Chazen J L, Talbott J F, Lantos J E, Dillon W P
From the Department of Radiology (J.L.C., J.E.L.), Weill Cornell Medical Center, New York, New York
Department of Radiology (J.F.T.), San Francisco General Hospital, San Francisco, California.
AJNR Am J Neuroradiol. 2014 Oct;35(10):2007-12. doi: 10.3174/ajnr.A3975. Epub 2014 May 22.
CT myelography has historically been the test of choice for localization of CSF fistula in patients with spontaneous intracranial hypotension. This study evaluates the additional benefits of intrathecal gadolinium MR myelography in the detection of CSF leak.
We performed a retrospective review of patients with spontaneous intracranial hypotension who underwent CT myelography followed by intrathecal gadolinium MR myelography. All patients received intrathecal iodine and off-label gadolinium-based contrast followed by immediate CT myelography and subsequent intrathecal gadolinium MR myelography with multiplanar T1 fat-suppressed sequences. CT myelography and intrathecal gadolinium MR myelography images were reviewed by an experienced neuroradiologist to determine the presence of CSF leak. Patient records were reviewed for demographic data and adverse events following the procedure.
Twenty-four patients met both imaging and clinical criteria for spontaneous intracranial hypotension and underwent CT myelography followed by intrathecal gadolinium MR myelography. In 3/24 patients (13%), a CSF leak was demonstrated on both CT myelography and intrathecal gadolinium MR myelography, and in 9/24 patients (38%), a CSF leak was seen on intrathecal gadolinium MR myelography (P = .011). Four of 6 leaks identified independently by intrathecal gadolinium MR myelography related to meningeal diverticula. CT myelography did not identify any leaks independently. There were no reported adverse events.
Present data demonstrate a higher rate of leak detection with intrathecal gadolinium MR myelography when investigating CSF leaks in our cohort of patients with spontaneous intracranial hypotension. Although intrathecal gadolinium is an FDA off-label use, all patients tolerated the medication without evidence of complications. Our data suggest that intrathecal gadolinium MR myelography is a well-tolerated examination with significant benefit in the evaluation of CSF leak, particularly for patients with leak related to meningeal diverticula.
在自发性颅内低压患者中，CT脊髓造影一直是脑脊液瘘定位的首选检查方法。本研究评估鞘内注射钆剂磁共振脊髓造影在检测脑脊液漏方面的额外益处。
我们对接受CT脊髓造影后再行鞘内注射钆剂磁共振脊髓造影的自发性颅内低压患者进行了回顾性研究。所有患者均接受鞘内注射碘剂及未按药品说明书使用的钆基造影剂，随后立即进行CT脊髓造影，以及随后采用多平面T1脂肪抑制序列的鞘内注射钆剂磁共振脊髓造影。由一位经验丰富的神经放射科医生对CT脊髓造影和鞘内注射钆剂磁共振脊髓造影图像进行评估，以确定是否存在脑脊液漏。查阅患者记录以获取人口统计学数据及术后不良事件。
24例患者符合自发性颅内低压的影像学及临床标准，接受了CT脊髓造影及随后的鞘内注射钆剂磁共振脊髓造影。在24例患者中有3例（13%）在CT脊髓造影和鞘内注射钆剂磁共振脊髓造影中均显示有脑脊液漏，9例（38%）在鞘内注射钆剂磁共振脊髓造影中发现有脑脊液漏（P = 0.011）。鞘内注射钆剂磁共振脊髓造影独立发现的6处漏口中有4处与脑膜憩室有关。CT脊髓造影未独立发现任何漏口。未报告有不良事件。
目前的数据表明，在我们的自发性颅内低压患者队列中，鞘内注射钆剂磁共振脊髓造影在检测脑脊液漏方面具有更高的检出率。尽管鞘内注射钆剂属于美国食品药品监督管理局（FDA）未按药品说明书使用的情况，但所有患者对该药物耐受性良好，未出现并发症迹象。我们的数据表明，鞘内注射钆剂磁共振脊髓造影耐受性良好，在评估脑脊液漏方面具有显著益处，尤其是对于与脑膜憩室相关的漏口患者。
