Bendella Zeynep, Haase Robert, Clauberg Ralf, Zülow Stefan, Kindler Christine, Radbruch Alexander, Paech Daniel, Deike Katerina
Department of Neuroradiology, University Medical Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.
Clinical Neuroimaging Group, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
J Neuroimaging. 2025 May-Jun;35(3):e70056. doi: 10.1111/jon.70056.
Intracranial hypotension (IH) results from cerebrospinal fluid (CSF) leakage from the dural sac, occurring spontaneously or iatrogenically (e.g., post-lumbar puncture), and may cause a wide range of symptoms with significant functional impairment. Accurate detection of the epidural CSF lamella is key to diagnosis. This study evaluated the diagnostic value of intravenous contrast-enhanced MRI using heavily T2-weighted FLAIR (HT2-FLAIR) spine imaging compared to nonenhanced MR myelography at 3 Tesla.
Ten consecutive patients with IH symptoms were prospectively examined using HT2-FLAIR imaging of the spine before and up to 3 h after gadolinium-based contrast agent administration, alongside noncontrast MR myelography. Two readers assessed the conspicuity of the CSF lamella on contrast-enhanced HT2-FLAIR (ceHT2-FLAIR) using a score from -2 to +2 and evaluated additional diagnostic benefit.
A CSF lamella was seen in eight of 10 patients as a strongly enhancing band on ceHT2-FLAIR. In one case, the lamella was visible exclusively on ceHT2-FLAIR (conspicuity score [CS] = 2, n = 1) and was more conspicuous in three cases (CS = 1, n = 3). Six cases showed equal conspicuity (CS = 0, n = 6). In two cases each, ceHT2-FLAIR either enabled diagnosis or provided supporting information. In six cases, it confirmed diagnosis based on noncontrast imaging. Beyond improved conspicuity, ceHT2-FLAIR helped detect low-flow leaks, optimize axial slice positioning, and assess CSF lamella distribution.
Intravenous ceHT2-FLAIR MRI may be considered as an additional tool in CSF leak evaluation, particularly when used for detecting indirect signs of IH.
颅内低压（IH）是由于硬脊膜囊脑脊液（CSF）漏出所致，可自发发生或医源性引起（如腰椎穿刺后），并可能导致一系列症状及明显的功能障碍。准确检测硬膜外脑脊液层是诊断的关键。本研究评估了在3特斯拉下，与非增强磁共振脊髓造影相比，使用重T2加权液体衰减反转恢复（HT2-FLAIR）脊柱成像的静脉注射对比增强MRI的诊断价值。
对10例连续出现IH症状的患者进行前瞻性研究，在注射钆基对比剂前及注射后3小时内对脊柱进行HT2-FLAIR成像，并同时进行非对比磁共振脊髓造影。两名阅片者使用-2至+2的评分评估对比增强HT2-FLAIR（ceHT2-FLAIR）上脑脊液层的显见度，并评估额外的诊断益处。
10例患者中有8例在ceHT2-FLAIR上可见脑脊液层，表现为明显强化带。1例中，该层仅在ceHT2-FLAIR上可见（显见度评分[CS]=2，n=1），3例中更明显（CS=1，n=3）。6例显见度相同（CS=0，n=6）。各有2例中，ceHT2-FLAIR要么实现了诊断，要么提供了支持信息。6例中，它基于非对比成像证实了诊断。除了提高显见度外，ceHT2-FLAIR有助于检测低流量漏出、优化轴向切片定位以及评估脑脊液层分布。
静脉注射ceHT2-FLAIR MRI可被视为脑脊液漏评估中的一种辅助工具，特别是用于检测IH的间接征象时。
