Yoshinori Tomoda, Presenter: Nothing to Disclose

Takatoshi Aoki MD, Abstract Co-Author: Nothing to Disclose

Hiroyuki Takahashi, Abstract Co-Author: Nothing to Disclose

Tomoaki Morioka, Abstract Co-Author: Nothing to Disclose

Yukunori Korogi MD, Abstract Co-Author: Nothing to Disclose

The pathogenesis of spontaneous intracranial hypotension (SIH) syndrome is not clearly elucidated, and it is considered to be related to a cerebrospinal fluid (CSF) leakage through small dural defects of the spine. Cranial MR findings of this syndrome are well known, while spinal studies are extremely few. Until recently, the gold standard for the depiction of CSF leakage has been radionuclide cisternography which is an invasive procedure with a long examination time. The purpose of this study was to compare MR myelography with radionuclide cisternography findings and to evaluate the feasibility of original 3D FSE images of MR myelography in detection of CSF leakage.

A total of 67 patients who were clinically suspected of SIH syndrome underwent indium-111 radionuclide cisternography between June 2002 and August 2003, and 27 patients (16 male and 11 female, aged between 26 and 58 years) who had direct findings of CSF leakage on the radionuclide cisternography were selected for this evaluation. Sequential images of radionuclide cisternography were acquired at 1, 3, 5 and 24 hour after injection. MR myelography with 3D FSE sequences (TR: 6000msec, TE: 203msec) was performed for all patients. We evaluated original images as well as MIP images of MR myelography and correlated with radionuclide cisternography findings. MR myelography of five healthy volunteers performed with the same protocol as patients were used as references. The MR detectability of the CSF leakage was graded as definite (the leakage was clearly visible), possible (the leakage was poorly seen) or absent (not shown).

CSF leakage was identified with original 3D FSE images in 22 (81.5%) of 27 patients. Of these 22 patients, 16 were graded as definite and 6 were graded as possible. For the definite cases, 3D FSE images clearly showed extent of the leaked CSF in the paraspinal structures. In the remaining 5 patients with absent findings, radionuclide cisternography showed only a slight radionuclide activity out of the arachnoid space.

Original 3D FSE images of MR myelography are highly sensitive in detection of CSF leakage. Invasive lumbar puncture may be reserved only for the equivocal cases.

Tomoda, Y, Aoki, T, Takahashi, H, Morioka, T, Korogi, Y, Diagnosis of Cerebrospinal Fluid Leakage in Intracranial Hypotension Syndrome: Usefulness of Original 3D FSE Images for MR Myelography.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4410850.html