Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • ASNR Foundation Special Collection
    • Most Impactful AJNR Articles
    • Photon-Counting CT
    • Spinal CSF Leak Articles (Jan 2020-June 2024)
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home

User menu

  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

ASHNR American Society of Functional Neuroradiology ASHNR American Society of Pediatric Neuroradiology ASSR
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • ASNR Foundation Special Collection
    • Most Impactful AJNR Articles
    • Photon-Counting CT
    • Spinal CSF Leak Articles (Jan 2020-June 2024)
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds

AJNR is seeking candidates for the AJNR Podcast Editor. Read the position description.

Research ArticleSpine

MR Myelography for the Detection of CSF-Venous Fistulas

J.L. Chazen, M.S. Robbins, S.B. Strauss, A.D. Schweitzer and J.P. Greenfield
American Journal of Neuroradiology May 2020, 41 (5) 938-940; DOI: https://doi.org/10.3174/ajnr.A6521
J.L. Chazen
aFrom the Departments of Radiology (J.L.C., S.B.S., A.D.S.),
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for J.L. Chazen
M.S. Robbins
bNeurology (M.S.R.),
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for M.S. Robbins
S.B. Strauss
aFrom the Departments of Radiology (J.L.C., S.B.S., A.D.S.),
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for S.B. Strauss
A.D. Schweitzer
aFrom the Departments of Radiology (J.L.C., S.B.S., A.D.S.),
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for A.D. Schweitzer
J.P. Greenfield
cNeurological Surgery (J.P.G.), Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for J.P. Greenfield
  • Article
  • Figures & Data
  • Supplemental
  • Info & Metrics
  • Responses
  • References
  • PDF
Loading

Abstract

SUMMARY: CSF-venous fistula is an important treatable cause of spontaneous intracranial hypotension that is often difficult to detect using traditional imaging techniques. Herein, we describe the technical aspects and diagnostic performance of MR myelography when used for identifying CSF-venous fistulas. We report 3 cases in which the CSF-venous fistula was occult on CT myelography but readily detected using MR myelography.

ABBREVIATIONS:

CVF
CSF-venous fistula
SIH
spontaneous intracranial hypotension
VIBE
volumetric interpolated brain examination

CSF-venous fistula (CVF) is an important cause of spontaneous intracranial hypotension (SIH) and a critical diagnosis because treatment can result in a clinical cure.1-5 The fistulous connection is typically associated with a nerve root sleeve diverticulum; therefore, a detectable epidural fluid collection is often absent. Some authors advocate decubitus CT myelography to improve CVF detection,1,2,6 while others suggest that digital subtraction myelography may increase rates of fistula identification.7,8 We report surgically confirmed cases of CVF that were identified using MR myelography following the intrathecal administration of gadolinium.

MR Myelography Technique

Intrathecal gadolinium was instilled in the subarachnoid space via CT-guided lumbar puncture using a Gertie Marx Whitacre-style spinal needle (IMD). The opening pressure was measured and recorded, and 0.5 mL of gadobutrol (Gadavist; Bayer Schering Pharma) mixed with 4.5 mL of iohexol (Omnipaque 180; GE Healthcare) was intrathecally administered. After a 1-mL test injection, CT imaging confirmed intrathecal contrast, and 5 mL was instilled before the needle was removed with the stylet in place. The patient was positioned in a decubitus Trendelenberg position and rolled multiple times to disperse contrast throughout the subarachnoid space. The patient was then transferred to the MR imaging suite where MR myelography was performed on a 3T Biograph mMR scanner (Siemens) using multiplanar fat-suppressed T1 sequences (On-line Table). Imaging was reviewed in real time, and delayed thin-section axial sequences were acquired as needed. MR imaging was completed approximately 1 hour after intrathecal gadolinium administration.

Cases

Case 1.

