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. 2017 Sep;38(9):1742-1747.
doi: 10.3174/ajnr.A5273. Epub 2017 Jul 6.

Pericortical Enhancement on Delayed Postgadolinium Fluid-Attenuated Inversion Recovery Images in Normal Aging, Mild Cognitive Impairment, and Alzheimer Disease

W M Freeze  1   2 , R S Schnerr  2 , W M Palm  2 , J F Jansen  2 , H I Jacobs  3 , E I Hoff  4 , F R Verhey  3 , W H Backes  2
Affiliations

Pericortical Enhancement on Delayed Postgadolinium Fluid-Attenuated Inversion Recovery Images in Normal Aging, Mild Cognitive Impairment, and Alzheimer Disease

W M Freeze et al. AJNR Am J Neuroradiol. 2017 Sep.

Abstract

Background and purpose: Breakdown of BBB integrity occurs in dementia and may lead to neurodegeneration and cognitive decline. We assessed whether extravasation of gadolinium chelate could be visualized on delayed postcontrast FLAIR images in older individuals with and without cognitive impairment.

Materials and methods: Seventy-four individuals participated in this study (15 with Alzheimer disease, 33 with mild cognitive impairment, and 26 with normal cognition). We assessed the appearance of pericortical enhancement after contrast administration, MR imaging markers of cerebrovascular damage, and medial temporal lobe atrophy. Three participants who were positive for pericortical enhancement (1 with normal cognition and 2 with mild cognitive impairment) were followed up for approximately 2 years. In vitro experiments with a range of gadolinium concentrations served to elucidate the mechanisms underlying the postcontrast FLAIR signals.

Results: Postcontrast pericortical enhancement was observed in 21 participants (28%), including 6 individuals with Alzheimer disease (40%), 10 with mild cognitive impairment (30%), and 5 with normal cognition (19%). Pericortical enhancement was positively associated with age (P < .02) and ischemic stroke (P < .05), but not with cognitive status (P = .3). Foci with enhanced signal remained stable across time in all follow-up cases. The in vitro measurements confirmed that FLAIR imaging is highly sensitive for the detection of low gadolinium concentrations in CSF, but not in cerebral tissue.

Conclusions: Postcontrast pericortical enhancement on FLAIR images occurs in older individuals with normal cognition, mild cognitive impairment, and dementia. It may represent chronic focal superficial BBB leakage. Future longitudinal studies are needed to determine its clinical significance.

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Figures

Fig 1.
Fig 1.
Pericortical enhancement is evident on sagittal, coronal, and transverse postcontrast FLAIR images of a 76-year-old male patient with MCI. No signal enhancement is apparent on the precontrast FLAIR image (upper right) (A). Pericortical enhancement remains stable across time in a male healthy control participant 87 years of age at baseline (B) and in a male MCI participant 71 years of age at baseline (C).
Fig 2.
Fig 2.
Two foci of pericortical enhancement on transverse (A) and coronal (B) postcontrast FLAIR images in a 73-year-old female participant with AD.
See this image and copyright information in PMC

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