MRI Complete Spine Without IV Contrast MRI complete spine without IV contrast optimized with fluid sensitive sequences is most useful in the initial evaluation of suspected SIH, particularly when performed with 3-D T2-weighted fat saturated sequences, which increases sensitivity for detecting fluid collections outside of the thecal sac [52]. This examination can detect with a high degree of accuracy the presence of epidural fluid collections and meningeal diverticula that can inform positioning and regions of interest for subsequent CSF leak localization imaging examinations, such as dynamic CT myelogram complete spine and digital subtraction myelography complete spine [25,34-36]. MRI Head With IV Contrast There is no relevant literature to support the use of MRI head with IV contrast in the initial imaging of suspected SIH. MRI Head Without and With IV Contrast MRI head without and with IV contrast is most useful in the initial evaluation of suspected SIH. Suggestive imaging features of SIH are best visualized on MRI head without and with IV contrast and include qualitative signs (engorgement of venous sinuses, pachymeningeal enhancement, midbrain descent, superficial siderosis, subdural hygroma or hematoma, and convex superior surface of the pituitary) and quantitative signs (pituitary height, pontomesencephalic angle, suprasellar cistern, prepontine cistern, midbrain descent, venous-hinge angle, mamillopontine angle, tonsillar descent, and area cavum veli interpositi) [16,25,26]. The cumulative presence of these intracranial findings has been shown to correlate with the likelihood of finding a spinal leak source [16]. MRI Head Without IV Contrast MRI head without IV contrast can be useful in the initial evaluation of suspected SIH.
Imaging of Suspected Intracranial Hypotension PCAs. MRI Complete Spine Without IV Contrast MRI complete spine without IV contrast optimized with fluid sensitive sequences is most useful in the initial evaluation of suspected SIH, particularly when performed with 3-D T2-weighted fat saturated sequences, which increases sensitivity for detecting fluid collections outside of the thecal sac [52]. This examination can detect with a high degree of accuracy the presence of epidural fluid collections and meningeal diverticula that can inform positioning and regions of interest for subsequent CSF leak localization imaging examinations, such as dynamic CT myelogram complete spine and digital subtraction myelography complete spine [25,34-36]. MRI Head With IV Contrast There is no relevant literature to support the use of MRI head with IV contrast in the initial imaging of suspected SIH. MRI Head Without and With IV Contrast MRI head without and with IV contrast is most useful in the initial evaluation of suspected SIH. Suggestive imaging features of SIH are best visualized on MRI head without and with IV contrast and include qualitative signs (engorgement of venous sinuses, pachymeningeal enhancement, midbrain descent, superficial siderosis, subdural hygroma or hematoma, and convex superior surface of the pituitary) and quantitative signs (pituitary height, pontomesencephalic angle, suprasellar cistern, prepontine cistern, midbrain descent, venous-hinge angle, mamillopontine angle, tonsillar descent, and area cavum veli interpositi) [16,25,26]. The cumulative presence of these intracranial findings has been shown to correlate with the likelihood of finding a spinal leak source [16]. MRI Head Without IV Contrast MRI head without IV contrast can be useful in the initial evaluation of suspected SIH.