Imaging the Perivascular Space as a Potential Biomarker of Neurovascular and Neurodegenerative Diseases

Cell Mol Neurobiol. 2016 Mar;36(2):289-99. doi: 10.1007/s10571-016-0343-6. Epub 2016 Mar 18.


Although the brain lacks conventional lymphatic vessels found in peripheral tissue, evidence suggests that the space surrounding the vasculature serves a similar role in the clearance of fluid and metabolic waste from the brain. With aging, neurodegeneration, and cerebrovascular disease, these microscopic perivascular spaces can become enlarged, allowing for visualization and quantification on structural MRI. The purpose of this review is to: (i) describe some of the recent pre-clinical findings from basic science that shed light on the potential neurophysiological mechanisms driving glymphatic and perivascular waste clearance, (ii) review some of the pathobiological etiologies that may lead to MRI-visible enlarged perivascular spaces (ePVS), (iii) describe the possible clinical implications of ePVS, (iv) evaluate existing qualitative and quantitative techniques used for measuring ePVS burden, and (v) propose future avenues of research that may improve our understanding of this potential clinical neuroimaging biomarker for fluid and metabolic waste clearance dysfunction in neurodegenerative and neurovascular diseases.

Keywords: Alzheimer’s disease; Cerebrovascular disease; Dementia; Interstitial fluid drainage; Perivascular metabolic clearance; Perivascular space; Virchow–Robin space.

Publication types

  • Review

MeSH terms

  • Animals
  • Cerebrovascular Disorders / diagnostic imaging*
  • Cerebrovascular Disorders / immunology
  • Cerebrovascular Disorders / pathology*
  • Humans
  • Lymphatic System / diagnostic imaging*
  • Lymphatic System / immunology
  • Lymphatic System / pathology*
  • Neurodegenerative Diseases / diagnostic imaging*
  • Neurodegenerative Diseases / immunology
  • Neurodegenerative Diseases / pathology*
  • Neuroimaging / methods*
  • Translational Medical Research