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AJNR - American Journal of Neuroradiology

Published ahead of print on January 17, 2008
doi: 10.3174/ajnr.A0920

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American Journal of Neuroradiology 29:649-654, April 2008
© 2008 American Society of Neuroradiology

SPINE

Detection of CSF Leak in Spinal CSF Leak Syndrome Using MR Myelography: Correlation with Radioisotope Cisternography

H.-M. Yoo^a,e, S.J. Kim^a, C.G. Choi^a, D.H. Lee^a, J.H. Lee^a, D.C. Suh^a, J.W. Choi^a, K.S. Jeong^a, S.J. Chung^b, J.S. Kim^c and S.-C. Yun^d

^a Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
^b Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
^c Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
^d Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
^e Department of Radiology, Konyang University College of Medicine, Chungnam, South Korea

Please address correspondence to Sang Joon Kim, MD, Asan Medical Center, University of Ulsan College of Medicine, 388-one Pungnap 2-dong; Songpa-gu, Seoul, 138-736, Korea; e-mail: sjkimjb{at}amc.seoul.kr

BACKGROUND AND PURPOSE: Spinal CSF leak syndrome is a unique disorder caused by spinal CSF leak. In this study, we attempted to determine whether MR myelography (MRM) can detect the leakage site in the spine.

MATERIALS AND METHODS: We performed both MRM and radioisotope cisternography (RIC) in 15 patients with spinal CSF leak syndrome. Patients were included in this study if they had at least 2 of the following criteria: 1) orthostatic headache, 2) low CSF opening pressure, and 3) diffuse pachymeningeal enhancement on brain MR imaging. For comparison, we performed MRM in 15 subjects without symptoms of spinal CSF leak syndrome. MRM was performed with the 2D turbo spin-echo technique in the entire spine by using a 1.5T scanner. Two blinded radiologists evaluated the MRM findings in a total of 30 cases, composed of patient and control groups, with regard to the presence of leakage and the level of leakage if present. RIC was performed only in the patient group and was assessed by consensus among 3 physicians experienced in nuclear medicine. The diagnostic performance of MRM and RIC was evaluated on the basis of the clinical diagnosis of spinal CSF leak syndrome.

RESULTS: The sensitivity, specificity, and accuracy of MR myelography for detecting CSF leak was 86.7%, 86.7%, and 86.7% for reader 1, respectively, and 80.0%, 93.3%, and 86.7% for reader 2, respectively. The sensitivity of RIC was 93.3%. Agreement between the 2 techniques for the detection of CSF leak was substantial in reader 1 and moderate in reader 2 ( = 0.634 and 0.444, respectively).

CONCLUSION: MRM is an effective tool for detecting CSF leak in the spine in patients with spinal CSF leak syndrome.