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Neurology. 2013 Nov 12;81(20):1789-92. doi: 10.1212/01.wnl.0000435555.13695.22. Epub 2013 Oct 9.

Sensitivity of MRI of the spine compared with CT myelography in orthostatic headache with CSF leak.

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From the Departments of Neurology (A.S., R.H., B.B.V., E.H., D.D.), Radiology (J.M.H.), and Anesthesiology (T.T.), Mayo Clinic, Phoenix; and Arizona State University (F.H.), Tempe, AZ.



To investigate the sensitivity of MRI of the spine compared with CT myelography (CTM) in detecting CSF leaks.


Between July 1998 and October 2010, 12 patients with orthostatic headache and a CTM-confirmed spinal CSF leak underwent an MRI of the spine with and without contrast. Using CTM as the gold standard, we retrospectively investigated the sensitivity of spinal MRI in detecting a CSF leak.


Eleven of 12 patients with a CSF leak documented by CTM also had extradural fluid collections on spinal MRI (sensitivity 91.7%). Six patients with extradural fluid collections on spinal MRI also had spinal dural enhancement.


When compared with the gold standard of CTM, MRI of the spine appears to be a sensitive and less invasive imaging modality for detecting a spinal CSF leak, suggesting that MRI of the spine should be the imaging modality of first choice for the detection of spinal CSF leaks.

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