Ju young Park MD, Presenter: Nothing to Disclose

In Ho Lee MD, Abstract Co-Author: Nothing to Disclose

It is important to find the CSF leakage site in the patients with spontaneous or iatrogenic intracranial hypotension. The purpose of this study is to evaluate the efficiency of MR myelography using heavily T2 weighted image for evaluation of CSF leakage.  

We included 19 patients with clinically suspected CSF leakage between June 2010 and February 2012. We retrospectively evaluated the MR myelography using heavily T2 weighted image and brain MR imaging in these patients. Among them, 14 patients (M:F = 6:8, mean age: 43 years, age range, 17-53 years) showed CSF leakage in MR myelography. All 14 patients underwent MR myelography and brain MR imaging and 8 of 14 patients underwent follow up MR myelography. We evaluated the presence and location of CSF leakage in MR myelography as well as diffuse dural thickening with enhancement in brain MR imaging. We also evaluated the improvement of CSF leakage after epidural blood patch.  

All MR examinations were performed on 3-Tunits (Intera Achieva; Philips). The parameters used in MR myelography were TR= 5883 ms, TE = 650 ms, NEX =1, and matrix size 320x320. The spontaneous cause was 9 of 14 patients and iatrogenic cause such as lumbar puncture or operation was 5 of 14 patients. The leakage sites were T-spine (n=4), L-spine (n=2), cervicothoracic junction (n=1), C-T-L spine (n=2), T-L-S spine( n=1), and L-S spine (n=4). 8 of 14 patients (57%) with CSF leakage showed diffuse dural thickening with enhancement on brain MR imaging. Orthostatic headache in all patients was improved after epidural blood patch (n=12 patients) and conservative treatment (n=2). 8 of 14 patients underwent follow up MR myelogrpahy and 8 of 8 patients showed improvement of CSF leakage after epidural blood patch (n=7) and conservative treatment (n=1).

MR myelography using heavily T2WI is useful for detection of CSF leakage site as well as evaluation of improvement, regardless of spontaneous or idiopathic cause. MR myelography may be more sensitive to find CSF leakage than brain MRI showing dural thickening with enhancement.

MR myelography using heavily T2WI is useful for detection of CSF leakage site as well as evaluation of improvement, regardless of spontaneous or idiopathic cause.

Park, J, Lee, I, The Role of MR Myelography with Heavily T2-weighted Image in the Evaluation of CSF Leakage.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12023994.html