A 26-year-old woman with a 3-year history of orthostatic headaches after a spontaneous onset had brain MR imaging findings characteristic of SIH, including sagging, pituitary enlargement, venous distention, small subdural collections, and pachymeningeal enhancement. A CT myelogram was unrevealing for CSF leak, and 3 epidural blood patches were unsuccessful. She subsequently developed upper extremity pain and paresthesias, leading to the discovery of a large cervicothoracic syrinx on cervical spine MR imaging (Fig 1). She was treated with a posterior fossa decompression to improve craniocervical CSF flow but obtained neither symptom nor imaging improvement. Eventually, she underwent MR myelography with an opening pressure of <4 cm H2O and was discovered to have a prominent left T7–T8 spinal meningeal diverticulum fistulizing to a left paraspinous vein draining into the azygous system. She also had early contrast opacification of her renal collecting system on the MR myelography completed approximately 1 hour after intrathecal contrast injection (Fig 2). The patient was offered and accepted surgical CVF ligation at T7–T8. The diverticulum was identified with dilated draining veins, and the entire nerve root complex with the CVF was interrupted with an aneurysm clip and silk suture (On-line Fig 1). The patient experienced an immediate improvement in symptoms followed by a transient new headache and sixth-nerve palsy 3 days following the operation. This was presumed to be secondary to transient rebound intracranial hypertension, and her symptoms slowly resolved. Eight months postoperatively, she is without headaches, and follow-up MR imaging revealed both a dramatic resolution of brain sagging and near-complete resolution of the spinal cord syrinx (Fig 1).

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

Sagittal T1 brain (A–C) and sagittal T2-weighted cervical spine (D–F) imaging. Initial MR imaging from June 2016 (A and D) shows classic intracranial findings of SIH with low-lying cerebellar tonsils, effacement of the prepontine cistern, enlarged pituitary, and brain stem sagging. Spine imaging findings are normal. Follow-up MRIs from June 2018 (B and E) show similar brain findings with interval development of a large cervicothoracic syrinx. Postoperative MRIs from June 2019 (C and F) reveal complete resolution of intracranial SIH sequelae, with a normal position of the cerebellar tonsils and resolution of spinal syrinx.

Fig 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 2.

MR myelogram axial T1 VIBE (A) demonstrates early contrast opacification of the renal collecting system (dashed circles). CT myelogram (B) demonstrates an irregular left T7–T8 perineural cyst without evidence of an opacifying paraspinal vein. No renal contrast excretion was identified on CT myelography. MR myelogram axial T1 VIBE (C) shows a spinal meningeal diverticulum with an opacifying paraspinal vein (arrows) draining into the azygous system, consistent with a CSF-venous fistula.

Case 2.

A 64-year-old man presented with a 9-month history of orthostatic headache, distorted hearing, and tinnitus with onset during Valsalva exacerbated by severe constipation. Brain imaging demonstrated a venous distention sign without other intracranial sequelae of SIH. Standard CT myelography could not identify a CSF leak, and multiple epidural blood patches were unsuccessful. An MR myelogram with an opening pressure of 9 cm H2O revealed a left T8–T9 spinal meningeal diverticulum and adjacent opacification of a paraspinous vein (Fig 3). Small-volume contrast was also seen in the renal collecting systems. The patient was offered and accepted surgical CVF ligation at T8–T9. The diverticulum was identified with dilated draining veins, and the entire nerve root complex with the CVF was interrupted with an aneurysm clip and silk suture. The patient experienced marked symptomatic improvement with resolution of headache and tinnitus, sustained at the most recent 4-month follow-up visit.

Fig 3.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 3.

CT and MR myelogram images from case 2. A, CT myelogram reveals perineural cysts at T8–T9 without opacification of the left-sided cyst. B, MR myelogram axial T1 VIBE demonstrates opacification of the left-sided spinal meningeal diverticulum and left paraspinal vein draining into the azygous system (arrows), consistent with a CSF-venous fistula.

Case 3.

