Visualization of cerebrospinal fluid flow in syringomyelia through noninvasive magnetic resonance imaging with a time-spatial labeling inversion pulse (Time-SLIP)

Context: We report a case of syringomyelia assessed by magnetic resonance imaging (MRI) with a time-spatial labeling inversion pulse (Time-SLIP), which is a non-contrast MRI technique that uses the cerebrospinal fluid (CSF) as an intrinsic tracer, thus removing the need to administer a contrast agent. Time-SLIP permits investigation of flow movement for over 3 seconds without any limitations associated with the cardiac phase, and it is a clinically accessible method for flow analysis.Findings: We investigated an 85-year-old male experiencing progressive gait disturbance, with leg numbness and muscle weakness. Conventional MRI revealed syringomyelia from C7 to T12, with multiple webs of cavities. We then applied the Time-SLIP approach to characterize CSF flow in the syringomyelic cavities. Time-SLIP detected several unique CSF flow patterns that could not be observed by conventional imaging. The basic CSF flow pattern in the subarachnoid space was pulsatile and was harmonious with the heartbeat. Several un...