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Diagnostic yield of MR myelography in patients with newly diagnosed spontaneous intracranial hypotension: a systematic review and meta-analysis

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Abstract

Objectives

To investigate the pooled diagnostic yield of MR myelography in patients with newly diagnosed spontaneous intracranial hypotension (SIH).

Methods

A literature search of the MEDLINE/PubMed and Embase databases was conducted until July 25, 2021, including studies with the following inclusion criteria: (a) population: patients with newly diagnosed SIH; (b) diagnostic modality: MR myelography or MR myelography with intrathecal gadolinium for evaluation of CSF leakage; (c) outcomes: diagnostic yield of MR myelography or MR myelography with intrathecal gadolinium. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. DerSimonian–Laird random-effects modeling was used to calculate the pooled estimates. Subgroup analysis regarding epidural fluid collection and meta-regression were additionally performed.

Results

Fifteen studies with 643 patients were included. Eight studies used MR myelography with intrathecal gadolinium, and 11 used MR myelography. The overall quality of the included studies was moderate. The pooled diagnostic yield of MR myelography was 86% (95% CI, 80–91%) and that of MR myelography with intrathecal gadolinium was 83% (95% CI, 51–96%). There was no significant difference in pooled diagnostic yield between MR myelography and MR myelography with intrathecal gadolinium (p = 0.512). In subgroup analysis, the pooled diagnostic yield of the epidural fluid collection was 91% (95% CI, 84–94%). In meta-regression, the diagnostic yield was unaffected regardless of consecutive enrollment, magnet strength, or 2D/3D.

Conclusions

MR myelography had a high diagnostic yield in patients with SIH. MR myelography is non-invasive and not inferior to MR myelography with intrathecal gadolinium.

Key Points

• The pooled diagnostic yield of MR myelography was 86% (95% CI, 80–91%) in patients with spontaneous intracranial hypotension.

• There was no significant difference in pooled diagnostic yield between MR myelography and MR myelography with intrathecal gadolinium.

• MR myelography is non-invasive and not inferior to MR myelography with intrathecal gadolinium.

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Abbreviations

SIH:

Spontaneous intracranial hypotension

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Funding

This work was supported by the National Research Foundation of Korea (NRF-2021R1C1C1014413 to Chong Hyun Suh).

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Author notes

  1. So Jeong Lee and Dana Kim contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    So Jeong Lee, Chong Hyun Suh, Woo Hyun Shim & Sang Joon Kim

  2. University of Ulsan College of Medicine, Seoul, Republic of Korea

    Dana Kim

  3. Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Hwon Heo

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  1. So Jeong Lee
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Correspondence to Chong Hyun Suh.

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Lee, S.J., Kim, D., Suh, C.H. et al. Diagnostic yield of MR myelography in patients with newly diagnosed spontaneous intracranial hypotension: a systematic review and meta-analysis. Eur Radiol 32, 7843–7853 (2022). https://doi.org/10.1007/s00330-022-08845-w

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