSD Error
    20 min120 min20 min120 min20 min120 minp20p120
    AC central
     Control640.271.790.51.390.060.17
     AEC300.843.400.792.210.140.40.000.001
     PEC960.512.490.661.800.070.18.055.041
    AC lateral
     Control640.291.100.620.990.080.12
     AEC300.861.930.921.430.170.26.001.005
     PEC960.501.400.681.260.070.13.201.241
    VB
     Control640.040.160.260.430.030.05
     AEC300.110.420.200.490.040.09.020.090
     PEC960.040.440.260.640.030.07.169.006
    Distal optic nerve
     Control640.311.461.161.230.140.15
     AEC300.441.770.571.210.100.22.860.699
     PEC960.331.780.761.650.080.17.999.308
    MC
     Control640.451.610.711.150.090.14
     AEC300.722.100.711.160.130.21.138.184
     PEC960.531.810.531.260.050.13.812.647
    Basel cistern
     Control320.0040.240.290.220.050.04
     AEC150.150.380.220.380.060.09.340.898
     PEC480.850.370.330.630.050.09.576.461
    Lateral ventricles
     Control320.040.270.340.390.060.07
     AEC150.210.400.240.280.060.07.210.650
     PEC480.080.310.270.430.040.06.945.922
    • Note:—AC central indicates central aqueous chamber of the eye; AC lateral, lateral aqueous chamber of the eye; MC, Meckel cave.

    • ↵a Reported values are estimated mean (SD), errors of SD, and P values.

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Cite this article
P. Manava, C. Eckrich, F. Luciani, J. Schmidbauer, M.M. Lell, K. Detmar
Glymphatic System in Ocular Diseases: Evaluation of MRI Findings
American Journal of Neuroradiology Jun 2022, DOI: 10.3174/ajnr.A7552

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Glymphatic System in Ocular Diseases: Evaluation of MRI Findings
P. Manava, C. Eckrich, F. Luciani, J. Schmidbauer, M.M. Lell, K. Detmar
American Journal of Neuroradiology Jun 2022, DOI: 10.3174/ajnr.A7552
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