Figure 6.
Meningeal vascular MRI in humans. (A) Schematic of the workflow for meningeal vascular 3D mapping by MRI in humans. Native sequences were acquired from a 3T MRI before and after i.v. gadobutrol injection. 3D-Slicer platform was used for semiautomated signal intensity–based thresholding and segmentation of native sequences. (B–G) Native VW-MRI (B and C) and meningeal vascular 3D mapping (D–G) after gadobutrol injection of a patient with MS (number 7 in Table 1). (B) Native 3D T1 SPACE DANTE in an oblique axial plane crossing the transverse axis of both the superior longitudinal (SSS) and the straight sinuses (StS). The black-blood contrast allowed to darken the lumen of venous sinuses, while dural lymphatics (white) were strongly enhanced by gadobutrol and precisely segregated from the unenhanced perisinusal dura mater (blue arrowheads). (C) Native 3D T1 SPACE DANTE sequence in a sagittal plane along the longitudinal axis of the left internal jugular vein (ijv) covering both the head and neck. cLNs (arrows) surrounding the ijv were enhanced by the contrast agent and distinct from adjacent soft tissues. (D) Oblique posterior view of the dorsolateral group of dural venous sinuses (blue), including the SSS, the StS, the transverse (TS), and the sigmoid sinuses (SS). The ijv represents the major venous outflow of the dorsolateral group of sinuses. Dorsolateral perisinusal fluids (yellow) concentrate in perisinusal areas and include vessel-like compartments (arrows) associated with flattened vesicles (arrowheads). Perisinusal fluids were detected along the internal carotid arteries (ica) and until the dcLNs. (E) Posterior view of the meningeal vascularization in the anterior part of the skull. Left (L) and right (R) CAV are connected at the midline by the superior (S) and inferior (I) coronary sinuses. The superior petrosal sinus (SPS) connects the CAV with the SS, while the inferior petrosal sinus (IPS) connects the CAV with the IJV. The IPS is also connected with the marginal sinus (MS), which drains caudally in the perivertebral venous plexuses. In the intracavernous segments, the ica crosses the CAV before intradural bifurcation in middle (MCA) and anterior (ACA) cerebral arteries. Perisinusal fluids were detected in the perisinusal areas of the CAV, the MS surrounding the foramen magnum, and along the IPS. Exit routes of perisinusal fluids from the skull followed the pericarotid route in the carotid canal, anteriorly, and the perivertebral canal along the vertebral arteries, posteriorly. (F and G) Parasagittal (F) and posterior (G) views of fluid exit routes from the CAV perisinusal area, showing the pericarotid route inside the carotid canal as well as several transforaminal routes along the branches of trigeminal nerve, including the superior orbital fissure (sof) along the ophthalmic branch, the foramen rotundum (fr) along the maxillary branch, and the foramen ovale (fo) along the mandibular branch. Besides their specific trigeminal nerve branches, these foramina contain corresponding emissary veins that collect extracranially in the extracranial veins, including the pterygoid plexuses (PP). No perisinusal flow was observed through the optical canal (oc). Scale bar: 1 cm (B–G).

Meningeal vascular MRI in humans. (A) Schematic of the workflow for meningeal vascular 3D mapping by MRI in humans. Native sequences were acquired from a 3T MRI before and after i.v. gadobutrol injection. 3D-Slicer platform was used for semiautomated signal intensity–based thresholding and segmentation of native sequences. (B–G) Native VW-MRI (B and C) and meningeal vascular 3D mapping (D–G) after gadobutrol injection of a patient with MS (number 7 in Table 1). (B) Native 3D T1 SPACE DANTE in an oblique axial plane crossing the transverse axis of both the superior longitudinal (SSS) and the straight sinuses (StS). The black-blood contrast allowed to darken the lumen of venous sinuses, while dural lymphatics (white) were strongly enhanced by gadobutrol and precisely segregated from the unenhanced perisinusal dura mater (blue arrowheads). (C) Native 3D T1 SPACE DANTE sequence in a sagittal plane along the longitudinal axis of the left internal jugular vein (ijv) covering both the head and neck. cLNs (arrows) surrounding the ijv were enhanced by the contrast agent and distinct from adjacent soft tissues. (D) Oblique posterior view of the dorsolateral group of dural venous sinuses (blue), including the SSS, the StS, the transverse (TS), and the sigmoid sinuses (SS). The ijv represents the major venous outflow of the dorsolateral group of sinuses. Dorsolateral perisinusal fluids (yellow) concentrate in perisinusal areas and include vessel-like compartments (arrows) associated with flattened vesicles (arrowheads). Perisinusal fluids were detected along the internal carotid arteries (ica) and until the dcLNs. (E) Posterior view of the meningeal vascularization in the anterior part of the skull. Left (L) and right (R) CAV are connected at the midline by the superior (S) and inferior (I) coronary sinuses. The superior petrosal sinus (SPS) connects the CAV with the SS, while the inferior petrosal sinus (IPS) connects the CAV with the IJV. The IPS is also connected with the marginal sinus (MS), which drains caudally in the perivertebral venous plexuses. In the intracavernous segments, the ica crosses the CAV before intradural bifurcation in middle (MCA) and anterior (ACA) cerebral arteries. Perisinusal fluids were detected in the perisinusal areas of the CAV, the MS surrounding the foramen magnum, and along the IPS. Exit routes of perisinusal fluids from the skull followed the pericarotid route in the carotid canal, anteriorly, and the perivertebral canal along the vertebral arteries, posteriorly. (F and G) Parasagittal (F) and posterior (G) views of fluid exit routes from the CAV perisinusal area, showing the pericarotid route inside the carotid canal as well as several transforaminal routes along the branches of trigeminal nerve, including the superior orbital fissure (sof) along the ophthalmic branch, the foramen rotundum (fr) along the maxillary branch, and the foramen ovale (fo) along the mandibular branch. Besides their specific trigeminal nerve branches, these foramina contain corresponding emissary veins that collect extracranially in the extracranial veins, including the pterygoid plexuses (PP). No perisinusal flow was observed through the optical canal (oc). Scale bar: 1 cm (B–G).

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