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Heavily T2-weighted Fluid-attenuated Inversion Recovery (FLAIR) is sensitive to T1 changes induced by solutes, but conventional magnitude reconstruction (e.g., HYDROPS subtraction) suffers from artifacts like signal cancellation, paradoxical gadolinium-based contrast agent (GBCA) effects, and motion misregistration. This review summarizes the technical characteristics and diverse applications of PRISM (Polarity-preserving Real Inversion Solute Mapping), a robust 3D-real Inversion Recovery (IR) sequence developed to overcome these limitations. PRISM achieves high T1-sensitivity using phase-sensitive (real) reconstruction with an ultra-long repetition time (TR), allowing whole-brain coverage and simultaneous assessment of CSF, the eyeball, and the inner ear within a clinically feasible time. Critically, its polarity-preserving display depicts fluids lacking T1-shortening solutes with a negative signal (black), clearly differentiating them from bone and air. Clinically, PRISM\u2019s utility spans both non-contrast and contrast-enhanced applications. Non-contrast PRISM is useful for assessing CSF protein concentration variations, meningeal lymphatic stasis, or compositional changes indicating inner ear pathologies. When combined with GBCA, time-course PRISM (pre-contrast up to 24\u00a0h delayed) uniquely visualizes solute dynamics, providing profound insights into blood-barrier integrity (e.g., blood-labyrinth barrier) and glymphatic waste clearance (e.g., CSF washout, perivascular space enhancement). Moreover, PRISM is a reliable, single-acquisition method for visualizing delayed contrast-enhanced endolymphatic hydrops, bypassing prior subtraction pitfalls. PRISM\u2019s ability to detect subtle compositional markers with high resolution positions it as a highly promising MRI advancement. However, to facilitate its routine widespread clinical adoption, further standardization, broader validation, and multi-platform reproducibility are essential. Continued efforts to establish robust protocols will be necessary to realize its potential as a non-invasive tool for screening and monitoring glymphatic function.<\/jats:p>","DOI":"10.1007\/s11604-026-02007-4","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T04:20:45Z","timestamp":1780114845000},"page":"1503-1518","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond FLAIR: PRISM (polarity-preserving real inversion solute mapping)\u2014a new Frontier in real inversion recovery MRI for intracranial and sensory organ fluid assessment"],"prefix":"10.1007","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0214-613X","authenticated-orcid":false,"given":"Shinji","family":"Naganawa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rintaro","family":"Ito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Kato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiaki","family":"Taoka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,30]]},"reference":[{"key":"2007_CR1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.2463\/mrms.2013-0056","volume":"13","author":"S Naganawa","year":"2014","unstructured":"Naganawa S, Suzuki K, Yamazaki M, Sakurai Y. 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All the other authors declare that they have no competing interests.","order":1,"name":"Ethics","label":"Conflict of interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This article is a review. All individual cases included in the reviewed literature had undergone appropriate institutional ethical approval and informed consent in accordance with the relevant guidelines and regulations. For the cases presented from the authors\u2019 institution, institutional ethical approval was obtained.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}