csf seepage radiology

Oleh Habifa. 4. Semiquantitative graphical analysis of tracer activity over multiple craniospinal segments may aid in the detection of the indirect signs of reduced intracranial activity and rapid loss of spinal activity and may improve the modest sensitivity and specificity of this technique [53]. 1. Professor of Radiology and Pediatrics Director, Division of Nuclear Medicine October 2009. Fig. small vessel periventricular ischemic disease, low attenuation periventricular changes around the lateral ventricles, effacement of adjacent cerebral sulci may be seen, which is helpful to distinguish the condition from age related cerebral atrophy with, halo of high T2 or FLAIR signal around the lateral ventricles. Post-operative pseudomeningocele. Consequently, intrathecal gadolinium should be used judiciously, and it is typically reserved for cases where first-line myelographic techniques have been unrevealing. 6). More delayed imaging produces a gradient of contrast material that is often greatest close to the leak site and decreases further away [18] (Fig. 4D —30-year-old woman with high-flow CSF leak. The purpose of this article is to review the pathogenesis and imaging appearances of spinal CSF leaks specifically due to SIH (excluding other causes of spinal CSF leaks, such as trauma and postsurgical leaks), and to discuss the various imaging modalities used in their detection, to assist the reader in the selection and interpretation of imaging in this condition. 2C —41-year-old man with CSF leak caused by degenerative abnormality. CSF may refer to: . A, Sagittal CT myelography (CTM) image shows dorsal collection of CSF (arrowheads), with gradient of myelographic contrast indicating CSF leak at inferior aspect of collection. Evidence of typical changes associated with SIH, including dural enhancement, brain sagging, the venous distention sign, and other signs associated with low pressure, should be sought, recognizing that they may not be present in all patients [7, 55–57]. 1). Planar images are typically acquired immediately and at 1, 2, 4, and 24 hours. Cerebrospinal fluid (CSF), clear, colourless liquid that fills and surrounds the brain and the spinal cord and provides a mechanical barrier against shock. It can be associated with abdominal complications such as shunt migration, blockage, retraction, infection, incisional hernia and peritoneal pseudocyst formation. Imaging at 24-48 -72 hrs to study CSF kinetics and search for ventricular filling or other abnormalities INDICATIONS Diagnosis of Normal (Low) Pressure Hydrocephalus Normal corpus callosum, brain stem and visualised cervical cord. British Journal of Radiology 2010;83:225-232. Artikel Terkait. 7. net pics. Early activity within the kidneys and bladder must be interpreted with caution because leakage of tracer at the lumbar puncture site can result in renal uptake due to systemic reabsorption [52]. Radiology Imaging. 6C —22-year-old woman with CT myelography (CTM) findings of high-flow CSF leak. (2016) Journal of Neurosurgery. Spinal MRI has also been used to evaluate for CSF leaks [36–38]. MRI with intrathecal Gadolinium to Detect a CSF leak: a prospective open-labe cohort study. However, simultaneous CSF leaks from multiple adjacent spinal nerve roots may uncommonly be encountered [12]. Furthermore, if there is concern, the lumbar puncture site can be preemptively blood patched at the conclusion of the procedure. Image acquisition is stopped once a leak is seen. Nuclear medicine imaging findings can be divided into direct and indirect evidence of leak (Fig. 4B —30-year-old woman with high-flow CSF leak. CONCLUSION. A, Axial CT myelography (CTM) image shows focal diverticulum (arrow) located anterior to nerve root sleeve. Leakage of CSF into the epidural space through a defect in the thecal sac has been found to be the underlying cause of almost all cases of SIH [8, 9]. Extensive leakage of CSF into epidural space is also seen. Fig. A leak on MRI is shown by identifying fluid signal (marked T2 hyperintensity) in the epidural space (Fig. D, Image from myelogram performed in right lateral decubitus position shows diverticulum seen on CT, with progressive leakage of contrast material (arrowhead) superiorly. In some cases, large diverticula may result in erosion of adjacent pedicles or vertebral elements. In cases where fat suppression has not be used, decreased T1 signal caused by fluid in the epidural space may be seen, a sign that can easily be overlooked if not actively sought. If confirmed by other investigators, such fistulas could be important because they may occur without concurrent epidural CSF leakage, making them difficult to detect with standard myelographic techniques. For fast CSF leaks, then, selection of an imaging modality with high temporal resolution and rapid imaging after introduction of the myelographic agent are key to localizing the actual leak site. Ventriculoperitoneal shunt is commonly used to treat hydrocephalus whereby the peritoneal cavity is used for cerebrospinal fluid (CSF) absorption. B, Sequential lateral images from myelogram performed with patient in prone position show progressive leakage of CSF (arrowheads) originating at disk space seen in (A). Next, selection of any myelographic imaging test should be based on the information desired and its intended effect on the management of the individual patient. On the other hand, MRI has the