The "Crossing Collection Sign": A Diagnostic Tool on Spine Magnetic Resonance Imaging For Localizing Cerebrospinal...

Area of Science:

• Neurosurgery
• Radiology
• Spinal Imaging

Background:

• Spinal longitudinal extradural CSF collections (SLECs) are challenging to localize for effective treatment.
• Accurate identification of CSF leak sites is crucial for successful surgical repair and patient outcomes.

Purpose of the Study:

• To evaluate if the "crossing collection sign" on initial MRI can predict the confirmed CSF leak site.
• To assess the utility of this sign in guiding further diagnostic and therapeutic interventions for suspected CSF leaks.

Main Methods:

• Retrospective analysis of 38 patients with suspected CSF leaks and SLECs who underwent MRI, myelography, and/or surgical repair.
• Defined the "crossing collection sign" as the intersection of ventral and dorsal SLECs on MRI.
• Compared the location of the "crossing collection sign" with the confirmed leak site.

Main Results:

• The "crossing collection sign" was present in 76% of patients.
• This sign accurately predicted the CSF leak site in 48% of cases and was within 3 vertebral segments in 90% of cases.
• Confirmed leaks were most frequent in the thoracic spine (n=17), followed by cervical (n=9) and lumbar (n=3).

Conclusions:

• The "crossing collection sign" is a valuable indicator for identifying spinal regions with a high probability of CSF leakage.
• This finding can optimize subsequent diagnostic steps like dynamic myelography and surgical exploration, potentially improving patient management.