AJR Am J Roentgenol. Leak detection and localization are important for both diagnosis and treatment. Department of Radiology, B Y L Nair Charitable Hospital and Topiwala National Medical College, Mumbai, Maharashtra, India ... subsequent slow seepage of CSF. Extensive leakage of CSF into epidural space is also seen. Such techniques are optimally performed with some pretest probability based on prior imaging as to what spinal region the leak is coming from (e.g., cervical, thoracic, or lumbar), and what surface of the thecal sac is involved (e.g., ventral, dorsal, or lateral), and are therefore less commonly used as an initial screening tool. Artikel Terkait. It is important to distinguish interstitial edema from a commonly seen variant of a slight increase in signal anterior to the frontal horns, and posterior to the occipital horns, which is known as ependymitis granularis 3. Occasionally, though, the collections may be more circumscribed, particularly with leaks of more long-standing duration, possibly the result of partial containment by surrounding soft-tissue planes or within the subdural space [27, 28]. For example, if the diagnosis of SIH is not in doubt and a nontargeted epidural blood patch is planned as first-line therapy, myelography of any sort may be unnecessary. However, the examination provides relatively poor spatial resolution and provides only moderate sensitivity and specificity [53]. Ho ML, Rojas R, Eisenberg RL. B, Scans using 111In-DTPA show evidence of lumbar spinal CSF leak in 36-year-old man. 2 Department of Radiology, Mayo Clinic, Rochester, MN. {"url":"/signup-modal-props.json?lang=us\u0026email="}. The Role of Digital Subtraction Myelography in the Diagnosis and Localization of Spontaneous Spinal CSF Leaks. A, Axial CT myelography (CTM) image shows focal contrast material leak (arrowhead) ventral to nerve root. Cerebrospinal fluid is contained within the cerebral ventricles, the spinal canal and the subarachnoid space (space between arachnoid externally and pia mater internally) surrounding the brain and spinal cord (Figure 1182.1).Cerebrospinal fluid (CSF) is reabsorbed into the blood through the arachnoid villi of dural venous sinuses. Image acquisition is stopped once a leak is seen. FLAIR is the most sensitive MRI sequence for detection. Morphometric study of the midsagittal MR imaging plane in cases of hydrocephalus and atrophy and in normal brains. As a result, a number of imaging tests have been refined to detect these leaks, each with its own strengths and weaknesses. 1. If there is evidence of a fast CSF leak on initial imaging, a test with high temporal resolution may be needed to further localize the leak. Cerebrospinal fluid (CSF) spaces include ventricles and cerebral and spinal subarachnoid spaces. In addition to cross-sectional images, maximum-intensity-projection images can be used to create a 3D representation of the thecal sac [40]. 124 (2): 334. The brain is surrounded by cerebrospinal fluid (CSF) within the sulci, fissures and basal cisterns.CSF is also found centrally within the ventricles.The sulci, fissures, basal cisterns and ventricles together form the 'CSF spaces', also known as the 'extra-axial spaces'. Fig. In a significant proportion of cases of SIH, no leak will be seen on myelography despite exhaustive investigation. 3). Close attention should be paid to the presence of thoracic disk protrusions or osteophytes in patients with this leak type, because degenerative lesions often cause fast CSF leaks [18]. In response to the challenges of multiple types of CSF leaks in SIH, multiple myelographic imaging techniques have been developed. The collection may be extensive, spanning over multiple vertebral segments and, occasionally, involving nearly the entire spine. 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