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Contrast-enhanced MR myelography in spontaneous intracranial hypotension: description of an artefact imitating CSF leakage

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Abstract

In contrast-enhanced (CE) MR myelography, hyperintense signal outside the intrathecal space in T1-weighted sequences with spectral presaturation inversion recovery (SPIR) is usually considered to be due to CSF leakage. We retrospectively investigated a hyperintense signal at the apex of the lung appearing in this sequence in patients with SIH (n = 5), CSF rhinorrhoea (n = 2), lumbar spine surgery (n = 1) and in control subjects (n = 6). Intrathecal application of contrast agent was performed in all patients before MR examination, but not in the control group. The reproducible signal increase was investigated with other fat suppression techniques and MR spectroscopy. All patients and controls showed strongly hyperintense signal at the apex of the lungs imitating CSF leakage into paraspinal tissue. This signal increase was identified as an artefact, caused by spectroscopically proven shift and broadening of water and lipid resonances (1–2 ppm) in this anatomical region. Only patients with SIH showed additional focal enhancement along the spinal nerve roots and/or in the spinal epidural space. In conclusion CE MR myelography with spectral selective fat suppression shows a reproducible cervicothoracic artefact, imitating CSF leakage. Selective water excitation technique as well as periradicular and epidural contrast collections may be helpful to discriminate between real pathological findings and artefacts.

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Authors and Affiliations

  1. Institute of Neuroradiology, University of Frankfurt, Schleusenweg 2 – 16, 60528, Frankfurt, Germany

    Elke Hattingen, Richard DuMesnil & Ulrich Pilatus

  2. Department of Neurosurgery, University of Frankfurt, Frankfurt, Germany

    Andreas Raabe & Jürgen Beck

  3. Department of Neurology, University of Frankfurt, Frankfurt, Germany

    Timo Kahles

Authors
  1. Elke Hattingen
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  2. Richard DuMesnil
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  3. Ulrich Pilatus
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  4. Andreas Raabe
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  5. Timo Kahles
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  6. Jürgen Beck
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Correspondence to Elke Hattingen.

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Hattingen, E., DuMesnil, R., Pilatus, U. et al. Contrast-enhanced MR myelography in spontaneous intracranial hypotension: description of an artefact imitating CSF leakage. Eur Radiol 19, 1799–1808 (2009). https://doi.org/10.1007/s00330-009-1347-0

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  • DOI: https://doi.org/10.1007/s00330-009-1347-0

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