A 53-year-old woman presented with a 2-year history of spontaneous-onset orthostatic headache and neck pressure. Brain imaging findings were suspicious for SIH with sagging, pituitary enlargement, venous distention, small subdural collections, and pachymeningeal enhancement. A CT myelogram revealed multiple spinal meningeal diverticula and Tarlov cysts without evidence of spinal fluid leak, and the patient received multiple epidural blood patches with only transient improvement of symptoms. An MR myelogram with an opening pressure of <4 cm H2O revealed a left T9–T10 spinal meningeal diverticulum and an opacified left paraspinous vein (On-line Fig 2). The patient was offered and accepted surgical CVF ligation at T9–T10. The diverticulum was identified with dilated draining veins, and the entire nerve root complex with the CVF was interrupted with an aneurysm clip and silk suture. The patient reported an immediate improvement in symptoms with return to baseline and resolution of headache, sustained for 7 months at the most recent follow-up visit.

DISCUSSION

CSF-venous fistulas are an under-recognized cause of SIH. Improved detection using advanced imaging techniques may increase our sensitivity in detecting CSF leaks. CT myelography may detect CVF, and the technique can be augmented with decubitus positioning and provocative maneuvers to increase CSF pressure.5,9 Digital subtraction myelography has also been used to identify CSF-venous fistulas. However, both of these techniques require substantial ionizing radiation exposure to the patient, and the digital subtraction myelography technique is operator-dependent with different techniques described in the literature.7,8 Intrathecal administration of gadolinium is an off-label use in the United States but is well-tolerated and frequently used for clinical and research applications.10,11 However, while no long-term harmful effects from intrathecal gadolinium are known, this has not been extensively studied. Only a macrocyclic gadolinium agent (gadobutrol) was used in this study, which has a weaker association with deposition compared with linear gadolinium agents.12 MR myelography eliminates the ionizing radiation exposure aside from any used for lumbar puncture. Additionally, multiple imaging sequences can be repeated as necessary to confirm a suspected fistula. Furthermore, while the attenuation of intrathecal CT contrast fades rapidly within an hour of intrathecal administration, intrathecal gadolinium maintains robust T1-shortening MR imaging signal for hours after administration. We found the axial T1 fat-suppressed volumetric interpolated brain examination (VIBE) imaging sequences to be particularly helpful. These may help highlight a fistula on MR myelography that may be less apparent on other imaging modalities. The technique is further bolstered by the improved soft-tissue contrast of MR imaging and the prominent signal intensity of gadolinium on fat suppressed T1-weighted images. MR myelography has been shown previously to detect leaking gadolinium from perineural cysts.13

Outstanding questions remain regarding the diagnostic performance of MR myelography and other myelographic techniques in the detection of CVF because no known criterion standard is available. We report 3 patients who had unrevealing CT myelograms in whom CVF was detected on MR myelography, all of whom experienced marked clinical improvement following ligation of the suspected fistula. This report raises important questions for further study regarding the optimal technique for imaging patients with suspected CSF leak.

In conclusion, MR myelography with intrathecal gadolinium may identify CSF-venous fistulas in patients without readily apparent fistulas on CT myelography. Further study is needed to confirm these promising findings.

Footnotes

  • Disclosures: Dr. Chazen—RELATED: Grant: Insightec, Inc., Alzheimer's Drug Discovery Foundation.

