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