title: Visualization of cerebrospinal fluid flow in syringomyelia through noninvasive magnetic resonance imaging with a time-spatial labeling inversion pulse (Time-SLIP).
abstract: 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.
  
  
  
  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 unique flow patterns, such as bubbles, jumping, and fast flow, were observed within syringomyelic cavities by Time-SLIP imaging. These patterns likely reflect the complex flow paths through the septum and/or webs of cavities.
  
  
  
  Time-SLIP permits observation of CSF motion over a long period of time and detects patterns of flow velocity and direction. Thus, this novel approach to CSF flow analysis can be used to gain a more extensive understanding of spinal disease pathology and to optimize surgical access in the treatment of spinal lesions. Additionally, Time-SLIP has broad applicability in the field of spinal research.
authors: a Department of Orthopedic Surgery , National Hospital Organization Okayama Medical Center , Okayama , Japan.
authors: Kazuhiro
authors: K
authors: Takeuchi
authors: b Department of Radiology , Kousei Hospital , Okayama , Japan.
authors: Atsushi
authors: A
authors: Ono
authors: b Department of Radiology , Kousei Hospital , Okayama , Japan.
authors: Yusuke
authors: Y
authors: Hashiguchi
authors: a Department of Orthopedic Surgery , National Hospital Organization Okayama Medical Center , Okayama , Japan.
authors: Haruo
authors: H
authors: Misawa
authors: a Department of Orthopedic Surgery , National Hospital Organization Okayama Medical Center , Okayama , Japan.
authors: Tomohiro
authors: T
authors: Takahata
authors: a Department of Orthopedic Surgery , National Hospital Organization Okayama Medical Center , Okayama , Japan.
authors: Arubi
authors: A
authors: Teramoto
authors: a Department of Orthopedic Surgery , National Hospital Organization Okayama Medical Center , Okayama , Japan.
authors: Shinnosuke
authors: S
authors: Nakahara
mesh_terms: D000369:Aged, 80 and over; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D013595:Syringomyelia / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging*
keywords: Cerebrospinal fluid (CSF); Magnetic resonance imaging (MRI); Spinal disease; Syringomyelia; Time-spatial labeling inversion pulse (Time-SLIP)