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Diagnostic Yield of Intrathecal Gadolinium MR Myelography for CSF Leak Localization

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Abstract

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.

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Abbreviations

CTM:

Computed tomographic myelography

CVF:

CSF-venous fistula

DSM:

Digital subtraction myelography

GdM:

Intrathecal gadolinium MR myelography

MRM:

MR myelography

SIH:

Spontaneous intracranial hypotension

SLEC:

Spinal longitudinal extradural collection

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 First St SW, MN 55905, Rochester, USA

    Ajay A. Madhavan, Carrie M. Carr, John C. Benson, Waleed Brinjikji, Felix E. Diehn, Dong Kun Kim, Vance T. Lehman, Greta B. Liebo, Pearse P. Morris, Darya P. Shlapak, Jared T. Verdoorn & Jonathan M. Morris

Authors
  1. Ajay A. Madhavan
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  2. Carrie M. Carr
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  3. John C. Benson
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  4. Waleed Brinjikji
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  5. Felix E. Diehn
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  6. Dong Kun Kim
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  7. Vance T. Lehman
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  8. Greta B. Liebo
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  9. Pearse P. Morris
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  10. Darya P. Shlapak
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  11. Jared T. Verdoorn
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  12. Jonathan M. Morris
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Corresponding author

Correspondence to Ajay A. Madhavan.

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Conflict of interest

A.A. Madhavan, C.M. Carr, J.C. Benson, W. Brinjikji, F.E. Diehn, D.K. Kim, V.T. Lehman, G.B. Liebo, P.P. Morris, D.P. Shlapak, J.T. Verdoorn and J.M. Morris declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Madhavan, A.A., Carr, C.M., Benson, J.C. et al. Diagnostic Yield of Intrathecal Gadolinium MR Myelography for CSF Leak Localization. Clin Neuroradiol 32, 537–545 (2022). https://doi.org/10.1007/s00062-021-01060-y

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  • DOI: https://doi.org/10.1007/s00062-021-01060-y

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