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. 2008 Jan;29(1):116-21.
doi: 10.3174/ajnr.A0746. Epub 2007 Oct 18.

Gadolinium-enhanced MR cisternography to evaluate dural leaks in intracranial hypotension syndrome

S Albayram  1 , F Kilic, H Ozer, S Baghaki, N Kocer, C Islak
Affiliations

Gadolinium-enhanced MR cisternography to evaluate dural leaks in intracranial hypotension syndrome

S Albayram et al. AJNR Am J Neuroradiol. 2008 Jan.

Abstract

Background and purpose: We evaluated the use of MR cisternography after intrathecal administration of gadopentetate dimeglumine to detect the presence and localization of CSF leaks in 19 patients diagnosed with spontaneous intracranial hypotension syndrome according to the criteria of International Headache Society.

Materials and methods: Lumbar puncture with an injection of 0.5 mL of gadopentetate dimeglumine into the subarachnoid space in the lumbar area was performed. MR images of the cervical, thoracic, and lumbar regions in axial, coronal, and sagittal planes with fat-saturated T1-weighted images were acquired.

Results: We observed objective CSF leakage in 17 (89%) of 19 patients. In 14 of these 17 patients, the site of dural tear was demonstrated accurately. In 3 of these 17 patients, the contrast leakage was diffuse, and site of the leak could not be located accurately. No leakage was observed in 2 patients. No complications were detected in any of the patients during the first 24 hours after the procedure or during the 6- to 12-month follow-up.

Conclusion: The current results demonstrate the relative safety, accuracy, and feasibility of intrathecal gadolinium-enhanced MR cisternography to evaluate dural leaks.

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Figures

Fig 1.
Fig 1.
Axial T1-weighted fat-saturated MR image shows a right-sided CSF leak at the cervicothoracic junction extending into the right paraspinal soft tissue (arrows) and epidural collection (arrowhead).
Fig 2.
Fig 2.
Coronal (A) and axial (B and C) T1-weighted fat-saturated MR images reveal diffuse epidural (arrowhead) and paravertebral contrast accumulation (arrows) at the thoracolumbar area.
Fig 3.
Fig 3.
Coronal and sagittal T1-weighted fat-saturated MR images show multiple bilateral meningeal diverticula (arrows) at the thoracic and lumbar level.
Fig 4.
Fig 4.
A, Axial CT cisternography image shows right meningeal diverticulum (arrow) without CSF leak at the level of L1. B, Axial T1-weighted fat-saturated MR image reveals both a CSF leak on the right side (arrowheads) and a right meningeal diverticulum (arrow).
See this image and copyright information in PMC

Comment in

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