Spinal Cerebrospinal Fluid Leakage in Spontaneous Intracranial Hypotension: An Intrathecal Gadolinium Enhanced MR-Myelography Study

Abstract

In the present study, the authors presented the intrathecal gadolinium enhanced MR-myelography findings of patients with spontaneous intracranial hypotension. Materials and Methods: Intrathecal gadolinium enhanced MR-myelography (Gd-MR-myelography) examinations between October 2012 and September 2018 in patients having clinical and radiological findings of spontaneous intracranial hypotension were evaluated retrospectively. Sites and types of contrast leakages in 20 patients who met inclusion criteria were reviewed. All patients had undergone T1-fat suppressed sagittal images of cervical, thoracic and lumbar region after the off label intrathecal injection of 1 ml gadolinium-based contrast agent. Results: Patients (18 female, 2 male) are aged between 23 and 62 years-old (mean age: 41.1). Cerebrospinal fluid (CSF) leakages were cervical in 6 patients, thoracic in 5 patients, lumbar in 5 patients. One patient had leakage in multiple levels on both cervical and thoracic region and another patient on both cervicalthoracic and lumbar regions. No patients had adverse effects related to intrathecal injection of gadolinium. Conclusions: Gd-MR-myelography is effective imaging modality to reveal spinal CSF leakages in patients with spontaneous intracranial hypotension.

Detection rate of MR myelography without intrathecal gadolinium in patients with newly diagnosed spontaneous intracranial hypotension

“…In previous studies, the diagnostic yield of CT myelography was 74% 5 and the diagnostic yield of MR myelography with intrathecal gadolinium was 14e100%. 1,2,6,7,19,20 The detection rate of MR myelography in the present study was 88%, which is high compared to that of other modalities. The interobserver agreement between the two readers for the detection of CSF leakage (k ¼ 0.76) in the present study was high.…”

“…The main advantages of MR myelography without intrathecal gadolinium include its lack of invasiveness, radiation hazard, adverse effects from contrast agents, and requirement for lumbar puncture for contrast medium injection 1,3,6,12 ; however, it is a static method that detect CSF pooling after leakage. 5,10 MR myelography with intrathecal gadolinium and CT myelography are dynamic methods that can detect CSF leakage accurately 22e24 ; however, these are invasive procedures that require lumbar puncture, 6 which can exacerbate CSF volume depletion in patients with low CSF pressure.…”

An unusual postural headache: a case report

“…Should the autogolous blood fail to improve the condition a larger injection of 20-100 mL can be attempted after a 5 day period [4]. However, if the larger autogolous injection fails, surgery is then performed to repair the defect [30,31]. This approach is usually successful however in cases where it is not, the prognosis is poor [32].…”

Glymphatic MRI techniques in sleep and neurodegenerative diseases

“…The intrathecal injection for glymphatic MRI can be performed under clinical research investigations [17,18] and under limited clinical conditions, such as diagnosing idiopathic normal pressure hydrocephalus (iNPH) [19][20][21][22][23] and aqueductal stenosis, evaluating the third ventriculostomy. Intrathecal administration of GBCA is a valuable alternative to iodinated contrast for diagnostic workup for patients with idiopathic intracranial hypotension for detecting a site of CSF leak [24][25][26], or spinal dural venous fistula among patients [27,28].…”