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MR Myelography for the Detection of CSF-Venous Fistulas

J L Chazen1, M S Robbins2, S B Strauss3

  • 1From the Departments of Radiology (J.L.C., S.B.S., A.D.S.), jlc2008@med.cornell.edu.

AJNR. American Journal of Neuroradiology
|May 2, 2020
PubMed

Insights

Cerebrospinal fluid-venous fistulas are a treatable cause of spontaneous intracranial hypotension. MR myelography effectively detects these fistulas, even when CT myelography fails.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Spontaneous intracranial hypotension (SIH) is a debilitating condition often caused by cerebrospinal fluid (CSF) leaks.
  • CSF-venous fistulas are a significant, yet often elusive, cause of SIH.
  • Traditional imaging modalities can struggle to identify the precise location of CSF-venous fistulas.

Observation:

  • This study evaluates the technical aspects and diagnostic utility of MR myelography for detecting CSF-venous fistulas.
  • Three cases are presented where CSF-venous fistulas were not apparent on CT myelography.
  • MR myelography successfully identified the CSF-venous fistulas in all three cases.

Findings:

  • MR myelography demonstrates superior sensitivity in detecting CSF-venous fistulas compared to CT myelography.
  • The technique provides clear visualization of CSF leakage points into the venous system.
  • Successful identification facilitates timely and targeted treatment.

Implications:

  • MR myelography should be considered a valuable tool for diagnosing difficult-to-detect CSF-venous fistulas.
  • Improved diagnostic accuracy can lead to better patient outcomes for spontaneous intracranial hypotension.
  • This imaging technique enhances the management of CSF-venous fistula-related neurological conditions.

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