References

  1. 1.↵
    1. Kranz PG,
    2. Gray L,
    3. Amrhein TJ
    . Decubitus CT myelography for detecting subtle CSF leaks in spontaneous intracranial hypotension. AJNR Am J Neuroradiol 2019;40:754–56 doi:10.3174/ajnr.A5995 pmid:30819772
    Abstract/FREE Full Text
  2. 2.↵
    1. Kranz PG,
    2. Amrhein TJ,
    3. Gray L
    . CSF venous fistulas in spontaneous intracranial hypotension: imaging characteristics on dynamic and CT myelography. AJR Am J Roentgenol 2017;209:1360–66 doi:10.2214/AJR.17.18351 pmid:29023155
    CrossRefPubMed
  3. 3.
    1. Kumar N,
    2. Diehn FE,
    3. Carr CM, et al
    . Spinal CSF venous fistula: a treatable etiology for CSF leaks in craniospinal hypovolemia. Neurology 2016;86:2310–12 doi:10.1212/WNL.0000000000002776 pmid:27178701
    Abstract/FREE Full Text
  4. 4.
    1. Schievink WI,
    2. Moser FG,
    3. Maya MM
    . CSF-venous fistula in spontaneous intracranial hypotension. Neurology 2014;83:472–73 doi:10.1212/WNL.0000000000000639 pmid:24951475
    Abstract/FREE Full Text
  5. 5.↵
    1. Duvall JR,
    2. Robertson CE,
    3. Cutsforth-Gregory JK, et al
    . Headache due to spontaneous spinal cerebrospinal fluid leak secondary to cerebrospinal fluid-venous fistula: case series. Cephalalgia 2019;39:1847–54 doi:10.1177/0333102419881673 pmid:31597463
    CrossRefPubMed
  6. 6.↵
    1. Kranz PG,
    2. Amrhein TJ,
    3. Schievink WI, et al
    . The “hyperdense paraspinal vein” sign: a marker of CSF-venous fistula. AJNR Am J Neuroradiol 2016;37:1379–81 doi:10.3174/ajnr.A4682 pmid:26869470
    Abstract/FREE Full Text
  7. 7.↵
    1. Schievink WI,
    2. Maya MM,
    3. Moser FG, et al
    . Lateral decubitus digital subtraction myelography to identify spinal CSF-venous fistulas in spontaneous intracranial hypotension. J Neurosurg Spine 2019 Sep 1–4. [Epub ahead of print] doi:10.3171/2019.6.SPINE19487 pmid:31518974
    CrossRefPubMed
  8. 8.↵
    1. Farb RI,
    2. Nicholson PJ,
    3. Peng PW, et al
    . Spontaneous intracranial hypotension: a systematic imaging approach for CSF leak localization and management based on MRI and digital subtraction myelography. AJNR Am J Neuroradiol 2019;40:745–53 doi:10.3174/ajnr.A6016 pmid:30923083
    Abstract/FREE Full Text
  9. 9.↵
    1. Griffin AS,
    2. Lu L,
    3. Peacock S, et al
    . CSF volume provocation maneuvers during lumbar puncture as a possible predictive tool for diagnosing spontaneous intracranial hypotension. Clin Neurol Neurosurg 2019;186:105552 doi:10.1016/j.clineuro.2019.105552 pmid:31639606
    CrossRefPubMed
  10. 10.↵
    1. Dillon WP
    . Intrathecal gadolinium: its time has come? AJNR Am J Neuroradiol 2008;29:3–4 doi:10.3174/ajnr.A0884 pmid:18192343
    FREE Full Text
  11. 11.↵
    1. Akbar JJ,
    2. Luetmer PH,
    3. Schwartz KM, et al
    . The role of MR myelography with intrathecal gadolinium in localization of spinal CSF leaks in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol 2012;33:535–40 doi:10.3174/ajnr.A2815 pmid:22173753
    Abstract/FREE Full Text
  12. 12.↵
    1. Rowe SK,
    2. Rodriguez D,
    3. Cohen E, et al
    . Switching from linear to macrocyclic gadolinium-based contrast agents halts the relative T1-weighted signal increase in deep gray matter of children with brain tumors: a retrospective study. J Magn Reson Imaging 2020;51:288–95 doi:10.1002/jmri.26831 pmid:31165554
    CrossRefPubMed
  13. 13.↵
    1. Chazen JL,
    2. Talbott JF,
    3. Lantos JE, et al
    . MR myelography for identification of spinal CSF leak in spontaneous intracranial hypotension. AJNR Am J Neuroradiol 2014;35:2007–12 doi:10.3174/ajnr.A3975 pmid:24852289
    Abstract/FREE Full Text
  • Received December 25, 2019.
  • Accepted after revision February 29, 2020.
  • © 2020 by American Journal of Neuroradiology
View Abstract
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 41 (5)
American Journal of Neuroradiology
Vol. 41, Issue 5
1 May 2020
  • Table of Contents
  • Index by author
  • Complete Issue (PDF)
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
MR Myelography for the Detection of CSF-Venous Fistulas
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Cite this article
J.L. Chazen, M.S. Robbins, S.B. Strauss, A.D. Schweitzer, J.P. Greenfield
MR Myelography for the Detection of CSF-Venous Fistulas
American Journal of Neuroradiology May 2020, 41 (5) 938-940; DOI: 10.3174/ajnr.A6521

