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 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]. MRI Complete Spine With IV Contrast There is no relevant literature to support the use of MRI complete spine with IV contrast as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. MRI Complete Spine Without and With IV Contrast MRI complete spine without and with IV contrast can be useful as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. The noncontrast component of this examination optimized with fluid sensitive sequences is most useful, particularly when performed with 3-D T2-weighted fat saturated sequences, which increases the sensitivity for detecting fluid collections outside of the thecal sac [52]. It 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]. The contrast component of this examination may demonstrate dural enhancement and engorged epidural venous plexus, which are also imaging features that support a diagnosis of SIH [28,29].
Imaging of Suspected Intracranial Hypotension PCAs. 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 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]. MRI Complete Spine With IV Contrast There is no relevant literature to support the use of MRI complete spine with IV contrast as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. MRI Complete Spine Without and With IV Contrast MRI complete spine without and with IV contrast can be useful as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. The noncontrast component of this examination optimized with fluid sensitive sequences is most useful, particularly when performed with 3-D T2-weighted fat saturated sequences, which increases the sensitivity for detecting fluid collections outside of the thecal sac [52]. It 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]. The contrast component of this examination may demonstrate dural enhancement and engorged epidural venous plexus, which are also imaging features that support a diagnosis of SIH [28,29].