title: Detection of cerebrospinal fluid leakage: initial experience with three-dimensional fast spin-echo magnetic resonance myelography.
abstract: BACKGROUND
  The pathogenesis of cerebrospinal fluid (CSF) hypovolemia is supposed to be caused by CSF leakage through small dural defects.
  
  
  OBJECTIVE
  To compare source three-dimensional (3D) fast spin-echo (FSE) images of magnetic resonance (MR) myelography with radionuclide cisternography findings, and to evaluate the feasibility of MR myelography in the detection of CSF leakage.
  
  
  METHODS
  A total of 67 patients who were clinically suspected of CSF hypovolemia underwent indium-111 radionuclide cisternography, and 27 of those who had direct findings of CSF leakage were selected for evaluation. MR myelography with 3D FSE sequences (TR/TE 6000/203 ms) was performed at the lumbar spine for all patients. We evaluated source images and maximum intensity projection (MIP) images of MR myelography, and the findings were correlated with radionuclide cisternography findings. MR myelography of five healthy volunteers was used as a reference. The MR visibility of the CSF leakage was graded as definite (leakage clearly visible), possible (leakage poorly seen), or absent (not shown).
  
  
  RESULTS
  CSF leakage was identified with source 3D FSE images in 22 (81.5%) of 27 patients. Of the 22 patients, 16 were graded as definite and six were graded as possible. For the definite cases, 3D FSE images clearly showed the extent of the leaked CSF in the paraspinal structures. In the remaining five patients with absent findings, radionuclide cisternography showed only slight radionuclide activity out of the arachnoid space.
  
  
  CONCLUSIONS
  Source 3D FSE images of MR myelography seem useful in the detection of CSF leakage. Invasive radionuclide cisternography may be reserved for equivocal cases only.
authors.affiliation: Department of Radiology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan. tomoda@med.uoeh-u.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Tomoda
authors.forename: Y
authors.initials: Y
authors.lastname: Korogi
authors.forename: T
authors.initials: T
authors.lastname: Aoki
authors.forename: T
authors.initials: T
authors.lastname: Morioka
authors.forename: H
authors.initials: H
authors.lastname: Takahashi
authors.forename: M
authors.initials: M
authors.lastname: Ohno
authors.forename: I
authors.initials: I
authors.lastname: Takeshita
mesh_terms: D000328:Adult; D000368:Aged; D017352:Echo-Planar Imaging / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020896:Hypovolemia / Q000175:diagnosis / Q000209:etiology; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007205:Indium Radioisotopes; D019585:Intracranial Hypotension / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011877:Radionuclide Imaging; D012016:Reference Values; D012189:Retrospective Studies; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology; D013353:Subdural Effusion / Q000175:diagnosis*; D013997:Time Factors
chemical_list: D007205:Indium Radioisotopes