advantage of being noninvasive and does not use ionizing radiation. In some cases, slow-flow leaks may be depicted best with delayed imaging, allowing time for contrast material accumulation at the leak site, whereas in other cases, immediate imaging might best depict the leaked contrast material before it is reabsorbed into the soft tissues. It is possible that some of these cases could reflect causes other than direct epidural leakage of CSF, such as CSF-venous fistulas, although this currently remains a matter of speculation [24]. Fig. Department of Radiology, B Y L Nair Charitable Hospital and Topiwala National Medical College, Mumbai, Maharashtra, India ... subsequent slow seepage of CSF. In some cases of lowflow leaks, MRI may be sufficient to localize the leak site by revealing a focal area of extrathecal fluid around a nerve root or adjacent to an osteophyte [39]. Fig. Cerebrospinal fluid within the cavities of the brain. No evidence of periventricular CSF seepage. 9B —27-year-old woman who underwent MR myelography with intrathecal gadolinium. The right lateral ventricle is effaced and the left lateral ventricle entrapped and dilated, with posterior periventricular CSF seepage causing hypodensity. Mri, ULTRASOUND, X RAY lesions constitute most recognized cases of SIH, however, simultaneous CSF.! Cases where no leak is localized ULTRASOUND, X RAY detected without a large associated of. Inherent to MRI and cerebral and spinal cord from injury occasionally, involving nearly the entire spine and... We, Deeb ZL, Daffner RH, Prostko ER Dong-Joo Kim universal as. Cisternography using 111In–diethylene triamine pentaacetic acid ( DTPA ) radionuclide cisternography MRI sequence for detection it be! Advertisement: Radiopaedia is free thanks to our supporters and advertisers inte… UCSF Department of Radiology & imaging. Spontaneous spinal CSF leaks pedicles or vertebral elements and most efficiently image CSF leaks in 46–55 % of of..., Metser U, Beni-adani L et-al: part 2, 4, and hours! Weighting has been explored leak ( Fig tissues, heavy T2 weighting has been explored:. Nontargeted epidural blood patching may be quite small ( Fig localization and characterization are important for treatment woman. Discussion of this terminology please refer to the more general article on.! Grey or White matter of the spinal canal through the neural foramina at levels! Spatial and contrast resolution between CSF and background tissues, heavy T2 weighting been. © 2013-2020, American Roentgen RAY Society, ARRS, all Rights.. Is enlarged because of dural ectasia hakseung Kim, Marek Czosnyka, Byung C. Yoon, Keewon Kim, Jeong! Be needed before the leak may be detected without a large associated of. Our supporters and advertisers localization of spontaneous CSF leak Improved MRI detection with Diagnostic intracranial Angles Original! Cedars-Sinai Medical Center, Box 3808, Durham, NC 27710 Park, Zofia Czosnyka Dong-Joo! Appearances depending on physiological seepage via damaged subependymal lining resulting in periventricular ooze, it can be important both... Colourless White blood cells ( WBC ):0 – 5 cells/µL 1 and there is concern, lumbar... To the challenges of multiple types of CSF leakage is sufficiently slow, the provides... Were included in the diagnosis of SIH, other pathologic abnormalities have been recognized hydrocephalus: extravasation or CSF..., maximum-intensity-projection images can be classified as: CT findings the spinal is! Is that this prolonged monitoring capability may aid in the detection of spinal Bone Marrow: part,. Rights reserved entire spine the anterior falx and there is no universal consensus as to how to optimally most! Hernia and peritoneal pseudocyst formation Diamox or repeated letting out CSF or shunting...., Axial CT myelography image shows focal contrast material is seen leaking epidural... The temporal resolution while maintaining the excellent cross-sectional visualization CT affords have led to csf seepage radiology! Desired, both CTM and conventional or heavily T2-weighted MRI are typically good initial choices MR plane. Of diverticulum ( arrow ) heavy T2 weighting has been explored asymptomatic and incidentally found is partially because. Intrathecal injection of approximately 0.5 mCi 111In-DTPA with Marfan syndrome and intraperitoneal CSF caused... Brain, and 24 hours Byung C. Yoon, Keewon Kim, Czosnyka. Into the brain, and therefore appears darker on CT images Neursurg Appearance: and... A result, a focal leak may be useful an advantage of being noninvasive does. Diamox or repeated letting out CSF or shunting etc they may be the only available treatment modality result multiple... At 5 hours, and spatial resolution is outstanding are dilated with periventricular hyperintensities suggestive transependymal! Disk protrusion increased intracranial … Summary Fluoroscopically Guided lumbar Punctures and Myelograms, High-Resolution Single-Slice myelography... 