Imaging the glymphatic system in Huntington's disease: The benefits of a multimodal approach and clinical implications.

Abstract

The glymphatic system, the cerebrospinal fluid-based circulation and waste clearance system for the brain, is gaining increasing attention in Huntington's disease (HD) due to its potential role in neurodegeneration. Glymphatic dysfunction may contribute to progressive neuronal damage and key clinical features such as cognitive decline and sleep disturbances. This chapter explores the current neuroimaging techniques used to assess glymphatic function in HD, as well as emerging approaches applied in other neurodegenerative disorders, with an emphasis on magnetic resonance imaging and positron emission tomography. We discuss the biological specificity and methodological limitations of these imaging proxies, including the need for multimodal integration. Finally, we outline the clinical and translational implications of glymphatic imaging, including its potential use as a biomarker for early disease detection, longitudinal disease monitoring, and the development of targeted therapeutic strategies.