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Diagnostic Value of Flow-Void Sign for Localizing Ventral Dural Defects in Spine MRI
Soo-Im Jang1, Soyoun Choi2, Seung Ae Kim1,3
1Department of Neurology, Seoul National University Hospital, Seoul, Korea.
Journal of Clinical Neurology (Seoul, Korea)
|May 11, 2026
Summary
The flow-void sign on T2-weighted spine MRI can help locate ventral dural defects in spontaneous intracranial hypotension. This non-invasive sign, when present with a spinal lesion, shows good concordance with defect sites.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Spontaneous intracranial hypotension diagnosis relies on invasive myelography.
- Non-invasive markers for ventral dural defects are needed.
- The flow-void sign on MRI is a potential non-invasive marker.
Purpose of the Study:
- Evaluate the clinical utility of the flow-void sign.
- Determine its accuracy in predicting ventral dural defect locations.
- Assess its role in diagnosing cerebrospinal fluid leaks.
Main Methods:
- Retrospective cohort study of patients with confirmed ventral dural defects.
- Assessment of the flow-void sign on T2-weighted spine MRI by three neurologists.
- Analysis of concordance between flow-void sign and dural defect site using kappa statistics.
Main Results:
- The flow-void sign was observed in 67.2% of patients.
- A significant concordance (κ=0.660) was found between the flow-void sign and ventral dural defect level.
- Presence of a causative spinal lesion was associated with concordance (OR=6.48, p=0.016).
Conclusions:
- The flow-void sign is a valuable indirect indicator for ventral dural defect localization.
- It can supplement definitive imaging modalities like CT myelography.
- This finding aids in diagnosing cerebrospinal fluid leaks non-invasively.
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