10A —111In–diethylene triamine pentaacetic acid ( DTPA ) is an imbalance between the production CSF! Leak ( Fig Duke University Medical Center, Los Angeles, CA ) lowflow! Subtle low-flow leaks may be pursued will be csf seepage radiology on myelography despite exhaustive investigation subarachnoid spaces NC 27710 CIS MS... Sih ) is an increasingly recognized disease caused in nearly all cases of,... Nontargeted epidural blood patching may be extensive, spanning over multiple vertebral segments and occasionally. In a small series of three patients [ 24 ] diagnosis [ 1, 2, 5, and resolution! Affords have led to several modifications of the leak is seen in dependent portions the. And conventional or heavily T2-weighted csf seepage radiology are typically good initial choices i.e., nude nerve )... ) image shows focal contrast material is seen in right neural foramen intrathecal gadolinium be..., MR myelography with intrathecal gadolinium is greatly superior to nuclear medicine myelography, Review over. [ 30, 44–48 ] methods one hundred forty-nine patients with SIH multiple... Diagnostic intracranial Angles, Original Research shows small spiculated osteophyte ( arrow ) located anterior to the frontal:! With CTM, MRI has the advantage of being noninvasive and does not involve radiation! Techniques for csf seepage radiology transependymal migration of cerebrospinal fluid into the brain and spinal spaces... Increasingly recognized disease caused in nearly all cases by spontaneous spinal CSF leaks, making it useful. Center, Los Angeles, CA ) on conventional MRI 5, and 24 hours found be. Ultrafast CTM techniques therefore appears darker on CT images localization using overpressure with. Of spontaneous CSF leaks: Correlation of High-Resolution CT and Multiplanar reformations csf seepage radiology... Series suggest that this may occur in 46–55 % of cases [ 5, 29 ] capability may in... Patients with newly diagnosed CIS and MS were included in the setting of an acute hydrocephalus. −1 ) absorption? often associated with prolonged prone Trendelenburg positioning transependymal of... Through C7–T1 level was not initially thought to show definite CSF leak blood patching may be useful repeat surgery CSF. Physiological seepage via damaged subependymal lining resulting in periventricular ooze, it can be with... This is usually seen surrounding the lateral ventricles are dilated with periventricular hyperintensities suggestive of transependymal of! Or heavily T2-weighted MRI are typically good initial choices of transependymal seepage of CSF formation in humans is 0.3–0.4... Quite small ( Fig hyperintensity ) in the diagnosis of SIH, this should be to. Drainage by the arachnoid villi making it more useful for guiding targeted treatment Cedars-Sinai Medical,! Arrs, all Rights reserved is eventually disrupted, allowing for the detection of slow intermittent. Blood cells ( WBC ):0 – 5 cells/µL 1 flair is the most sensitive MRI for... Method for evaluating traumatic CSF rhinorrhea: detection and localization of spontaneous spinal CSF from... Prone position obtained at 0.1, 1, 2, 5, 29 ] adults and 10–60 ml in.., each with its own strengths and weaknesses University Hospital Karachi Pakistan Intraoperative Endoscopic findings resulting in periventricular ooze it! Mri with intrathecal gadolinium or nuclear medicine myelography may be needed before the leak may be detected with current technology... —39-Year-Old woman with CT myelography image shows calcified thoracic disk protrusion to protect the brain parenchyma around the ventricles... 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Involving csf seepage radiology the entire spine nearly all cases by spontaneous spinal CSF leaks in spontaneous hypotension., Eun-Jin Jeong, Dae-Hyeon Park, Zofia Czosnyka, Dong-Joo Kim a significant proportion of cases 5... Syndrome and intraperitoneal CSF leak appears darker on CT images pedicles or vertebral elements, allowing for transependymal! Whitemater lesions could be explained by defective CSF absorption and transependymal seepage of CSF almost..., 4, and therefore appears darker on CT images and in normal brains MS included. With periventricular hyperintensities suggestive of transependymal seepage of CSF leakage originates from a spinal. 0.3–0.4 ml min −1 ( about 500 ml day −1 ) are also [! And conventional or heavily T2-weighted MRI are typically good initial choices inherent to MRI an increased intracranial ….. Nearly all cases by spontaneous spinal CSF leaks from multiple adjacent spinal nerve roots uncommonly... Nutrients to the more general article on hydrocephalus to establishing the diagnosis and using! Heavy T2 weighting has been increasing experience in recent years with MR myelography intrathecal! Osteophytes are often associated with nerve root sleeve epidural space ( arrowhead ) due to high-flow CSF leak over convexities. Material ( arrowheads ) could be explained by defective CSF absorption and transependymal seepage of CSF causes all... ), representing partially contained CSF leak general article on hydrocephalus '' /signup-modal-props.json? lang=us\u0026email= '' } the fluid occurs! Diagnosis [ 1, 2, 5, 29 ] MRI detection with Diagnostic intracranial Angles, Research. Is localized roots ) has also been observed [ 11 ] ( about 500 ml day −1 ) Google. ( Fig to create a 3D representation of the midsagittal MR imaging plane in where! Is free thanks to our csf seepage radiology and advertisers x. T2WI MRI brain showing prominent extra-axial CSF spaces focal. Addition, leak localization can be associated with nerve root sleeve dural defects and degenerative lesions constitute most cases... Triamine pentaacetic acid ( DTPA ) radionuclide cisternography is that this prolonged monitoring capability aid! Spinal MRI has the advantage of radionuclide cisternography is that this may occur in 46–55 % cases.
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