J Korean Neurosurg Soc.  2022 Jan;65(1):13-21. 10.3340/jkns.2020.0326.

Heavily T2-Weighted Magnetic Resonance Myelography as a Safe Cerebrospinal Fluid Leakage Detection Modality for Nontraumatic Subdural Hematoma

• An S
• Jeong HG
• Seo D
• Jo H
• Lee SU
• Bang JS
• Oh CW
• Kim T

• KMID: 2523909
• DOI: http://doi.org/10.3340/jkns.2020.0326

Abstract

Objective
: Nontraumatic subdural hematoma (SDH) is a common disease, and spinal cerebrospinal fluid (CSF) leakage is a possible etiology of unknown significance, which is commonly investigated by several invasive studies. This study demonstrates that heavily T2-weighted magnetic resonance myelography (HT2W-MRM) is a safe and clinically effective imaging modality for detecting CSF leakage in patients with nontraumatic SDH.
Methods
: All patients who underwent HT2W-MRM for nontraumatic SDH workup at our institution were searched and enrolled in this study. Several parameters were measured and analyzed, including patient demographic data, initial modified Rankin Scale (mRS) score upon presentation, SDH bilaterality, hematoma thickness upon presentation, CSF leakage sites, treatment modalities, followup hematoma thickness, and follow-up mRS score.
Results
: Forty patients were identified, of which 22 (55.0%) had CSF leakage at various spinal locations. Five patients (12.5%) showed no change in mRS score, whereas the remaining (87.5%) showed decreases in follow-up mRS scores. In terms of the overall hematoma thickness, four patients (10.0%) showed increased thickness, two (5.0%) showed no change, 32 (80.0%) showed decreased thickness, and two (5.0%) did not undergo follow-up imaging for hematoma thickness measurement.
Conclusion
: HT2W-MRM is not only safe but also clinically effective as a primary diagnostic imaging modality to investigate CSF leakage in patients with nontraumatic SDH. Moreover, this study suggests that CSF leakage is a common etiology for nontraumatic SDH, which warrants changes in the diagnosis and treatment strategies.

Keyword

Hematoma, subdural; Cerebrospinal fluid leak; Intracranial hypotension; Myelography; Magnetic resonance image; Blood patch, epidural

Figure

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  Fig. 1. Patient selection and subgrouping flowchart. Number inside bracket represents patient count. HT2W-MRM : heavily T2-weighted magnetic resonance myelography, SDH : subdural hematoma, CSF : cerebrospinal fluid, Op : hematoma removal operation, EBP : epidural blood patch, Embo : middle meningeal artery embolization.

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  Fig. 2. A-C : Stacked bar chart for mRS grade change from initial presentation to the latest follow up visit within 6 months. Graph legend on the right side indicates bar colors assigned to each mRS grades. Each number at the center of the bar indicates patient count for specific mRS grades. mRS : modified Rankin Scale.

Reference

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