Spinal Cerebrospinal Fluid Leak Localization with Digital Subtraction Myelography: Tips, Tricks, and Pitfalls

Javier Galvan; Marcel Maya; Ravi S Prasad; Vikram S Wadhwa; Wouter Schievink

doi:10.1016/j.rcl.2023.10.004

Spinal Cerebrospinal Fluid Leak Localization with Digital Subtraction Myelography: Tips, Tricks, and Pitfalls

Radiol Clin North Am. 2024 Mar;62(2):321-332. doi: 10.1016/j.rcl.2023.10.004. Epub 2023 Nov 11.

Authors

Javier Galvan¹, Marcel Maya², Ravi S Prasad³, Vikram S Wadhwa³, Wouter Schievink⁴

Affiliations

¹ Department of Imaging, Cedars-Sinai Medical Center; Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Boulevard Taper Mezzanine M-335, Los Angeles, CA 90048.
² Department of Imaging, Cedars-Sinai Medical Center; Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Boulevard Taper Mezzanine M-335, Los Angeles, CA 90048. Electronic address: [email protected].
³ Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Boulevard Taper Mezzanine M-335, Los Angeles, CA 90048.
⁴ Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Boulevard Taper Mezzanine M-335, Los Angeles, CA 90048; Department of Neurosurgery, Cedars-Sinai Medical Center.

PMID: 38272624
DOI: 10.1016/j.rcl.2023.10.004

Abstract

Cerebrospinal fluid (CSF) leak can cause spontaneous intracranial hypotension (SIH) which can lead to neurologic symptoms, such as orthostatic headache. Over time, imaging techniques for detecting and localizing CSF leaks have improved. These techniques include computed tomography (CT) myelography, dynamic CT myelography, cone-beam CT, MRI, MR myelography, and digital subtraction myelography (DSM). DSM provides the highest sensitivity for identifying leak sites and has comparable radiation exposure to CT myelography. The introduction of the lateral decubitus DSM has proven invaluable in localizing leaks when other imaging tests have been inconclusive.

Keywords: CT myelography; Cerebrospinal fluid leak; Cerebrospinal fluid-venous fistula; Digital subtraction myelography; MR myelography; Spontaneous intracranial hypotension.

Publication types

Review

MeSH terms

Cerebrospinal Fluid Leak* / complications
Cerebrospinal Fluid Leak* / diagnostic imaging
Humans
Intracranial Hypotension* / diagnostic imaging
Magnetic Resonance Imaging / methods
Myelography / methods
Tomography, X-Ray Computed / methods