A Comparison Of Spinal MR Myelography And Gadolinium MR Myelography In Localizing Spinal CSF Leaks In Patients With Spontaneous Intracranial Hypotension

Objective:1. To analysis imaging findings of the Gadolinium MR myelography (GdM) in detecting spinal CSF leaks of spontaneous intracranial hypotension (SIH) and assess the security of GdM.2. To compare the diagnostic value between spinal MR myelography (MRM) and intrathecal Gadolinium MR myelography (GdM) in detecting spinal CSF leaks of SIH.3. To study the clinical strategies of the examination in detecting spinal CSF leaks of SIH.4. To preliminary explore the clinical value of MRM and GdM guided in those SIH patients with targeted EBP.Methods:1. The imaging findings and the security of GdM in detecting spinal CSF leaks of SIH.To collected 158 hospitalized patients were diagnosed with SIH between March 2010 and April 2014 in our hospital, Based on the International Classification of Headache Disorders,2nd edition (ICHD-2), criteria,of a total of 158 patients with SIH were diagnosed. Two experienced neuroradiologists retrospectively reviewed images of 24 patients togther. To assess the GdM security in outpatient department. The study protocol was approved by the Institutional Review Board of Sir Run Run Shaw Hospital of Zhejiang University School of Medical, and all patients gave written informed consent before entering the study.2. A comparison of spinal MR myelography and Gadolinium MR myelography in localizing spinal CSF leaks in patients with spontaneous intracranial hypotension.Retrospective analysis of imaging findings in 158 cases with SIH, including 24 cases MRM was performed first, followed by GdM, GdM was performed within a week. Evaluated CSF leaks along the nerve roots, morphological abnormalities of nerve root and abnormal CSF collections, Comparisons of these three findings between the two methods were made by McNemar statistics and Kappa test statisticsResults:1. The imaging findings and the security of GdM in detecting spinal CSF leaks of SIH.1.1.Morphological abnormalities of nerve root:In detecting of a total of 1104 nerve roots of the 24 cases, GdM show 176 morphological abnormalities of nerve roots.The finding including inflated nerve root and extended nerve root and brush-like nerve root and diverticulum of nerve root.1.2.CSF leaks along nerve roots:CSF leaks along nerve roots were identified in 15 patients on GdM.The leaks usually located in juncture of the cervical and thoracic.1.3 Nearby CSF collections:GdM detected 19 nearby CSF collections, which located in epidural space in the spinaland in bony rims of the spines and intervertebral foramina and Cl-2 retrospinal.abnormal CSF collections in bony rims of the ribs and spines.1.4 Removed CSF collections:GdM detected 18 removed CSF collections,which located in bony rims of the ribs and apex puplmonis and musculi psoas major1.5. The security of GdM in detecting spinal CSF leaks of SIH:Nobody occurred complication about GdM in 24 patients.2. A comparison of spinal MR myelography and Gadolinium MR myelography in localizing spinal CSF leaks in patients with spontaneous intracranial hypotension.2.1.In detecting of spinal CSF leaks along nerve of the 24 cases, CSF leaks along nerve roots were identified in 15 patients on MRM and GdM, both GdM and MRM failed to detect CSF leaks along the nerve for 5 cases; CSF leaks along the nerve roots were identified in 4 patients not on MRM but on GdM.67 lesions and 55 lesions of CSF leaks along the nerve roots were respectively detected by GdM and MRM,compared with MRM, GdM identified more 12 CSF leaks along nerve, and GdM was more sensitive in the detection rates of CSF leaks along nerve (P<0.05), MRM and GdM in detecting CSF leaks for patients with SIH have good consistency (Kappa=0.837, P=0.001).2.2.176 lesions and 163 lesions of morphological abnormalities of nerve root were respectively detected by GdM and MRM.In detecting of morphological abnormalities of nerve root of the 24 cases, GdM identified more 13 morphological abnormalities of nerve root, and GdM was more sensitive in the detection rates of morphological abnormalities of nerve root(P<0.05).2.3.6 lesions and 14 lesions of abnormal CSF collections in bony rims of spines were respectively detected by GdM and MRM; 12 lesions and 28 lesions of abnormal CSF collections in bony rims of the ribs were respectively detected by GdM and MRM; Compared with GdM, MRM is more sensitive with the detection of abnormal CSF collections in bony rims of the ribs and spines (P<0.05).11 lesions and 10 lesions of CSF collections of epidural space in the spinal were respectively detected by GdM and MRM; 1 lesions and 3 lesions of CSF collections of C1-2 retrospinal were respectively detected by GdM and MRM; No statistically significant differences between MRM and GdM in detecting CSF collections of epidural space in the spinal and Cl-2 retrospinal (p>0.05).2.4.19 SIH patients with targeted EBP who were detected leaks were guided according to MRM and GdM detected the location of the leaks,and obtained clinincal recovery.Conclusion:1. The direct signs of spinal CSF leaks of SIH included CSF along the nerve roots. The indirect signs of spinal CSF leaks of SIH included morphological abnormalities of nerve root and abnormal CSF collections. The leaks usually located in juncture of the cervical and thoracic, next is lumbar.2. MRM and GdM have their respective advantages in detecting spinal CSF leaks along the nerve roots and morphological abnormalities of nerve root and abnormal CSF collections.3. MRM combined GdM can provide more abundant information in localizing spinal CSF leaks for patients with SIH.4. Patients with targeted EBP who were detected leaks were guided, which based on MRM and GdM detected the location of the leaks,obtained clinincal recovery.