Mesoscale CISS Imaging for the Detection of Dural Defects in Spinal CSF Leaks
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Background and Purpose
Spontaneous intracranial hypotension (SIH) is most often attributable to cerebrospinal fluid (CSF) leaks from the spinal canal, yet precise localization of dural defects remains challenging. While fat-saturated heavily T2-weighted MR myelography (HT2-MRM) is sensitive to spinal longitudinal extradural CSF collections (SLECs), it does not reliably localize the leak site. This study evaluates a two-stage spine MRI protocol incorporating high resolution, mesoscale 3D constructive interference in steady state (meso-CISS) for targeted CSF leak localization.
Materials and Methods
Twenty consecutive patients with suspected SIH underwent a standardized total spine MRI protocol, including 3D HT2-MRM for SLEC screening. In cases with positive SLEC or indeterminate findings, meso-CISS was performed for targeted high-resolution leak localization.
Results
Eight patients (40%) demonstrated SLECs on HT2-MRM, prompting further evaluation with meso-CISS. Dural defects were successfully identified in five patients (1.5-8 mm in size). In one case, meso-CISS delineated intrathecal protrusion of ligamentum flavum calcification, suggesting an underlying defect. Compared with HT2-MRM, meso-CISS provided superior visualization of dural defects, arachnoid scarring, and neo-membrane formation. Two cases were limited by motion or metal artifacts.
Conclusion
A two-stage spine MRI protocol incorporating HT2-MRM and meso-CISS improves the localization of dural defects in SIH. Meso-CISS enhances visualization of small dural tears and associated pathology, facilitating targeted interventions and potentially reducing reliance on invasive myelography. Further studies are warranted to assess its broader clinical impact.
