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Headache. 2017 Jun;57(6):917-925. doi: 10.1111/head.13075. Epub 2017 Apr 16.

Dinosaur Tail Sign: A Useful Spinal MRI Finding Indicative of Cerebrospinal Fluid Leakage.

Author information

1
Department of Diagnostic Radiology, Tokyo Metropolitan Medical Center of Gerontology, Tokyo, Japan.
2
Department of Diagnostic Radiology, Yamagata University Faculty of Medicine, Yamagata, Japan.
3
Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
4
Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
5
Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
6
Nishio Clinic, Nakatsugawa, Japan.

Abstract

OBJECTIVE:

To evaluate the imaging characteristics and diagnostic utility of the "Dinosaur tail sign" in the diagnosis of cerebrospinal fluid (CSF) leakage.

BACKGROUND:

The authors propose the "Dinosaur tail sign," defined as a combination of the dorsal epidural hyperintensities, fat tissue, spinal cord, and cauda equine on lumbosacral sagittal fat-suppressed T2-weighted image (FST2WI), as a sensitive indicator for diagnosing CSF leakage.

METHODS:

Imaging characteristics of the "Dinosaur tail sign" was evaluated in seven spontaneous intracranial hypotension (SIH) and 23 iatrogenic CSF leakage (ICSFL) patients. Additionally, the diagnostic index was compared between the "Dinosaur tail sign" and other previously reported useful magnetic resonance imaging (MRI) and magnetic resonance myelography (MRM) findings.

RESULTS:

In contrast to other imaging findings including the epidural expansion, floating dural sac sign, and distension of the spinal epidural veins on MRI, and paraspinal fluid collections (PFC) on MRM, the "Dinosaur tail sign" was found equally in both SIH and ICSFL patients (6 SIH and 19 ICSFL; 83% of all patients with CSF leakage). The "Dinosaur tail sign" showed sufficient diagnostic utility (sensitivity 83%, specificity 94%, accuracy 89%) that was comparable to that of PFC.

CONCLUSION:

The "Dinosaur tail sign" is a useful imaging finding suggestive of CSF leakage. Evaluation of subtle interspinous arched hyperintensities on spinal MRI is mandatory for the diagnosis of SIH and ICSFL.

KEYWORDS:

cerebrospinal fluid leakage; dinosaur tail sign; fat-suppressed T2-weighted image; spinal magnetic resonance imaging; spontaneous intracranial hypotension

PMID:
28419438
DOI:
10.1111/head.13075
[Indexed for MEDLINE]

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