title: Use of fat-suppressed T2 -weighted sagittal images after infusion of excess saline into the subarachnoid space as a new diagnostic modality for cerebrospinal fluid hypovolemia: technical note.
abstract: The diagnosis of CSF hypovolemia remains controversial. The primary diagnostic factor relies on confirmation of leakage of the CSF based on reduced spinal fluid pressure. Determining the specific leakage site is the most important issue for effective treatment but remains a difficult task. Although CT myelography, radioisotope cisternography, and MRI are commonly performed in the diagnosis of CSF hypovolemia, these techniques can rarely identify the precise leakage site. Therefore, an epidural blood patch is performed in the lumbar spine in many cases. This study reports a new diagnostic modality that can help to confirm the leakage site. Fat-suppressed T2-weighted sagittal images were compared before and after the infusion of 20 ml of saline into the subarachnoid space of the lumbar region to detect the specific leakage site with high probability. Three patients were successfully treated by the epidural blood patch based on data obtained with the new diagnostic modality. Two patients were treated in the cervical region and 1 in the lumbar region. The use of fat-suppressed T2-weighted sagittal images after saline infusion could be a relevant diagnostic modality compared with images obtained by CT myelography, radioisotope cisternography, and ordinary MRI to achieve accurate diagnosis and effective treatment of patients with CSF hypovolemia.
authors.affiliation: Department of Neurosurgery, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Nakai
authors.affiliation: Department of Neurosurgery, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Takemura
authors.affiliation: Department of Neurosurgery, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Motonobu
authors.initials: M
authors.lastname: Nonaka
authors.affiliation: Department of Neurosurgery, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kawanishi
authors.affiliation: Department of Neurosurgery, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Noritaka
authors.initials: N
authors.lastname: Masahira
authors.affiliation: Department of Neurosurgery, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ueba
mesh_terms: D000273:Adipose Tissue; D000293:Adolescent; D000328:Adult; D000368:Aged; D017217:Blood Patch, Epidural / Q000379:methods; D065634:Cerebrospinal Fluid Leak / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D015170:Cerebrospinal Fluid Pressure; D002946:Cisterna Magna / Q000000981:diagnostic imaging; D005260:Female; D005471:Fluoroscopy; D006261:Headache / Q000209:etiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D019585:Intracranial Hypotension / Q000175:diagnosis*; D008161:Lumbosacral Region / Q000473:pathology; D008279:Magnetic Resonance Imaging; D019547:Neck Pain / Q000209:etiology; D011877:Radionuclide Imaging; D013346:Subarachnoid Space / Q000473:pathology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: CSDH = chronic subdural hematoma; CSFH = CSF hypovolemia; CTM = CT myelography; EBP = epidural blood patch; FST2WSI = fat-suppressed T2-weighted sagittal image; RIC = radioisotope cisternography; cerebrospinal fluid hypovolemia; epidural blood patch; fat-suppressed T2-weighted sagittal image