Madhavan Ajay A, Chazen J Levi
Continuum (Minneap Minn). 2025 Jun 1;31(3):668-687. doi: 10.1212/cont.0000000000001567.
Diagnostic imaging evaluation for patients with suspected spontaneous intracranial hypotension has evolved substantially in recent years. This article describes a practical algorithm for radiographic diagnosis of spontaneous intracranial hypotension and localization of spinal CSF leaks.
Brain and spine MRI is the mainstay of the initial diagnostic workup of patients with spontaneous intracranial hypotension. Recently, sophisticated myelographic techniques to precisely subtype and localize CSF leaks have been developed and refined. These include fluoroscopic techniques, such as digital subtraction myelography, and CT-based techniques, such as hyperdynamic CT myelography. These techniques improve the detection of various types of CSF leaks, thereby enabling targeted therapies.
Neurologists should familiarize themselves with the variety of imaging necessary to initially support a diagnosis of spontaneous intracranial hypotension and the myelographic techniques needed to precisely localize spinal CSF leaks.
近年来，对疑似自发性颅内低压患者的诊断性影像学评估有了显著进展。本文描述了一种用于自发性颅内低压的放射学诊断及脊髓脑脊液漏定位的实用算法。
脑和脊柱磁共振成像（MRI）是自发性颅内低压患者初始诊断检查的主要手段。最近，已开发并完善了用于精确区分脑脊液漏亚型和定位的复杂脊髓造影技术。这些技术包括透视技术，如数字减影脊髓造影，以及基于CT的技术，如动态CT脊髓造影。这些技术提高了对各种类型脑脊液漏的检测能力，从而能够进行靶向治疗。
神经科医生应熟悉初步支持自发性颅内低压诊断所需的各种影像学检查，以及精确定位脊髓脑脊液漏所需的脊髓造影技术。
