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Published on: February 29, 2020
Diagnostic Yield of Intrathecal Gadolinium MR Myelography for CSF Leak Localization
Ajay A Madhavan1, Carrie M Carr2, John C Benson2
1Department of Radiology, Mayo Clinic, 200 First St SW, MN 55905, Rochester, USA. madhavan.ajay@mayo.edu.
Purpose:
Intrathecal gadolinium magnetic resonance (MR) myelography can be used to localize various types of spinal cerebrospinal fluid (CSF) leaks; however, its diagnostic yield is not well known. We sought to determine the diagnostic yield of MR myelography in patients with spontaneous intracranial hypotension.
Methods:
A retrospective review was performed on all patients who had undergone intrathecal gadolinium MR myelography at our institution from 2002 to 2020 for suspected spinal CSF leak. The MR myelography images were reviewed for the presence or absence of a spinal CSF leak site. Images were also evaluated for the presence an extradural fluid collection.
Results:
A total of 97 patients were included in the final cohort. The average age was 52.6 years; 67.0% were female, 4 patients underwent 2 examinations each, yielding a total of 101 MR myelograms. The source of a spinal CSF leak was localized in 14 patients. The diagnostic yield for CSF leak localization on intrathecal gadolinium MR myelography was 14/101 (13.9%) per GdM examination and 14/97 (14.4%) per patient. Among the subset of patients without extradural fluid collections, the yield was 15.7% per examination. All detected leaks were either CSF-venous fistulas or distal nerve root sleeve tears.
Conclusion:
Intrathecal gadolinium MR myelography is capable of localizing CSF-venous fistulas and distal nerve root sleeve tears; however, our data show that it has a limited diagnostic yield. We suggest that other modalities may be a better first step before attempting intrathecal gadolinium MR myelography.
Insights
Intrathecal gadolinium MR myelography has a limited diagnostic yield for spinal cerebrospinal fluid (CSF) leaks. This method is effective for identifying CSF-venous fistulas and nerve root sleeve tears but may not be the best initial diagnostic step.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Spinal cerebrospinal fluid (CSF) leaks can cause spontaneous intracranial hypotension.
- Intrathecal gadolinium MR myelography is a potential diagnostic tool for localizing these leaks.
- The diagnostic efficacy of this imaging technique is not well-established.
Purpose of the Study:
- To determine the diagnostic yield of intrathecal gadolinium MR myelography in patients with suspected spinal CSF leaks.
- To evaluate the effectiveness of MR myelography in identifying the precise location of CSF leaks.
Main Methods:
- A retrospective review of 101 intrathecal gadolinium MR myelograms from 97 patients (2002-2020) was conducted.
- Images were analyzed to detect spinal CSF leak sites and the presence of extradural fluid collections.
- The diagnostic yield was calculated per examination and per patient.
Main Results:
- A spinal CSF leak was localized in 14 out of 97 patients (14.4% diagnostic yield per patient).
- The diagnostic yield was 13.9% per examination, increasing to 15.7% in patients without extradural fluid collections.
- Identified leaks included CSF-venous fistulas and distal nerve root sleeve tears.
Conclusions:
- Intrathecal gadolinium MR myelography can identify specific types of spinal CSF leaks, such as CSF-venous fistulas and nerve root sleeve tears.
- The overall diagnostic yield of this procedure is limited.
- Alternative diagnostic modalities may be more appropriate as a first-line investigation for suspected spinal CSF leaks.
