MR Myelography for Identification of Spinal CSF Leak in Spontaneous Intracranial Hypotension
Open Access
- 22 May 2014
- journal article
- Published by American Society of Neuroradiology (ASNR) in American Journal Of Neuroradiology
- Vol. 35 (10), 2007-2012
- https://doi.org/10.3174/ajnr.a3975
Abstract
BACKGROUND AND PURPOSE: CT myelography has historically been the test of choice for localization of CSF fistula in patients with spontaneous intracranial hypotension. This study evaluates the additional benefits of intrathecal gadolinium MR myelography in the detection of CSF leak. MATERIALS AND METHODS: We performed a retrospective review of patients with spontaneous intracranial hypotension who underwent CT myelography followed by intrathecal gadolinium MR myelography. All patients received intrathecal iodine and off-label gadolinium-based contrast followed by immediate CT myelography and subsequent intrathecal gadolinium MR myelography with multiplanar T1 fat-suppressed sequences. CT myelography and intrathecal gadolinium MR myelography images were reviewed by an experienced neuroradiologist to determine the presence of CSF leak. Patient records were reviewed for demographic data and adverse events following the procedure. RESULTS: Twenty-four patients met both imaging and clinical criteria for spontaneous intracranial hypotension and underwent CT myelography followed by intrathecal gadolinium MR myelography. In 3/24 patients (13%), a CSF leak was demonstrated on both CT myelography and intrathecal gadolinium MR myelography, and in 9/24 patients (38%), a CSF leak was seen on intrathecal gadolinium MR myelography (P = .011). Four of 6 leaks identified independently by intrathecal gadolinium MR myelography related to meningeal diverticula. CT myelography did not identify any leaks independently. There were no reported adverse events. CONCLUSIONS: Present data demonstrate a higher rate of leak detection with intrathecal gadolinium MR myelography when investigating CSF leaks in our cohort of patients with spontaneous intracranial hypotension. Although intrathecal gadolinium is an FDA off-label use, all patients tolerated the medication without evidence of complications. Our data suggest that intrathecal gadolinium MR myelography is a well-tolerated examination with significant benefit in the evaluation of CSF leak, particularly for patients with leak related to meningeal diverticula.This publication has 23 references indexed in Scilit:
- Detection and treatment of spinal CSF leaks in idiopathic intracranial hypotensionNeuroradiology, 2012
- When Should I Do Dynamic CT Myelography? Predicting Fast Spinal CSF Leaks in Patients with Spontaneous Intracranial HypotensionAmerican Journal Of Neuroradiology, 2011
- The Role of MR Myelography with Intrathecal Gadolinium in Localization of Spinal CSF Leaks in Patients with Spontaneous Intracranial HypotensionAmerican Journal of Neuroradiology, 2011
- Spontaneous CSF LeaksOtolaryngologic Clinics of North America, 2011
- Diffuse Pachymeningeal Enhancement and Subdural and Subarachnoid Space Opacification on Delayed Postcontrast Fluid-Attenuated Inversion Recovery Imaging in Spontaneous Intracranial Hypotension: Visualizing the Monro-Kellie Hypothesis: Fig 1.American Journal of Neuroradiology, 2010
- Gadolinium-Enhanced MR Cisternography to Evaluate Dural Leaks in Intracranial Hypotension SyndromeAmerican Journal of Neuroradiology, 2007
- Spontaneous Spinal Cerebrospinal Fluid Leaks and Intracranial HypotensionJama-Journal Of The American Medical Association, 2006
- Misdiagnosis of Spontaneous Intracranial HypotensionArchives of Neurology, 2003
- Spontaneous Cerebrospinal Fluid Leaks: From Intracranial Hypotension to Cerebrospinal Fluid Hypovolemia—Evolution of a ConceptMayo Clinic Proceedings, 1999
- Spontaneous intracranial hypotension.Journal of Neurology, Neurosurgery & Psychiatry, 1995