title: Detection of CSF leak in spinal CSF leak syndrome using MR myelography: correlation with radioisotope cisternography.
abstract: OBJECTIVE
  Spinal CSF leak syndrome is a unique disorder caused by spinal CSF leak. In this study, we attempted to determine whether MR myelography (MRM) can detect the leakage site in the spine.
  
  
  METHODS
  We performed both MRM and radioisotope cisternography (RIC) in 15 patients with spinal CSF leak syndrome. Patients were included in this study if they had at least 2 of the following criteria: 1) orthostatic headache, 2) low CSF opening pressure, and 3) diffuse pachymeningeal enhancement on brain MR imaging. For comparison, we performed MRM in 15 subjects without symptoms of spinal CSF leak syndrome. MRM was performed with the 2D turbo spin-echo technique in the entire spine by using a 1.5T scanner. Two blinded radiologists evaluated the MRM findings in a total of 30 cases, composed of patient and control groups, with regard to the presence of leakage and the level of leakage if present. RIC was performed only in the patient group and was assessed by consensus among 3 physicians experienced in nuclear medicine. The diagnostic performance of MRM and RIC was evaluated on the basis of the clinical diagnosis of spinal CSF leak syndrome.
  
  
  RESULTS
  The sensitivity, specificity, and accuracy of MR myelography for detecting CSF leak was 86.7%, 86.7%, and 86.7% for reader 1, respectively, and 80.0%, 93.3%, and 86.7% for reader 2, respectively. The sensitivity of RIC was 93.3%. Agreement between the 2 techniques for the detection of CSF leak was substantial in reader 1 and moderate in reader 2 (kappa = 0.634 and 0.444, respectively).
  
  
  CONCLUSIONS
  MRM is an effective tool for detecting CSF leak in the spine in patients with spinal CSF leak syndrome.
authors.affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: H-M
authors.initials: HM
authors.lastname: Yoo
authors.forename: S J
authors.initials: SJ
authors.lastname: Kim
authors.forename: C G
authors.initials: CG
authors.lastname: Choi
authors.forename: D H
authors.initials: DH
authors.lastname: Lee
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: D C
authors.initials: DC
authors.lastname: Suh
authors.forename: J W
authors.initials: JW
authors.lastname: Choi
authors.forename: K S
authors.initials: KS
authors.lastname: Jeong
authors.forename: S J
authors.initials: SJ
authors.lastname: Chung
authors.forename: J S
authors.initials: JS
authors.lastname: Kim
authors.forename: S-C
authors.initials: SC
authors.lastname: Yun
mesh_terms: D000293:Adolescent; D000328:Adult; D002555:Cerebrospinal Fluid; D015170:Cerebrospinal Fluid Pressure; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013116:Spinal Cord / Q000000981:diagnostic imaging* / Q000473:pathology*; D013577:Syndrome; D016284:Technetium Tc 99m Pentetate
chemical_list: D019275:Radiopharmaceuticals; D016284:Technetium Tc 99m Pentetate