Review ArticlesA Comprehensive View on MRI Techniques for Imaging Blood-Brain Barrier IntegrityElschot, Elles P. MSc∗,†; Backes, Walter H. PhD∗,†,§; Postma, Alida A. MD, PhD∗,†; van Oostenbrugge, Robert J. MD, PhD†,‡,§; Staals, Julie MD, PhD‡,§; Rouhl, Rob P.W. MD, PhD†,‡,¶; Jansen, Jacobus F.A. PhD∗,†,∥Author Information From the ∗Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ †School for Mental Health and Neuroscience, Maastricht University ‡Department of Neurology, Maastricht University Medical Center+ §CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht ∥Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven ¶Academic Center for Epileptology Kempenhaeghe/Maastricht University Medical Center+, Maastricht, the Netherlands. Received for publication June 29, 2020; and accepted for publication, after revision, August 1, 2020. This work is part of the program Translational Research 2 with project number 446002509, funded by ZonMw/Epilepsiefonds. Conflicts of interest and sources of funding: none declared. This project has also received funding from the European Union's Horizon 2020 research and innovation program under grant agreement number 848109. Correspondence to: Jacobus F.A. Jansen, PhD, Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, the Netherlands. E-mail: [email protected]. Investigative Radiology: January 2021 - Volume 56 - Issue 1 - p 10-19 doi: 10.1097/RLI.0000000000000723 Buy Metrics Abstract The blood-brain barrier (BBB) is the interface between the blood and brain tissue, which regulates the maintenance of homeostasis within the brain. Impaired BBB integrity is increasingly associated with various neurological diseases. To gain a better understanding of the underlying processes involved in BBB breakdown, magnetic resonance imaging (MRI) techniques are highly suitable for noninvasive BBB assessment. Commonly used MRI techniques to assess BBB integrity are dynamic contrast-enhanced and dynamic susceptibility contrast MRI, both relying on leakage of gadolinium-based contrast agents. A number of conceptually different methods exist that target other aspects of the BBB. These alternative techniques make use of endogenous markers, such as water and glucose, as contrast media. A comprehensive overview of currently available MRI techniques to assess the BBB condition is provided from a scientific point of view, including potential applications in disease. Improvements that are required to make these techniques clinically more easily applicable will also be discussed. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.