title: Spinal cerebrospinal fluid leaks detected by radionuclide cisternography and magnetic resonance imaging in patients suspected of intracranial hypotension.
abstract: OBJECTIVE
  Although many studies have described various features of neuroimaging tests associated with intracranial hypotension, few have examined their validity and reliability. We evaluated the association between CSF leaks detected by radionuclide cisternography and abnormal MRI findings in the accurate diagnosis of intracranial hypotension.
  
  
  METHODS
  We retrospectively assessed 250 patients who were suspected of intracranial hypotension and underwent subsequent radionuclide cisternography. We obtained 159 sagittal and 153 coronal T2-weighted MRI images and 101 gadolinium-enhanced T1-weighted MRI images. We assessed the CSF leaks in relation to a sagging brain, the maximum subdural space in sagittal and coronal images, and dural enhancement.
  
  
  RESULTS
  Overall, 186 (74%) patients showed CSF leaks on radionuclide cisternography. A sagging brain was observed in 21 (13%) of the 159 patients with sagittal MRIs. A sagging brain was not associated with CSF leaks (14% vs. 10%; p=0.49). Compared to patients without CSF leaks, those with CSF leaks tended to have a larger maximum subdural space in both the sagittal (3.7 vs. 4.1mm) and coronal (2.5 vs. 2.8mm) images; however, the differences were not significant (p=0.18 and p=0.53, respectively). Dural enhancement was observed only in one patient, who presented with CSF leaks on radionuclide cisternography.
  
  
  CONCLUSIONS
  Our study, which included a relatively large population, did not find any association between the findings of radionuclide cisternography and MRI. Future research should focus on identifying more valid neuroimaging findings to diagnose intracranial hypotension accurately.
authors.affiliation: Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan. Electronic address: ns-waki@med.teikyo-u.ac.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ohwaki
authors.affiliation: Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Yano
authors.affiliation: Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shinohara
authors.affiliation: Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Ogawa
authors.affiliation: Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Fujii
authors.affiliation: Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Tadayoshi
authors.initials: T
authors.lastname: Nakagomi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D002648:Child; D015331:Cohort Studies; D005260:Female; D005682:Gadolinium; D006261:Headache / Q000209:etiology*; D006784:Hospitals, Teaching; D006801:Humans; D019585:Intracranial Hypotension / Q000503:physiopathology*; D007564:Japan; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009192:Myelography; D011868:Radioisotopes; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D011868:Radioisotopes; D005682:Gadolinium
keywords: Cerebrospinal fluid; Headache; Intracranial hypotension; Magnetic resonance imaging; Radionuclide imaging