Gadolinium and multiple sclerosis: Vessels, barriers of the brain, and glymphatics

C. Saade, R. Bou-Fakhredin, D. M. Yousem, K. Asmar, L. Naffaa, F. El-Merhi

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations


The pathogenesis of multiple sclerosis is characterized by a cascade of pathobiologic events, ranging from focal lymphocytic infiltration and microglia activation to demyelination and axonal degeneration. MS has several of the hallmarks of an inflammatory autoimmune disorder, including breakdown of the BBB. Gadolinium-enhanced MR imaging is currently the reference standard to detect active inflammatory lesions in MS. Knowledge of the patterns and mechanisms of contrast enhancement is vital to limit the radiologic differential diagnosis in the staging and evaluation of MS lesion activity. The aim of this review was the following: 1) to outline the pathophysiology of the effect of lymphocyte-driven inflammation in MS, 2) to describe the effects of gadolinium on the BBB and glymphatic system, and 3) to describe gadolinium enhancement patterns and artifacts that can mimic lesions in MS.

Original languageEnglish (US)
Pages (from-to)2168-2176
Number of pages9
JournalAmerican Journal of Neuroradiology
Issue number12
StatePublished - Dec 1 2018

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology


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