Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Jan 1;95(1129):20210841.
doi: 10.1259/bjr.20210841. Epub 2021 Nov 22.

Magnetic resonance imaging predicted the therapeutic response of patients with spinal cerebrospinal fluid leakage undergoing targeted epidural blood patch

Hung-Chieh Chen  1   2 , Jyh-Wen Chai  1   3   4 , Chih-Cheng Wu  5   6   7 , Po-Lin Chen  2   8 , Chieh-Lin Teng  4   9   10   11
Affiliations
Case Reports

Magnetic resonance imaging predicted the therapeutic response of patients with spinal cerebrospinal fluid leakage undergoing targeted epidural blood patch

Hung-Chieh Chen et al. Br J Radiol. .

Abstract

Objective: Most patients with spinal cerebrospinal fluid (CSF) leakage require an epidural blood patch (EBP); however, the response to treatment is varied. This study aimed to compare the MRI findings at follow-up between EBP effective and non-effective groups and to identify imaging findings that predict EBP treatment failure.

Methods: We retrospectively reviewed 48 patients who received EBP treatment for spinal CSF leakage. These patients were stratified into two groups: EBP effective (n = 27) and EBP non-effective (n = 21) using the results of the 3 month MRI as the end point.

Results: Compared to the EBP non-effective group, the patients in the EBP effective group had a lower spinal CSF leakage number (2.67 vs 12.48; p = 0.001), lower spinal epidural fluid accumulation levels (3.00 vs 7.48; p = 0.004), brain descend (11.11% vs 38.10%; p = 0.027), pituitary hyperemia (18.52% vs 57.14%; p = 0.007), and decreased likelihood of ≥three numbers of spinal CSF leakage (25.93% vs 90.48%; p = 0.001) in the post-EBP MRI. Clinical non-responsiveness (OR: 57.84; 95% CI: 3.47-972.54; p = 0.005) and ≥three numbers of spinal CSF leakage (OR: 15.13; 95% CI: 1.45-159.06; p = 0.023) were associated with EBP failure. Between these variables, ≥three numbers of spinal CSF leakage identified using the post-EBP MRI demonstrated greater sensitivity in predicting EBP failure compared to clinical non-responsiveness (90.48% vs 61.9%).

Conclusion: The number of spinal CSF leakage identified using the post-EBP MRI with a cut-off value of three is an effective predictor of EBP failure.

Advances in knowledge: Compared to clinical responsiveness, the post-EBP MRI provided a more objective approach to predict the effectiveness of EBP treatment in patients with spinal CSF leakage.

PubMed Disclaimer

Conflict of interest statement

Competing interests: Chieh-Lin Jerry Teng received an honorarium and consulting fees from Novartis, Roche, Takeda, Johnson & Johnson, Amgen, BMS Celgene, Kirin, AbbVie, and MSD.

Figures

Figure 1.
Figure 1.
Schematic of patient enrollment. CSF, cerebrospinal fluid; EBP, epidural blood patch; MRM, magnetic resonance myelography.
Figure 2.
Figure 2.
(A) 3D MIP MRM of C-T spine shows CSF leakage at multiple neural sleeves (arrow). (B) Sagittal T2WI MRI of C-T spine shows abnormal anterior and posterior epidural fluid accumulation (arrowhead). (C) Sagittal T1WI magnetic resonance imaging of C-T spine shows abnormal anterior and posterior epidural fluid accumulation (arrowhead). (D) The post-epidural blood patch 3D MIP MRM reveals CSF leakage at multiple neural sleeves (arrow) despite significant improvements in the patient’s symptoms. (E) The 3 month 3D MIP MRM reveals absence of CSF leakage. 3D MIP, three-dimensional maximum intensity projection; CSF, cerebrospinal fluid; EBP, epidural blood patch; MRM, magnetic resonance myelography.; T1WI, T1 weighted imaging
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Chen H-C, Chen P-L, Tsai Y-H, Chen C-H, Chen CC-C, Chai J-W. Quantitative measurement of CSF in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol 2017; 38: 1061–7. doi: 10.3174/ajnr.A5134 - DOI - PMC - PubMed
    1. Kranz PG, Gray L, Malinzak MD, Amrhein TJ. Spontaneous intracranial hypotension: pathogenesis, diagnosis, and treatment. Neuroimaging Clin N Am 2019; 29: 581–94. doi: 10.1016/j.nic.2019.07.006 - DOI - PubMed
    1. Kanno H, Yoshizumi T, Nakazato N, Shinonaga M. Predictors of the response to an epidural blood patch in patients with spinal leakage of cerebrospinal fluid. J Clin Neurol 2020; 16: 1–8. doi: 10.3988/jcn.2020.16.1.1 - DOI - PMC - PubMed
    1. Yoo H-M, Kim SJ, Choi CG, Lee DH, Lee JH, Suh DC, et al. . Detection of CSF leak in spinal CSF leak syndrome using MR myelography: correlation with radioisotope cisternography. AJNR Am J Neuroradiol 2008; 29: 649–54. doi: 10.3174/ajnr.A0920 - DOI - PMC - PubMed
    1. Pannullo SC, Reich JB, Krol G, Deck MD, Posner JB. MRI changes in intracranial hypotension. Neurology 1993; 43: 919–26. doi: 10.1212/WNL.43.5.919 - DOI - PubMed

Publication types