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<meta name="DC.Description" content="Patients with spontaneous intracranial hypotension caused by type 1 dural defects typically have an epidural fluid collection on MRI, but the location of the defect is not usually readily identifiable on standard MRI sequences and can be at any point along the length of the collection. The most common location for type 1 leaks is ventral and as such are most commonly associated with ventral predominant epidural fluid. Dynamic myelography (either digital subtraction myelography or dynamic CT myelography) is currently the standard of care to localise the defect. We describe an imaging sign on T2-weighted images caused by CSF-flow egress at the site of the defect that may permit accurate prediction of the site of the CSF leak non-invasively. Importantly, this sign was only observed on 2D T2-weighted and STIR images and not on 3D acquisitions, which notably suppress artefact. This has implications for optimal MRI spine protocol construction. This sign can be used to limit myelographic range, reduce radiation dose and may increase diagnostic confidence to dural defect location.

ABBREVIATIONS: dCTM = Dynamic CT Myelography; DSM = Digital Subtraction Myelography; SIH = Spontaneous Intracranial Hypotension." />
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<meta name="DC.Contributor" content="Diogo. G.L. Edelmuth" />
<meta name="DC.Contributor" content="David Butteriss" />
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&lt;p&gt;Patients with spontaneous intracranial hypotension caused by type 1 dural defects typically have an epidural fluid collection on MRI, but the location of the defect is not usually readily identifiable on standard MRI sequences and can be at any point along the length of the collection. The most common location for type 1 leaks is ventral and as such are most commonly associated with ventral predominant epidural fluid. Dynamic myelography (either digital subtraction myelography or dynamic CT myelography) is currently the standard of care to localise the defect. We describe an imaging sign on T2-weighted images caused by CSF-flow egress at the site of the defect that may permit accurate prediction of the site of the CSF leak non-invasively. Importantly, this sign was only observed on 2D T2-weighted and STIR images and not on 3D acquisitions, which notably suppress artefact. This has implications for optimal MRI spine protocol construction. This sign can be used to limit myelographic range, reduce radiation dose and may increase diagnostic confidence to dural defect location.&lt;/p&gt;&lt;p&gt;ABBREVIATIONS: dCTM = Dynamic CT Myelography; DSM = Digital Subtraction Myelography; SIH = Spontaneous Intracranial Hypotension.&lt;/p&gt;" />
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<meta name="twitter:title" content="“Flow void sign”: flow artefact on T2-weighted MRI can be an indicator of dural defect location in ventral type 1 spinal CSF leaks" />
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<meta name="twitter:description" content="Patients with spontaneous intracranial hypotension caused by type 1 dural defects typically have an epidural fluid collection on MRI, but the location of the defect is not usually readily identifiable on standard MRI sequences and can be at any point along the length of the collection. The most common location for type 1 leaks is ventral and as such are most commonly associated with ventral predominant epidural fluid. Dynamic myelography (either digital subtraction myelography or dynamic CT myelography) is currently the standard of care to localise the defect. We describe an imaging sign on T2-weighted images caused by CSF-flow egress at the site of the defect that may permit accurate prediction of the site of the CSF leak non-invasively. Importantly, this sign was only observed on 2D T2-weighted and STIR images and not on 3D acquisitions, which notably suppress artefact. This has implications for optimal MRI spine protocol construction. This sign can be used to limit myelographic range, reduce radiation dose and may increase diagnostic confidence to dural defect location.

ABBREVIATIONS: dCTM = Dynamic CT Myelography; DSM = Digital Subtraction Myelography; SIH = Spontaneous Intracranial Hypotension." />
<meta name="og-title" property="og:title" content="“Flow void sign”: flow artefact on T2-weighted MRI can be an indicator of dural defect location in ventral type 1 spinal CSF leaks" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/08/14/ajnr.A8445" />
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<meta name="og-description" property="og:description" content="Patients with spontaneous intracranial hypotension caused by type 1 dural defects typically have an epidural fluid collection on MRI, but the location of the defect is not usually readily identifiable on standard MRI sequences and can be at any point along the length of the collection. The most common location for type 1 leaks is ventral and as such are most commonly associated with ventral predominant epidural fluid. Dynamic myelography (either digital subtraction myelography or dynamic CT myelography) is currently the standard of care to localise the defect. We describe an imaging sign on T2-weighted images caused by CSF-flow egress at the site of the defect that may permit accurate prediction of the site of the CSF leak non-invasively. Importantly, this sign was only observed on 2D T2-weighted and STIR images and not on 3D acquisitions, which notably suppress artefact. This has implications for optimal MRI spine protocol construction. This sign can be used to limit myelographic range, reduce radiation dose and may increase diagnostic confidence to dural defect location.

