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November 12, 2013; 81 (20) Article

Sensitivity of MRI of the spine compared with CT myelography in orthostatic headache with CSF leak

Amaal Starling, Fatima Hernandez, Joseph M. Hoxworth, Terrence Trentman, Rashmi Halker, Bert B. Vargas, Eric Hastriter, David Dodick
First published October 9, 2013, DOI: https://doi.org/10.1212/01.wnl.0000435555.13695.22
Amaal Starling
From the Departments of Neurology (A.S., R.H., B.B.V., E.H., D.D.), Radiology (J.M.H.), and Anesthesiology (T.T.), Mayo Clinic, Phoenix; and Arizona State University (F.H.), Tempe, AZ.
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Fatima Hernandez
From the Departments of Neurology (A.S., R.H., B.B.V., E.H., D.D.), Radiology (J.M.H.), and Anesthesiology (T.T.), Mayo Clinic, Phoenix; and Arizona State University (F.H.), Tempe, AZ.
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Joseph M. Hoxworth
From the Departments of Neurology (A.S., R.H., B.B.V., E.H., D.D.), Radiology (J.M.H.), and Anesthesiology (T.T.), Mayo Clinic, Phoenix; and Arizona State University (F.H.), Tempe, AZ.
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Terrence Trentman
From the Departments of Neurology (A.S., R.H., B.B.V., E.H., D.D.), Radiology (J.M.H.), and Anesthesiology (T.T.), Mayo Clinic, Phoenix; and Arizona State University (F.H.), Tempe, AZ.
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Rashmi Halker
From the Departments of Neurology (A.S., R.H., B.B.V., E.H., D.D.), Radiology (J.M.H.), and Anesthesiology (T.T.), Mayo Clinic, Phoenix; and Arizona State University (F.H.), Tempe, AZ.
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Bert B. Vargas
From the Departments of Neurology (A.S., R.H., B.B.V., E.H., D.D.), Radiology (J.M.H.), and Anesthesiology (T.T.), Mayo Clinic, Phoenix; and Arizona State University (F.H.), Tempe, AZ.
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Eric Hastriter
From the Departments of Neurology (A.S., R.H., B.B.V., E.H., D.D.), Radiology (J.M.H.), and Anesthesiology (T.T.), Mayo Clinic, Phoenix; and Arizona State University (F.H.), Tempe, AZ.
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David Dodick
From the Departments of Neurology (A.S., R.H., B.B.V., E.H., D.D.), Radiology (J.M.H.), and Anesthesiology (T.T.), Mayo Clinic, Phoenix; and Arizona State University (F.H.), Tempe, AZ.
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Citation
Sensitivity of MRI of the spine compared with CT myelography in orthostatic headache with CSF leak
Amaal Starling, Fatima Hernandez, Joseph M. Hoxworth, Terrence Trentman, Rashmi Halker, Bert B. Vargas, Eric Hastriter, David Dodick
Neurology Nov 2013, 81 (20) 1789-1792; DOI: 10.1212/01.wnl.0000435555.13695.22

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Abstract

Objective: To investigate the sensitivity of MRI of the spine compared with CT myelography (CTM) in detecting CSF leaks.

Methods: Between July 1998 and October 2010, 12 patients with orthostatic headache and a CTM-confirmed spinal CSF leak underwent an MRI of the spine with and without contrast. Using CTM as the gold standard, we retrospectively investigated the sensitivity of spinal MRI in detecting a CSF leak.

Results: Eleven of 12 patients with a CSF leak documented by CTM also had extradural fluid collections on spinal MRI (sensitivity 91.7%). Six patients with extradural fluid collections on spinal MRI also had spinal dural enhancement.

Conclusion: When compared with the gold standard of CTM, MRI of the spine appears to be a sensitive and less invasive imaging modality for detecting a spinal CSF leak, suggesting that MRI of the spine should be the imaging modality of first choice for the detection of spinal CSF leaks.

GLOSSARY

CTM=
CT myelography;
EBP=
epidural blood patch;
MR=
magnetic resonance;
SIH=
spontaneous intracranial hypotension

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received April 1, 2013.
  • Accepted in final form August 15, 2013.
  • © 2013 American Academy of Neurology
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