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PubMed This is a summary of 19 peer-reviewed journal articles Updated
Radiology

Decoding Your Diagnosis: MRI and Advanced Imaging Tests

At a Glance

An MRI is the gold standard for diagnosing syringomyelia. A complete evaluation requires imaging the entire brain and spine, along with a Cine-MRI flow study, to locate the fluid-filled syrinx, measure its exact size, and identify the underlying blockage causing the fluid buildup.

Navigating the world of diagnostic imaging can feel like learning a new language. For syringomyelia, the Magnetic Resonance Imaging (MRI) is the “gold standard” for diagnosis [1][2]. It is the only tool that allows doctors to see the delicate internal structure of your spinal cord and the fluid-filled cavity (syrinx) within it [3].

Understanding Your MRI Report

When you read your radiology report, you will likely encounter several technical terms. Here is what they mean in plain language:

  • Intramedullary: This simply means “inside the spinal cord” [3].
  • Syrinx (or Syrinx Cavity): The fluid-filled pocket. On a standard T2-weighted scan, this will look bright white (like the fluid around the cord), while on a T1-weighted scan, it will look dark [4][5].
  • Septated: This means the syrinx has small “walls” or divisions inside it, like a series of connected rooms rather than one open hallway [6].
  • Eccentric: This means the syrinx is not perfectly centered; it may be shifted to one side of the cord [7].
  • Pre-syrinx: A state where the spinal cord looks swollen or “edematous” (filled with extra fluid) but a defined cavity hasn’t fully formed yet [8].

The Role of Cine-MRI (Flow Study)

A standard MRI is like a high-quality photograph—it shows the anatomy, but not the movement. Because syringomyelia is a “plumbing” problem, doctors often order a Cine-MRI (also called Phase-Contrast MRI) [1].

Think of a Cine-MRI as a “movie” of your spinal fluid. It measures CSF flow dynamics, showing how fast the fluid is moving and whether it is flowing in the right direction [9][10]. This test is vital because it can pinpoint exactly where a blockage is occurring, such as at the base of the skull in a Chiari malformation, even if the anatomy looks mostly normal on a regular scan [11][12].

Beyond the Basics: Ruling Out Other Causes

A syrinx in the neck (cervical spine) might actually be caused by a problem in the lower back. To get a complete picture, a thorough diagnostic workup should include:

  1. The “Full Spine” Scan: It is critical to image the entire neuraxis (the brain and the full length of the spine) [13]. A syrinx can be “secondary” to a problem far away from where the fluid is collecting, such as a tethered cord at the base of the spine [14][15].
  2. Contrast-Enhanced MRI: In some cases, a doctor may inject a dye called gadolinium. This is used to look for “enhancement,” which helps rule out intramedullary tumors (growths inside the cord) that could be causing the syrinx [16][17].
  3. CT Myelogram: If the MRI isn’t clear or if your doctor suspects subtle “webs” of scar tissue (arachnoid webs) are blocking the fluid, they may use a CT scan combined with a special dye injected into the spinal fluid [5][18].

Completeness Checklist

To ensure your care team has all the information they need to make a treatment plan, you can check your records for the following:

  • [ ] Full Spine MRI: Was the cervical, thoracic, and lumbar spine all imaged?
  • [ ] Brain MRI: Was the base of the brain (foramen magnum) checked for Chiari malformation?
  • [ ] Flow Study: Was a Cine-MRI (Phase-Contrast) performed to check CSF movement?
  • [ ] Syrinx Dimensions: Does the report list the length (how many spinal levels) and the width (in millimeters) of the syrinx?
  • [ ] Comparison: If you’ve had previous scans, does the report explicitly compare the new images to the old ones to check for growth? [19]

