{"doi":"10.1161/strokeaha.111.632356","title":"The Hyperintense Acute Reperfusion Marker on Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging Is Caused by Gadolinium in the Cerebrospinal Fluid","abstract":"<jats:sec>\n            <jats:title>Background and Purposes—</jats:title>\n            <jats:p>The hyperintense acute reperfusion marker (HARM) on fluid-attenuated inversion recovery MRI is believed to be caused by gadolinium-based contrast agents crossing a disrupted blood–brain barrier. However, this hypothesis has never been directly verified in humans.</jats:p>\n          </jats:sec>\n          <jats:sec>\n            <jats:title>Methods—</jats:title>\n            <jats:p>In this study, we analyzed cerebrospinal fluid samples of patients with HARM on imaging regarding the presence and concentration of gadolinium-based contrast agents.</jats:p>\n          </jats:sec>\n          <jats:sec>\n            <jats:title>Results—</jats:title>\n            <jats:p>Gadobutrol was found in concentrations of approximately 50 μmol/L. Using phantom MRI experiments, we demonstrate that the detected concentrations are consistent with the observed HARM imaging pattern.</jats:p>\n          </jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions—</jats:title>\n            <jats:p>Our study yields first direct evidence in humans that the imaging phenomenon HARM is indeed caused by leakage of gadolinium-based contrast agents into the cerebrospinal fluid.</jats:p>\n          </jats:sec>","journal":"Stroke","year":2012,"id":647854,"datarank":4.891258494940782,"base_score":4.127134385045092,"endowment":4.127134385045092,"self_citation_contribution":0.6190701577567639,"citation_network_contribution":4.272188337184018,"self_endowment_contribution":0.6190701577567639,"citer_contribution":4.272188337184018,"corpus_percentile":null,"corpus_rank":null,"citation_count":61,"citer_count":59,"citers_with_citation_signal":50,"citers_with_endowment":50,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1688074,"name":"Tobias Struffert","orcid":null,"position":1,"is_corresponding":false},{"id":1688075,"name":"Thomas Frenzel","orcid":null,"position":2,"is_corresponding":false},{"id":1248007,"name":"Stefan Schwab","orcid":"0000-0001-9058-0632","position":3,"is_corresponding":false},{"id":690494,"name":"Arnd Doerfler","orcid":"0000-0002-3076-3231","position":4,"is_corresponding":false},{"id":1213536,"name":"Martin Köhrmann","orcid":"0000-0002-0701-9535","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"The Hyperintense Acute Reperfusion Marker on Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging Is Caused by Gadolinium in the Cerebrospinal Fluid","abstract":"<jats:sec>\n            <jats:title>Background and Purposes—</jats:title>\n            <jats:p>The hyperintense acute reperfusion marker (HARM) on fluid-attenuated inversion recovery MRI is believed to be caused by gadolinium-based contrast agents crossing a disrupted blood–brain barrier. However, this hypothesis has never been directly verified in humans.</jats:p>\n          </jats:sec>\n          <jats:sec>\n            <jats:title>Methods—</jats:title>\n            <jats:p>In this study, we analyzed cerebrospinal fluid samples of patients with HARM on imaging regarding the presence and concentration of gadolinium-based contrast agents.</jats:p>\n          </jats:sec>\n          <jats:sec>\n            <jats:title>Results—</jats:title>\n            <jats:p>Gadobutrol was found in concentrations of approximately 50 μmol/L. Using phantom MRI experiments, we demonstrate that the detected concentrations are consistent with the observed HARM imaging pattern.</jats:p>\n          </jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions—</jats:title>\n            <jats:p>Our study yields first direct evidence in humans that the imaging phenomenon HARM is indeed caused by leakage of gadolinium-based contrast agents into the cerebrospinal fluid.</jats:p>\n          </jats:sec>","is_dataset_classified":null,"base_score":4.127134385045092,"endowment":4.127134385045092,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"21980209","pmcid":null,"openalex_id":"https://openalex.org/W2153762333","authors":[],"funders":[],"total_grants":0,"fwci":2.0965,"citation_percentile":0.86546917,"influential_citations":7,"citation_trend":[{"year":2012,"count":3},{"year":2013,"count":2},{"year":2014,"count":3},{"year":2015,"count":4},{"year":2016,"count":5},{"year":2017,"count":7},{"year":2018,"count":6},{"year":2019,"count":3},{"year":2020,"count":4},{"year":2021,"count":5},{"year":2022,"count":5},{"year":2023,"count":8},{"year":2024,"count":3},{"year":2025,"count":2},{"year":2026,"count":1}],"oa_status":"bronze","license":null,"oa_locations":[{"url":"https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.111.632356","host_type":"journal"},{"url":"https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.111.632356","host_type":"BRONZE"},{"url":"https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.111.632356","host_type":"publisher"},{"url":"https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.111.632356","host_type":"publisher"},{"url":"https://doi.org/10.1161/strokeaha.111.632356","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/21980209","host_type":"repository"}],"fields_of_study":["Advanced MRI Techniques and Applications","Lanthanide and Transition Metal Complexes","Ultrasound and Hyperthermia Applications","Medicine","Adult","Aged","Blood-Brain Barrier","Extravasation of Diagnostic and Therapeutic Materials","Female","Gadolinium","Humans","Magnetic Resonance Imaging","Male"],"mesh_terms":["Adult","Aged","Blood-Brain Barrier","Extravasation of Diagnostic and Therapeutic Materials","Female","Gadolinium","Humans","Magnetic Resonance Imaging","Male"],"keywords":["Gadolinium","Medicine","Cerebrospinal fluid","Magnetic resonance imaging","Fluid-attenuated inversion recovery","Nuclear medicine","Pathology","Radiology"],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-10T01:58:08.254618Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}