Related Experiment Video
Updated: Apr 29, 2026
Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation
Published on: February 29, 2020
MR myelography for identification of spinal CSF leak in spontaneous intracranial hypotension
J L Chazen1, J F Talbott2, J E Lantos3
1From the Department of Radiology (J.L.C., J.E.L.), Weill Cornell Medical Center, New York, New York jlc2008@med.cornell.edu.
Background And Purpose:
CT myelography has historically been the test of choice for localization of CSF fistula in patients with spontaneous intracranial hypotension. This study evaluates the additional benefits of intrathecal gadolinium MR myelography in the detection of CSF leak.
Materials And Methods:
We performed a retrospective review of patients with spontaneous intracranial hypotension who underwent CT myelography followed by intrathecal gadolinium MR myelography. All patients received intrathecal iodine and off-label gadolinium-based contrast followed by immediate CT myelography and subsequent intrathecal gadolinium MR myelography with multiplanar T1 fat-suppressed sequences. CT myelography and intrathecal gadolinium MR myelography images were reviewed by an experienced neuroradiologist to determine the presence of CSF leak. Patient records were reviewed for demographic data and adverse events following the procedure.
Results:
Twenty-four patients met both imaging and clinical criteria for spontaneous intracranial hypotension and underwent CT myelography followed by intrathecal gadolinium MR myelography. In 3/24 patients (13%), a CSF leak was demonstrated on both CT myelography and intrathecal gadolinium MR myelography, and in 9/24 patients (38%), a CSF leak was seen on intrathecal gadolinium MR myelography (P = .011). Four of 6 leaks identified independently by intrathecal gadolinium MR myelography related to meningeal diverticula. CT myelography did not identify any leaks independently. There were no reported adverse events.
Conclusions:
Present data demonstrate a higher rate of leak detection with intrathecal gadolinium MR myelography when investigating CSF leaks in our cohort of patients with spontaneous intracranial hypotension. Although intrathecal gadolinium is an FDA off-label use, all patients tolerated the medication without evidence of complications. Our data suggest that intrathecal gadolinium MR myelography is a well-tolerated examination with significant benefit in the evaluation of CSF leak, particularly for patients with leak related to meningeal diverticula.
Insights
Intrathecal gadolinium MR myelography significantly improves cerebrospinal fluid (CSF) leak detection in spontaneous intracranial hypotension compared to CT myelography. This enhanced imaging technique is well-tolerated and particularly useful for identifying leaks from meningeal diverticula.
Area of Science:
- Radiology
- Neurology
- Medical Imaging
Background:
- Spontaneous intracranial hypotension (SIH) diagnosis historically relies on CT myelography for cerebrospinal fluid (CSF) fistula localization.
- This study investigates the added value of intrathecal gadolinium MR myelography in detecting CSF leaks.
Purpose of the Study:
- To evaluate the diagnostic efficacy of intrathecal gadolinium MR myelography in patients with SIH.
- To compare the detection rates of CSF leaks between CT myelography and intrathecal gadolinium MR myelography.
Main Methods:
- Retrospective review of 24 patients with SIH who underwent both CT myelography and intrathecal gadolinium MR myelography.
- Intrathecal iodine and off-label gadolinium-based contrast administration followed by multiplanar T1 fat-suppressed MR sequences.
- Independent review of imaging by a neuroradiologist to identify CSF leaks and assess adverse events.
Main Results:
- Intrathecal gadolinium MR myelography detected CSF leaks in 38% of patients, significantly higher than CT myelography (13%).
- Four of six leaks identified solely by MR myelography were associated with meningeal diverticula.
- No adverse events were reported during or after the procedures.
Conclusions:
- Intrathecal gadolinium MR myelography demonstrates a superior leak detection rate for CSF fistulas in SIH patients.
- The procedure is well-tolerated, even with off-label gadolinium use, suggesting a favorable safety profile.
- This advanced imaging modality offers significant benefits, especially for diagnosing leaks related to meningeal diverticula.
More Related Videos
Related Concept Videos
01:22Cerebral Edema ll: Pathophysiology
01:14Increased Intracranial Pressure l: Introduction