Common questions in this guide

What is a Cine-MRI and why is it used for syringomyelia?
A Cine-MRI, or flow study, acts like a video showing how your spinal fluid moves. It helps doctors measure fluid flow dynamics and pinpoint exact blockage locations, such as a Chiari malformation, that might not be visible on a standard scan.
What does 'intramedullary' mean on my MRI report?
Intramedullary is a medical term that simply means 'inside the spinal cord.' When referring to syringomyelia, it describes exactly where the fluid-filled syrinx is located.
Why do I need a full spine MRI if my syrinx is in my neck?
A syrinx in the upper spine or neck can actually be caused by an issue much lower down, such as a tethered cord. Imaging the entire brain and spine ensures doctors find the true root cause of the fluid backup.
What does a 'septated' syrinx mean?
If your MRI report describes the syrinx as septated, it means the fluid cavity has small walls or divisions inside it. This makes it look like a series of connected rooms rather than one open, continuous space.
Why might my doctor use contrast dye during my MRI?
Contrast dye, such as gadolinium, is used to look for areas of enhancement in the spinal cord. This helps your doctor rule out spinal cord tumors or other growths that could be causing the syrinx to form.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Does my MRI show the entire spinal cord from the base of the brain to the tailbone?
  2. 2.Was a Cine-MRI (flow study) performed to see exactly where the fluid blockage is located?
  3. 3.In my report, what does a specific term like 'septated' or 'eccentric' mean regarding my prognosis?
  4. 4.Is there any sign of a 'solid component' or 'enhancement' that would require the use of contrast dye to rule out a tumor?
  5. 5.Based on the flow dynamics, do you see evidence of an 'arachnoid web' or 'scarring' that might not be obvious on a standard MRI?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (19)
  1. 1

    Chiari Malformation Type I: A Review of Pathophysiology, Cerebrospinal Fluid Flow Dynamics, Diagnosis, Surgical Management, and Its Relationship to Syringomyelia.

    Alhosani MS, Gachechiladze S

    Cureus 2026; (18(1)):e101226 doi:10.7759/cureus.101226.

    PMID: 41674734
  2. 2

    Spontaneous improvement in syringomyelia in a patient with Chiari 1 malformation: illustrative case.

    Ozturk O, Cındıl E, Emmez H, et al.

    Journal of neurosurgery. Case lessons 2023; (6(3)).

    PMID: 37486887
  3. 3

    Cord Cystic Cavities: Syringomyelia and Prominent Central Canal.

    Jones BV

    Seminars in ultrasound, CT, and MR 2017; (38(2)):98-104 doi:10.1053/j.sult.2016.07.008.

    PMID: 28347422
  4. 4

    Syringomyelia Fluid Dynamics and Cord Motion Revealed by Serendipitous Null Point Artifacts during Cine MRI.

    Honey CM, Martin KW, Heran MKS

    AJNR. American journal of neuroradiology 2017; (38(9)):1845-1847 doi:10.3174/ajnr.A5328.

    PMID: 28751514
  5. 5

    Syringomyelia secondary to "occult" dorsal arachnoid webs: Report of two cases with review of literature.

    Sayal PP, Zafar A, Carroll TA

    Journal of craniovertebral junction & spine 2016; (7(2)):101-4 doi:10.4103/0974-8237.181862.

    PMID: 27217656
  6. 6

    Ruptured Spinal Dermoid Cysts with Lipid Droplets into the Syrinx Cavity : Reports of Fourteen Cases.

    Cheng C, Li R, Gao H, et al.

    Journal of Korean Neurosurgical Society 2022; (65(3)):430-438 doi:10.3340/jkns.2021.0159.

    PMID: 35462526
  7. 7

    MINIMALLY INVASIVE TREATMENT OF IDIOPATHIC SYRINGOMYELIA USING MYRINGOTOMY T-TUBES: A CASE REPORT AND TECHNICAL NOTE.

    Jugović D, Bošnjak R, Rotim K, Feigl GC

    Acta clinica Croatica 2020; (59(1)):177-182 doi:10.20471/acc.2020.59.01.23.

