The current understanding of cerebral waste clearance (CWC) involves CSF participation but lacks the direct participation of the parenchymal vascular system. We used SPIO-enhanced SWI on rats to simultaneously study parenchymal veins, arteries and their corresponding para-vascular spaces, and observed not only CSF participation, but also parenchymal venous participation in CWC following intra-cisterna magna infusion of CSF tracers. These results lead to the speculation of a new CWC mechanism with directional brain parenchyma-to-blood permeability. The substantial role of the parenchymal venous system in CWC raises intriguing questions on the differential contributions of parenchymal venous versus CSF pathways in neurodegenerative disease.
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