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AJNR - American Journal of Neuroradiology

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Dynamic CT Myelography: A Technique for Localizing High-Flow Spinal Cerebrospinal Fluid Leaks

Patrick H. Luetmer^a and Bahram Mokri^b

^a Department of Radiology, Mayo Clinic, Rochester, Minnesota
^b Department of Neurology, Mayo Clinic, Rochester, Minnesota

View larger version (140K): [in a new window]   FIG 1. A 47-year-old man with a 4-year history of severe orthostatic headaches and tinnitus had documented low CSF opening pressures. Head MR imaging examinations showed diffuse pachymeningeal enhancement. Selected images from routine CT myelogram at the T5 (A), T6 (B), T7 (C), and T9 (D) interspaces demonstrate diffuse extrathecal contrast material (black arrows). The study lacks the temporal resolution necessary to locate the site of leak.

View larger version (125K): [in a new window]   FIG 2. Axial dynamic CT myelogram at the level of the T7–T8 interspace in the left lateral decubitus (A), right lateral decubitus (B), supine (C), and prone (D) positions demonstrates accumulation of extra-arachnoid contrast material along the ventral right aspect of the thecal sac, which increases in attenuation in the right lateral decubitus positioning (open arrows). The final prone images, which were obtained 30 minutes after injection of contrast, demonstrate dilution of contrast material in the previously unopacified epidural fluid collection and outlines the underlying T7 disk protrusion (black arrow)

View larger version (167K): [in a new window]   FIG 3. Axial dynamic CT myelogram at the level of the C7–T1 interspace in the left lateral decubitus (A), right lateral decubitus (B), supine (C), and prone (D) positions demonstrates accumulation of extra-arachnoid contrast material along the left C8 root sleeve (open arrow). The final prone images, which were obtained 30 minutes after injection of contrast material, demonstrate dilution of contrast material in the previously unopacified epidural fluid collection (black arrow). Additional leaks were located at the level of the right T6 root sleeve and along the ventral aspect of the junction of the right T9 root sleeve and thecal sac (not pictured).