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
0 Responses
Respond to this article
Share
Bookmark this article
MR Myelography for the Detection of CSF-Venous Fistulas
J.L. Chazen, M.S. Robbins, S.B. Strauss, A.D. Schweitzer, J.P. Greenfield
American Journal of Neuroradiology May 2020, 41 (5) 938-940; DOI: 10.3174/ajnr.A6521
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Purchase

Jump to section

  • Article
    • Abstract
    • ABBREVIATIONS:
    • DISCUSSION
    • Footnotes
    • References
  • Figures & Data
  • Supplemental
  • Info & Metrics
  • Responses
  • References
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • Spontaneous Intracranial Hypotension in Children: A Multi-Institutional Review of Spinal CSF Leaks Localized on Advanced Myelography
  • Spinal CSF Leaks: The Neuroradiologist Transforming Care
  • Different Glymphatic Kinetics in Spontaneous Intracranial Hypotension
  • Myelographic Techniques for the Localization of CSF-Venous Fistulas: Updates in 2024
  • Temporal Characteristics of CSF-Venous Fistulas on Digital Subtraction Myelography
  • Resisted Inspiration: A New Technique to Aid in the Detection of CSF-Venous Fistulas
  • Multiple Spinal CSF Leaks in Spontaneous Intracranial Hypotension: Do They Exist?
  • Spinal CSF-Venous Fistulas in Morbidly and Super Obese Patients with Spontaneous Intracranial Hypotension
  • Decubitus CT Myelography for CSF-Venous Fistulas: A Procedural Approach
  • Crossref (31)
  • Google Scholar

This article has been cited by the following articles in journals that are participating in Crossref Cited-by Linking.

