Dynamic CT myelography involves an initial scan followed by delayed phase scans in immediate succession and, when performed in the decubitus position, may require 2 separate contrast injections due to the transient temporal characteristics associated with CSF-venous fistula visualization as well as limitations in contrast dosing [40-44]. DTPA Cisternography DTPA cisternography of the spine can detect CSF leaks with similar accuracy to conventional CT myelography [45]. Due to its limited spatial resolution, a positive DTPA cisternogram may require further investigation with subsequent dynamic CT myelography or dynamic digital subtraction myelography to definitively localize leak for treatment planning [45,46]. MR Myelography Complete Spine An MR myelogram with intrathecal gadolinium administration has been used in several studies to increase sensitivity for the detection of slow leaking dural and meningeal diverticular defects [47-49]. Some limited evidence suggests a potential role for MR myelography in the detection of CSF-venous fistulas [50]. It should be noted that intrathecal use of gadolinium is currently off label. Although studies have suggested that intrathecal gadolinium can Imaging of Suspected Intracranial Hypotension be administered safely in small doses, the safety profile of such imaging is not formally approved for such use, and special dosing caution is required to avoid potential of gadolinium induced neurotoxicity [51]. Radiographic Myelography Digital Subtraction Complete Spine Dynamic digital subtraction myelography plays an important role in the subsequent imaging workup of SIH after initial brain and spine imaging [53].
Imaging of Suspected Intracranial Hypotension PCAs. Dynamic CT myelography involves an initial scan followed by delayed phase scans in immediate succession and, when performed in the decubitus position, may require 2 separate contrast injections due to the transient temporal characteristics associated with CSF-venous fistula visualization as well as limitations in contrast dosing [40-44]. DTPA Cisternography DTPA cisternography of the spine can detect CSF leaks with similar accuracy to conventional CT myelography [45]. Due to its limited spatial resolution, a positive DTPA cisternogram may require further investigation with subsequent dynamic CT myelography or dynamic digital subtraction myelography to definitively localize leak for treatment planning [45,46]. MR Myelography Complete Spine An MR myelogram with intrathecal gadolinium administration has been used in several studies to increase sensitivity for the detection of slow leaking dural and meningeal diverticular defects [47-49]. Some limited evidence suggests a potential role for MR myelography in the detection of CSF-venous fistulas [50]. It should be noted that intrathecal use of gadolinium is currently off label. Although studies have suggested that intrathecal gadolinium can Imaging of Suspected Intracranial Hypotension be administered safely in small doses, the safety profile of such imaging is not formally approved for such use, and special dosing caution is required to avoid potential of gadolinium induced neurotoxicity [51]. Radiographic Myelography Digital Subtraction Complete Spine Dynamic digital subtraction myelography plays an important role in the subsequent imaging workup of SIH after initial brain and spine imaging [53].