Diagnostic Yield of Intrathecal Gadolinium MR Myelography for CSF Leak Localization.

Abstract

Intrathecal gadolinium magnetic resonance (MR) myelography can be used to localize various types of spinal cerebrospinal fluid (CSF) leaks; however, its diagnostic yield is not well known. We sought to determine the diagnostic yield of MR myelography in patients with spontaneous intracranial hypotension. Aretrospective review was performed on all patients who had undergone intrathecal gadolinium MR myelography at our institution from 2002 to 2020 for suspected spinal CSF leak. The MR myelography images were reviewed for the presence or absence of aspinal CSF leak site. Images were also evaluated for the presence an extradural fluid collection. A total of 97patients were included in the final cohort. The average age was 52.6years; 67.0% were female, 4 patients underwent 2 examinations each, yielding atotal of 101 MR myelograms. The source of aspinal CSF leak was localized in 14patients. The diagnostic yield for CSF leak localization on intrathecal gadolinium MR myelography was 14/101 (13.9%) per GdM examination and 14/97 (14.4%) per patient. Among the subset of patients without extradural fluid collections, the yield was 15.7% per examination. All detected leaks were either CSF-venous fistulas or distal nerve root sleeve tears. Intrathecal gadolinium MR myelography is capable of localizing CSF-venous fistulas and distal nerve root sleeve tears; however, our data show that it has alimited diagnostic yield. We suggest that other modalities may be abetter first step before attempting intrathecal gadolinium MR myelography.