Spine MRI in Spontaneous Intracranial Hypotension for CSF Leak Detection: Nonsuperiority of Intrathecal Gadolinium to Heavily T2-Weighted Fat-Saturated Sequences.

Dobrocky, Tomas; Winklehner, Anna; Breiding, Philipe Sebastian; Grunder, Lorenz Nicolas; Peschi, Giovanni; Häni, Levin; Mosimann, Pascal John; Branca, Mattia; Kaesmacher, Johannes; Mordasini, Pasquale; Raabe, Andreas; Ulrich, Christian Thomas; Beck, J; Gralla, Jan; Piechowiak, Eike Immo (2020). Spine MRI in Spontaneous Intracranial Hypotension for CSF Leak Detection: Nonsuperiority of Intrathecal Gadolinium to Heavily T2-Weighted Fat-Saturated Sequences. AJNR. American journal of neuroradiology, 41(7), pp. 1309-1315. American Society of Neuroradiology 10.3174/ajnr.A6592

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BACKGROUND AND PURPOSE

Spine MR imaging plays a pivotal role in the diagnostic work-up of spontaneous intracranial hypotension. The aim of this study was to compare the diagnostic accuracy of unenhanced spine MR imaging and intrathecal gadolinium-enhanced spine MR imaging for identification and localization of CSF leaks in patients with spontaneous intracranial hypotension.

MATERIALS AND METHODS

A retrospective study of patients with spontaneous intracranial hypotension examined from February 2013 to October 2017 was conducted. Their spine MR imaging was reviewed by 3 blinded readers for the presence of epidural CSF using 3 different sequences (T2WI, 3D T2WI fat-saturated, T1WI gadolinium). In patients with leaks, the presumed level of the leak was reported.

RESULTS

In total, 103 patients with spontaneous intracranial hypotension (63/103 [61%] women; mean age, 50 years) were evaluated. Seventy had a confirmed CSF leak (57/70 [81%] proved intraoperatively), and 33 showed no epidural CSF on multimodal imaging. Intrathecal gadolinium-enhanced spine MR imaging was nonsuperior to unenhanced spine MR imaging for the detection of epidural CSF (P = .24 and .97). All MR imaging sequences had a low accuracy for leak localization. In all patients, only 1 leakage point was present, albeit multiple suspicious lesions were reported in all sequences (mean, 5.0).

CONCLUSIONS

Intrathecal gadolinium-enhanced spine MR imaging does not improve the diagnostic accuracy for the detection of epidural CSF. Thus, it lacks a rationale to be included in the routine spontaneous intracranial hypotension work-up. Heavily T2-weighted images with fat saturation provide high accuracy for the detection of an epidural CSF collection. Low accuracy for leak localization is due to an extensive CSF collection spanning several vertebrae (false localizing sign), lack of temporal resolution, and a multiplicity of suspicious lesions, albeit only a single leakage site is present. Thus, dynamic examination is mandatory before targeted treatment is initiated.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Dobrocky, Tomas; Winklehner, Anna; Breiding, Philipe Sebastian; Grunder, Lorenz Nicolas; Peschi, Giovanni; Häni, Levin; Mosimann, Pascal John; Branca, Mattia; Kaesmacher, Johannes; Mordasini, Pasquale; Raabe, Andreas; Ulrich, Christian Thomas; Gralla, Jan and Piechowiak, Eike Immo

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1936-959X

Publisher:

American Society of Neuroradiology

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

30 Jun 2020 16:34

Last Modified:

14 Aug 2020 08:53

Publisher DOI:

10.3174/ajnr.A6592

PubMed ID:

32554417

BORIS DOI:

10.7892/boris.144779

URI:

https://boris.unibe.ch/id/eprint/144779

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