MRI myelography, a feasible alternative to CT for detecting CSF leaks: Study

USA: MRI myelography is a less invasive way for detection of cerebrospinal fluid (CSF) leaks in spontaneous intracranial hypotension patients compared to the CT version of the same exam, finds a recent study. Also, MRI myelography performed comparably to the CT version. The study is published as a research letter in JAMA Neurology.

According to a team of researchers led by Angelique Sao-Mai Sy Tay, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, and colleagues, the results could help clinicians expand their toolkit for patients suffering from this condition. 

The authors wrote that "Eliminating radiation exposure, obviating the need for lumbar puncture and intrathecal contrast injection, and decreasing resource utilization and cost are among the most important advantages of MRM [MRI myelography] over CTM [CT myelography]."

Spontaneous intracranial hypotension (SIH) is an important cause of headaches. For initial evaluation of patients with suspected SIH, post-myelography computed tomography (CT myelography or CTM) has long been considered the gold standard for the detection of cerebrospinal fluid (CSF) leaks, but spine magnetic resonance imaging including heavily T2-weighted magnetic resonance myelography (MRM) may be a noninvasive alternative. 

The researchers aimed to compare the diagnostic accuracy of MRM with CTM for the identification of spinal CSF leaks. 

The study included 576 patients who underwent MR myelography and CT myelography exams. Of these, 276 (47.9%) were diagnosed with CSF leaks on both CT and MR myelography.

The results indicate MRI myelography could be a feasible alternative to CT. 

"MRM may be a suitable alternative to CTM for the initial evaluation of patients with spontaneous intracranial hypotension," the authors concluded.

Reference:

The study titled, "Computed Tomography vs Heavily T2-Weighted Magnetic Resonance Myelography for the Initial Evaluation of Patients With Spontaneous Intracranial Hypotension," is published in JAMA Neurology. 

DOI:https://jamanetwork.com/journals/jamaneurology/article-abstract/2783666