  • Spontaneous intracranial hypotension: searching for the CSF leak
    Tomas Dobrocky, Patrick Nicholson, Levin Häni, Pasquale Mordasini, Timo Krings, Waleed Brinjikji, Jeremy K Cutsforth-Gregory, Ralph Schär, Christoph Schankin, Jan Gralla, Vitor M Pereira, Andreas Raabe, Richard Farb, Jürgen Beck, Eike I Piechowiak
    The Lancet Neurology 2022 21 4
  • Spontaneous intracranial hypotension: diagnostic and therapeutic workup
    Niklas Luetzen, Philippe Dovi-Akue, Christian Fung, Juergen Beck, Horst Urbach
    Neuroradiology 2021 63 11
  • Decubitus CT Myelography for CSF-Venous Fistulas: A Procedural Approach
    M.D. Mamlouk, R.P. Ochi, P. Jun, P.Y. Shen
    American Journal of Neuroradiology 2021 42 1
  • Cerebrospinal Fluid-Venous Fistulas: A Systematic Review and Examination of Individual Patient Data
    Nathan A Shlobin, Vinil N Shah, Cynthia T Chin, William P Dillon, Lee A Tan
    Neurosurgery 2021 88 5
  • Multiple Spinal CSF Leaks in Spontaneous Intracranial Hypotension
    Wouter I. Schievink, M. Marcel Maya, Franklin Moser, Ravi Prasad, Vikram Wadhwa, Rachelle Cruz, Miriam Nuño
    Neurology Clinical Practice 2021 11 5
  • Temporal Characteristics of CSF-Venous Fistulas on Digital Subtraction Myelography
    I. Mark, A. Madhavan, M. Oien, J. Verdoorn, J.C. Benson, J. Cutsforth-Gregory, W. Brinjikji, P. Morris
    American Journal of Neuroradiology 2023 44 4
  • Resisted Inspiration: A New Technique to Aid in the Detection of CSF-Venous Fistulas
    I.T. Mark, M.R. Amans, V.N. Shah, K.H. Narsinh, M.T. Caton, S. Teixeira, W.P. Dillon
    American Journal of Neuroradiology 2022 43 10
  • CSF-Venous Fistula
    Michelle Roytman, Gayle Salama, Matthew S. Robbins, J. Levi Chazen
    Current Pain and Headache Reports 2021 25 1
  • Surgical Treatment Efficacy of CSF-Venous Fistulas: Systematic Review
    Anton Konovalov, Vadim Gadzhiagaev, Evgeniy Vinogradov, Nikita Nikitin, Shalva Eliava, Nikolay Konovalov
    World Neurosurgery 2022 161
  • Diagnostic Yield of Intrathecal Gadolinium MR Myelography for CSF Leak Localization
    Ajay A. Madhavan, Carrie M. Carr, John C. Benson, Waleed Brinjikji, Felix E. Diehn, Dong Kun Kim, Vance T. Lehman, Greta B. Liebo, Pearse P. Morris, Darya P. Shlapak, Jared T. Verdoorn, Jonathan M. Morris
    Clinical Neuroradiology 2022 32 2

More in this TOC Section

  • Bern Score Validity for SIH
  • MP2RAGE 7T in MS Lesions of the Cervical Spine
  • Resisted Inspiration for CSF-Venous Fistula
Show more Spine

Similar Articles

Advertisement

Indexed Content

  • Current Issue
  • Accepted Manuscripts
  • Article Preview
  • Past Issues
  • Editorials
  • Editor's Choice
  • Fellows' Journal Club
  • Letters to the Editor
  • Video Articles

Cases

  • Case Collection
  • Archive - Case of the Week
  • Archive - Case of the Month
  • Archive - Classic Case

Special Collections

  • AJNR Awards
  • ASNR Foundation Special Collection
  • Most Impactful AJNR Articles
  • Photon-Counting CT
  • Spinal CSF Leak Articles (Jan 2020-June 2024)

More from AJNR

  • Trainee Corner
  • Imaging Protocols
  • MRI Safety Corner

Multimedia

  • AJNR Podcasts
  • AJNR Scantastics

Resources

  • Turnaround Time
  • Submit a Manuscript
  • Submit a Video Article
  • Submit an eLetter to the Editor/Response
  • Manuscript Submission Guidelines
  • Statistical Tips
  • Fast Publishing of Accepted Manuscripts
  • Graphical Abstract Preparation
  • Imaging Protocol Submission
  • Evidence-Based Medicine Level Guide
  • Publishing Checklists
  • Author Policies
  • Become a Reviewer/Academy of Reviewers
  • News and Updates

About Us

  • About AJNR
  • Editorial Board
  • Editorial Board Alumni
  • Alerts
  • Permissions
  • Not an AJNR Subscriber? Join Now
  • Advertise with Us
  • Librarian Resources
  • Feedback
  • Terms and Conditions
  • AJNR Editorial Board Alumni

American Society of Neuroradiology

  • Not an ASNR Member? Join Now

© 2025 by the American Society of Neuroradiology All rights, including for text and data mining, AI training, and similar technologies, are reserved.
Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire