Role of MR Myelography with Intrathecal Gadolinium in Localization of Spinal CSF Leaks

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mri-gadolinium-contrastA, Pre- and post-intrathecal gadolinium fat-suppressed T1 images demonstrate typical artifacts, which may simulate a leak at C1-C2 seen in 6 of 41 of our patients. Note the inhomogeneous fat saturation on this precontrast sagittal T1 image at C1-2 (arrow). B, Recognizing this artifact on precontrast imaging is important because with the addition of intrathecal gadolinium, this inhomogeneous fat saturation can potentially mimic a leak (arrow).

Full article and images available here: http://www.ajnr.org/content/33/3/535/F2.expansion.html

Detection of CSF Leak in Spinal CSF Leak Syndrome Using MR Myelography

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Schematic drawing of 4-point-scale grading system of CSF leak on MRM (A) and RIC (B). A, Our grading scale on MRM is depicted as follows: grade zero, no leak (normal findings on MR myelogram); grade 1, possible leak (expansion of the CSF space column around the nerve root sleeve); grade 2, probable leak (streaky hyperintensity lateral to the nerve root sleeves but with length less than the transverse diameter of the thecal sac); and grade 3, definite leak (lateral extension greater than the transverse diameter of the thecal sac). However, actual grading of the case is determined on the basis of the highest grade in each level of the spine. B, Grade of CSF leak on RIC is depicted as follows: grade zero, no paraspinal activity; grade 1, possible leak (faint paraspinal activity with length under the transverse diameter of spinal canal activity); grade 2, probable leak (hot paraspinal activity with the length under the transverse diameter of spinal canal activity); and grade 3, definite leak (hot paraspinal activity with the length over the transverse diameter of spinal canal activity)‏

Full article and PowerPoint presentation available here: http://www.ajnr.org/content/29/4/649/F1.expansion.html

The Value of Changing Position in the Detection of CSF Leakage

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ABSTRACT: Radionuclide Cisternography (RNC) is of potential value in pointing out the sites of cerebrospinal fluid (CSF) leakage in patients with spontaneous intracranial hypotension (SIH). In the current report, we present two patients who underwent RNC for suspected CSF leakage. Both patients underwent magnetic resonance imaging (MRI) and RNC for evaluation. We describe a simple method to increase the detection ability of RNC for CSF leakage in patients with SIH.