Heavily T2-weighted MR myelography in patients with spontaneous intracranial hypotension: a case-control study.
We performed whole-spine heavily T2-weighted magnetic resonance (MR) myelography using a single-shot fast spin-echo pulse sequence in 17 patients (8 M/9 F) with spontaneous intracranial hypotension (SIH) to detect abnormal cerebrospinal fluid (CSF) collections. In addition, a group of age- and sex-matched controls were recruited. Follow-up MR myelography was also done at 3 weeks. MR myelography showed three kinds of abnormal CSF collections in 15 patients with SIH (88%): epidural fluid collection (n = 15, 88%), C1-2 extraspinal collections (n = 6, 35%) and CSF collections along nerve roots in the lower cervical or upper thoracic spines (n = 6, 35%). One patient (6%) showed a meningeal diverticulum. In contrast, none of the controls showed these findings. Overall, MR myelography results helped in early diagnosis of SIH in four (24%) patients whose initial brain MRIs failed to show typical SIH findings. Follow-up MR myelography results were compatible with the clinical changes with kappa statistics of 0.52 and an agreement rate of 76%. Our study showed heavily T2-weighted MR myelography provided a rapid, non-invasive and high yield method to diagnose and follow-up patients with SIH. Whether the CSF collections along the nerve roots represent the ongoing leakage sites warrants further study.
Tsai
P-H
PH
Neurological Department, Suao Veterans Hospital, Yi-Lan, Taiwan.
Fuh
J-L
JL
Lirng
J-F
JF
Wang
S-J
SJ
D000328:Adult; D017217:Blood Patch, Epidural; D001921:Brain / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000175:diagnosis* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D009192:Myelography; D013116:Spinal Cord / Q000473:pathology*