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Imaging the glymphatic system: Between promise and proof in modern radiology

Lipika Singh · Journal of Applied & Clinical Radiology · 2026

Abstract: The glymphatic system provides a fascinating way to think about how the brain keeps itself in balance. For years, it was believed that the brain had no lymphatic system until the concept of glymphatic circulation was introduced. In this circulation, cerebrospinal and interstitial fluids exchange through glial channels that pulse with the heartbeat. What once sounded like a theoretical model now has imaging evidence showing real, measurable perivascular flow. For radiology, this idea shifts the attention from static anatomy to an active ongoing process. Techniques such as dynamic contrast-enhanced magnetic resonance imaging (MRI), diffusion tensor imaging, and hybrid positron emission tomography/MRI are helpful in visualizing this pathway, although differences in imaging protocols and natural physiological changes still make reproducibility difficult. Newer tools such as radiomics, artificial intelligence, and computational modeling may help refine these methods and add some consistency. This review looks at how imaging of the glymphatic system has evolved, the main challenges that still remain and how radiology might use these insights to explore brain h

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