Utility of heavily T2-weighted MR myelography as the first step in CSF leak detection and the planning of epidural blood patches |
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| Institution: | 1. University of Huddersfield, Queensgate, HD1 3DH, Huddersfield, UK;2. Calderdale and Huddersfield NHS Foundation Trust, UK;1. Department of Neurosurgery, Kwong Wah Hospital, Hong Kong;2. Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong;3. Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong;4. Division of Neurosurgery, Department of Surgery, The University of Hong Kong, Hong Kong;1. Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Guro, Seoul, South Korea;2. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Sungkyunkwan, South Korea;3. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Sungkyunkwan, South Korea;1. Department of Neurosurgery, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia;2. National Trauma Research Institute, Level 4, 89 Commercial Road, Melbourne, Victoria 3004, Australia;3. Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria 3800, Australia |
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| Abstract: | Heavily T2-weighted MR myelography (HT2W-MRM) is emerging as an alternative approach for detection and follow up of CSF leaks. We aimed to assess epidural blood patch (EBP) treatment outcome when using HT2W-MRM as the primary modality for detecting CSF leak and planning EBP placement in routine clinical practice. Since 2018, patients at our institute suspected of having CSF leak, routinely HT2W-MRM instead of CT myelography to determine presence of the leak and identify the EBP target site. Fifty-nine consecutive patients suspected of having a CSF leak underwent HT2W-MRM. After excluding patients with subdural hematoma and poor image quality, 26 (10 men, 16 women; mean age 44.92 ± 12.6 years) patients were included in this study. Patients received EBP on the basis of HT2W-MRM assessments and clinical assessment. Imaging findings and clinical outcome were evaluated. CSF leak was identified in 21 patients (80.8%, 21/26) based HT2W-MRM. Most cases were graded on a confidence scale as CSF leak definitely (n = 13) or probably (n = 3) present. Successful clinical EBP treatment was achieved in 14 of 17 patients (82.4%) after first targeted EBP, and patient symptoms significantly improved after treatment (numerical rating score 6.4 before EBP, 1.3 after EBP, P < 0.001). HT2W-MRM based EBP are the rational and effective choices for CSF leak treatment in routine clinical practice. |
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| Keywords: | Cerebrospinal fluid leak Intracranial hypotension Myelography Magnetic resonance imaging Blood patch Epidural |
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