    PMID: 32724291
  8. 8

    Development of pre-syrinx state and syringomyelia following a minor injury: a case report.

    Kleindienst A, Engelhorn T, Roeckelein V, Buchfelder M

    Journal of medical case reports 2020; (14(1)):223 doi:10.1186/s13256-020-02568-6.

    PMID: 33203466
  9. 9

    Cerebrospinal Fluid Flow Studies and Recent Advancements.

    Kelly EJ, Yamada S

    Seminars in ultrasound, CT, and MR 2016; (37(2)):92-9.

    PMID: 27063659
  10. 10

    Imaging of cerebrospinal fluid flow: fundamentals, techniques, and clinical applications of phase-contrast magnetic resonance imaging.

    Korbecki A, Zimny A, Podgórski P, et al.

    Polish journal of radiology 2019; (84()):e240-e250 doi:10.5114/pjr.2019.86881.

    PMID: 31481996
  11. 11

    Cerebrospinal fluid velocity amplitudes within the cerebral aqueduct in healthy children and patients with Chiari I malformation.

    Bapuraj JR, Londy FJ, Delavari N, et al.

    Journal of magnetic resonance imaging : JMRI 2016; (44(2)):463-70 doi:10.1002/jmri.25160.

    PMID: 26788935
  12. 12

    Cerebrospinal Fluid Flow Analysis in Tuberculous Meningitis Using Phase Contrast Technique on 3 Tesla MRI: A New Paradigm and Our Initial Experience.

    Ashta A, Prakash A, Dixit R, Kumar N

    Neurology India 2022; (70(3)):1025-1031 doi:10.4103/0028-3886.349627.

    PMID: 35864634
  13. 13

    Imaging in Chiari I Malformation.

    Pindrik J, McAllister AS, Jones JY

    Neurosurgery clinics of North America 2023; (34(1)):67-79 doi:10.1016/j.nec.2022.08.006.

    PMID: 36424066
  14. 14

    Holocord syringomyelia caused by tethered cord syndrome: case report and literature review.

    Zheng L, Liao Z, Duan H

    BMC neurology 2024; (24(1)):439 doi:10.1186/s12883-024-03951-2.

    PMID: 39528987
  15. 15

    Optimizing Therapeutic Strategies for Syringomyelia Associated with Tethered Cord Syndrome: A Comprehensive Review.

    Mosleh MM, Sohn MJ

    Children (Basel, Switzerland) 2024; (11(8)) doi:10.3390/children11080961.

    PMID: 39201896
  16. 16

    Specific microstructural changes of the cervical spinal cord in syringomyelia estimated by diffusion tensor imaging.

    Wu W, Li X, Yang Z, et al.

    Scientific reports 2021; (11(1)):5111 doi:10.1038/s41598-021-84164-2.

    PMID: 33664296
  17. 17

    Origin of Syrinx Fluid in Syringomyelia: A Physiological Study.

    Heiss JD, Jarvis K, Smith RK, et al.

    Neurosurgery 2019; (84(2)):457-468 doi:10.1093/neuros/nyy072.

    PMID: 29618081
  18. 18

    Response to "Syringomyelia secondary to 'occult' dorsal arachnoid webs: Report of two cases with review of literature" by Sayal et al.

    Srinivasan VM, Omeis I

    Journal of craniovertebral junction & spine 2016; (7(3)):189 doi:10.4103/0974-8237.188416.

    PMID: 27630482
  19. 19

    Dynamic transition from spinal arachnoid diverticulum to syringohydromyelia in a cat: Correlation between computed tomography myelography and magnetic resonance imaging.

    Nakata K, Matsuno M, Komatsu M, et al.

    Open veterinary journal 2025; (15(10)):5373-5382 doi:10.5455/OVJ.2025.v15.i10.55.

    PMID: 41246418

This page explains syringomyelia imaging terminology for educational purposes. Always consult your neurologist, neurosurgeon, or radiologist to interpret your specific MRI results and medical imaging.

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