ABBREVIATIONS: dCTM = Dynamic CT Myelography; DSM = Digital Subtraction Myelography; SIH = Spontaneous Intracranial Hypotension." />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node109835--5" data-node-nid="109835" id="top-node-109835--61932952745" data-pisa="ajnr;ajnr.A8445v2" data-pisa-master="ajnr;ajnr.A8445" data-apath="/ajnr/early/2024/08/14/ajnr.A8445.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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      <h1 class="highwire-cite-title" id="page-title">“Flow void sign”: flow artefact on T2-weighted MRI can be an indicator of dural defect location in ventral type 1 spinal CSF leaks</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Lalani Carlton Jones</span>, <span class="highwire-citation-author" data-delta="1">Diogo. G.L. Edelmuth</span>, <span class="highwire-citation-author" data-delta="2">David Butteriss</span> and <span class="highwire-citation-author" data-delta="3">Daniel J. Scoffings</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2024,  </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8445; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8445 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-109835--61932952745" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Lalani Carlton Jones </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology, Guy’s & St Thomas’ Hospitals NHS Foundation Trust, London, UK (LCJ), Department of Neuroradiology, King’s College Hospital NHS Foundation Trust, London, UK (LCJ), Radiology Department, Instituto de Ortopedia E Traumatologia, Hospital das Clínicas HCFMUSP, São Paulo, Brazil (DGLE), Departments of Radiology and Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil (DGLE), Department of Neuroradiology, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK (DB) and Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK (DJS).</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Lalani%2BCarlton%2BJones%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Jones%20LC&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ALalani%2BCarlton%2BJones%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Diogo. G.L. Edelmuth </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology, Guy’s & St Thomas’ Hospitals NHS Foundation Trust, London, UK (LCJ), Department of Neuroradiology, King’s College Hospital NHS Foundation Trust, London, UK (LCJ), Radiology Department, Instituto de Ortopedia E Traumatologia, Hospital das Clínicas HCFMUSP, São Paulo, Brazil (DGLE), Departments of Radiology and Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil (DGLE), Department of Neuroradiology, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK (DB) and Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK (DJS).</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Diogo.%2BG.L.%2BEdelmuth%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Edelmuth%20DG&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ADiogo.%2BG.L.%2BEdelmuth%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">David Butteriss </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology, Guy’s & St Thomas’ Hospitals NHS Foundation Trust, London, UK (LCJ), Department of Neuroradiology, King’s College Hospital NHS Foundation Trust, London, UK (LCJ), Radiology Department, Instituto de Ortopedia E Traumatologia, Hospital das Clínicas HCFMUSP, São Paulo, Brazil (DGLE), Departments of Radiology and Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil (DGLE), Department of Neuroradiology, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK (DB) and Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK (DJS).</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=David%2BButteriss%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Butteriss%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ADavid%2BButteriss%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Daniel J. Scoffings </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology, Guy’s & St Thomas’ Hospitals NHS Foundation Trust, London, UK (LCJ), Department of Neuroradiology, King’s College Hospital NHS Foundation Trust, London, UK (LCJ), Radiology Department, Instituto de Ortopedia E Traumatologia, Hospital das Clínicas HCFMUSP, São Paulo, Brazil (DGLE), Departments of Radiology and Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil (DGLE), Department of Neuroradiology, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK (DB) and Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK (DJS).</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Daniel%2BJ.%2BScoffings%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Scoffings%20DJ&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ADaniel%2BJ.%2BScoffings%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2024, </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8445; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8445 </span></div>
  
  
  
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