Intravenous Contrast-Enhanced MR Myelography in CSF Leakage for the Detection of Spinal CSF Lamellae

IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY
Zeynep Bendella, Robert Haase, Ralf Clauberg, Stefan Zülow, Christine Kindler, Alexander Radbruch, Daniel Paech, Katerina Deike
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Abstract

Background and Purpose

Intracranial hypotension (IH) results from cerebrospinal fluid (CSF) leakage from the dural sac, occurring spontaneously or iatrogenically (e.g., post-lumbar puncture), and may cause a wide range of symptoms with significant functional impairment. Accurate detection of the epidural CSF lamella is key to diagnosis. This study evaluated the diagnostic value of intravenous contrast-enhanced MRI using heavily T2-weighted FLAIR (HT2-FLAIR) spine imaging compared to nonenhanced MR myelography at 3 Tesla.

Methods

Ten consecutive patients with IH symptoms were prospectively examined using HT2-FLAIR imaging of the spine before and up to 3 h after gadolinium-based contrast agent administration, alongside noncontrast MR myelography. Two readers assessed the conspicuity of the CSF lamella on contrast-enhanced HT2-FLAIR (ceHT2-FLAIR) using a score from −2 to +2 and evaluated additional diagnostic benefit.

Results

A CSF lamella was seen in eight of 10 patients as a strongly enhancing band on ceHT2-FLAIR. In one case, the lamella was visible exclusively on ceHT2-FLAIR (conspicuity score [CS] = 2, n = 1) and was more conspicuous in three cases (CS = 1, n = 3). Six cases showed equal conspicuity (CS = 0, n = 6). In two cases each, ceHT2-FLAIR either enabled diagnosis or provided supporting information. In six cases, it confirmed diagnosis based on noncontrast imaging. Beyond improved conspicuity, ceHT2-FLAIR helped detect low-flow leaks, optimize axial slice positioning, and assess CSF lamella distribution.

Conclusions

Intravenous ceHT2-FLAIR MRI may be considered as an additional tool in CSF leak evaluation, particularly when used for detecting indirect signs of IH.

静脉磁共振增强脊髓造影对脑脊液渗漏的检测
背景和目的颅内低血压(IH)是由脑脊液(CSF)从硬脑膜囊渗漏引起的,可自发或医源性发生(如腰椎穿刺后),并可引起广泛的症状和显著的功能损害。硬膜外脑脊液片的准确检测是诊断的关键。本研究评估了静脉内对比增强MRI使用重t2加权FLAIR (HT2-FLAIR)脊柱成像与非增强MRI脊髓造影在3特斯拉时的诊断价值。方法对10例连续出现IH症状的患者进行前瞻性检查,在给予钆造影剂前和注射后3小时内使用HT2-FLAIR脊柱成像,同时进行非对比MR脊髓造影。两位读者评估了对比增强HT2-FLAIR (ceHT2-FLAIR)的脑脊液板层的显著性,评分从- 2到+2,并评估了额外的诊断价值。结果10例患者中有8例脑脊液板层为ceHT2-FLAIR强增强带。1例片层仅在ceHT2-FLAIR上可见(显著性评分[CS] = 2, n = 1), 3例片层更明显(CS = 1, n = 3)。6例显著性相等(CS = 0, n = 6)。在两种情况下,ceHT2-FLAIR要么启用诊断,要么提供支持信息。在6例病例中,它根据非对比成像证实了诊断。除了提高可视性外,ceHT2-FLAIR还有助于检测低流量泄漏,优化轴向切片定位,评估脑脊液板层分布。结论静脉注射ceHT2-FLAIR MRI可作为脑脊液泄漏评估的附加工具,特别是用于检测IH的间接征象时。
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来源期刊
Journal of Neuroimaging
Journal of Neuroimaging 医学-核医学
CiteScore
4.70
自引率
0.00%
发文量
117
审稿时长
6-12 weeks
期刊介绍: Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on: MRI CT Carotid Ultrasound and TCD SPECT PET Endovascular Surgical Neuroradiology Functional MRI Xenon CT and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!
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