MRI Thoracic Spine Without IV Contrast MRI spine without IV contrast is useful in the initial imaging evaluation of headache with features of intracranial hypotension. The primary purpose is to look for an extradural fluid collection in the spinal canal, usually at the level of the thoracic spine, that would be consistent with a dural tear (type 1 or type 2 CSF leak). Identification of such a fluid collection can help to guide further management or to confirm a diagnosis of SIH in rare cases in which brain MRI is normal. Other spine MRI findings that have been reported in SIH include dural enhancement, distension of epidural veins, and abnormal visualization of nerve root sleeves. Although some patients with a spinal CSF leak will respond to horizontal bedrest and/or nontargeted epidural blood patches in the lumbar spine, others will have refractory symptoms and require spinal CSF leak localization for targeted therapy. Heavily T2-weighted MR myelography without the use of intrathecal contrast is an emerging noninvasive technique for detecting CSF leaks without the need for a lumbar puncture and radiation exposure. This technique can also be used to guide targeted epidural blood patches. A study conducted in Korea replaced CT myelography with heavily T2-weighted MR myelography (performed on a 3T MRI) for 26 patients who presented with headache attributed to Headache low CSF pressure. This study demonstrated CSF leak detection in 80.8% of the patients. The findings of heavily T2-weighted MR myelography was used to plan epidural blood patches placement; complete relief of symptoms was achieved in 82.4% of patients in whom a CSF leak was seen using heavily T2-weighted MR myelography [46]. Minimally invasive methods for spinal CSF leak localization include conventional CT myelography, dynamic CT myelography, digital subtraction myelography, and MR myelography with intrathecal injection of contrast.
Headache PCAs. MRI Thoracic Spine Without IV Contrast MRI spine without IV contrast is useful in the initial imaging evaluation of headache with features of intracranial hypotension. The primary purpose is to look for an extradural fluid collection in the spinal canal, usually at the level of the thoracic spine, that would be consistent with a dural tear (type 1 or type 2 CSF leak). Identification of such a fluid collection can help to guide further management or to confirm a diagnosis of SIH in rare cases in which brain MRI is normal. Other spine MRI findings that have been reported in SIH include dural enhancement, distension of epidural veins, and abnormal visualization of nerve root sleeves. Although some patients with a spinal CSF leak will respond to horizontal bedrest and/or nontargeted epidural blood patches in the lumbar spine, others will have refractory symptoms and require spinal CSF leak localization for targeted therapy. Heavily T2-weighted MR myelography without the use of intrathecal contrast is an emerging noninvasive technique for detecting CSF leaks without the need for a lumbar puncture and radiation exposure. This technique can also be used to guide targeted epidural blood patches. A study conducted in Korea replaced CT myelography with heavily T2-weighted MR myelography (performed on a 3T MRI) for 26 patients who presented with headache attributed to Headache low CSF pressure. This study demonstrated CSF leak detection in 80.8% of the patients. The findings of heavily T2-weighted MR myelography was used to plan epidural blood patches placement; complete relief of symptoms was achieved in 82.4% of patients in whom a CSF leak was seen using heavily T2-weighted MR myelography [46]. Minimally invasive methods for spinal CSF leak localization include conventional CT myelography, dynamic CT myelography, digital subtraction myelography, and MR myelography with intrathecal injection of contrast.