The role of digital subtraction myelography in the diagnosis and localization of spontaneous spinal CSF leaks

Joseph M. Hoxworth, Terrence L. Trentman, Amy L. Kotsenas, Kent R. Thielen, Kent D. Nelson, David W. Dodick

Research output: Contribution to journalArticlepeer-review

47 Scopus citations

Abstract

OBJECTIVE. The objective of our study was to review the clinical utility of digital subtraction myelography for the diagnosis of spinal CSF leaks in patients with spontaneous intracranial hypotension (SIH) and those with superficial siderosis. MATERIALS AND METHODS. Procedure logs from 2007 to 2011 were reviewed to identify cases in which digital subtraction myelography was performed to diagnose spinal CSF leaks. Electronic medical records were reviewed to obtain information regarding diagnosis and outcome. For patients to be included in the study, preprocedural spinal MRI had to show an extradural fluid collection spanning more than one vertebral level and postmyelographic CT had to confirm the presence of an active CSF leak. If digital subtraction myelography successfully showed the site of the CSF leak, the location was documented. RESULTS. Eleven patients (seven men and four women; mean age, 49.0 years) underwent digital subtraction myelography during the study period. Six patients had SIH and five patients had superficial siderosis. The extradural fluid collection on spinal MRI averaged a length of 15.5 vertebral levels. Digital subtraction myelography successfully showed the site of the CSF leak in nine of the 11 patients, and all of the dural tears were located in the thoracic spine between T3 and T11. CONCLUSION. Digital subtraction myelography is a valuable diagnostic tool for the localization of rapid spinal CSF leaks and should be considered in patients who are clinically suspected to have a dural tear that is accompanied by a longitudinally extensive extradural fluid collection on spinal MRI.

Original languageEnglish (US)
Pages (from-to)649-653
Number of pages5
JournalAmerican Journal of Roentgenology
Volume199
Issue number3
DOIs
StatePublished - Sep 1 2012

Keywords

  • Digital subtraction myelography
  • Dural tear
  • Spinal CSF leak
  • Spontaneous intracranial hypotension
  • Superficial siderosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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