MR myelography for identification of spinal CSF leak in spontaneous intracranial hypotension.
OBJECTIVE
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.


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.
From the Department of Radiology (J.L.C., J.E.L.), Weill Cornell Medical Center, New York, New York jlc2008@med.cornell.edu.
J L
JL
Chazen
Department of Radiology (J.F.T.), San Francisco General Hospital, San Francisco, California.
J F
JF
Talbott
From the Department of Radiology (J.L.C., J.E.L.), Weill Cornell Medical Center, New York, New York.
J E
JE
Lantos
Department of Radiology and Biomedical Imaging (W.P.D.), University of California, San Francisco, San Francisco, California.
W P
WP
Dillon
D000328:Adult; D065634:Cerebrospinal Fluid Leak / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005682:Gadolinium / Q000008:administration & dosage; D006801:Humans; D007278:Injections, Spinal; D019585:Intracranial Hypotension / Q000150:complications*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009192:Myelography / Q000379:methods*; D056687:Off-Label Use; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000009:adverse effects
D005682:Gadolinium