I hope this is treatment I might need for possible csf venous fistula.. Waiting for more imaging and type/location/treatment of possible leak is the hardest part of this journey. Video appointment with Dr Ian Carroll at Stanford on July 7, only 2 more months of waiting. Am learning all I can about different types of leaks and imaging and treatments before then! At least that keeps me busy.

Spine MRI Diverticular Patterns Predict CSF-Venous Fistula Location: A 100-Patient Study

Abstract

Background and purpose: CSF-venous fistulas (CVFs) are an increasingly recognized cause of spontaneous intracranial hypotension and require invasive myelography for localization. Whether spine MRI can noninvasively predict CVF origin remains unclear. The purpose of our study was to determine if spine MRI features, particularly the size and location of spinal meningeal diverticula, are predictive of the CVF location identified on myelography.

Materials and methods: Retrospective review was conducted of 100 patients with a CVF confirmed on decubitus CT myelography who underwent preprocedural spine MRI. The primary outcome was whether the CVF arose at or adjacent to the largest diverticulum. Secondary outcomes included distribution patterns of the largest adjacent-level diverticula and their spatial relationship to the CVF (cranial, caudal, ipsilateral, contralateral). χ^(2) tests, 1-sided binomial tests, and t tests were used to assess statistical significance.

Results: CVFs originated at or adjacent to the largest diverticulum in 77% of patients, significantly more than expected by chance (P < .001); 71.7% of CVFs were within 1 level of the adjacent largest diverticulum on spine MRI. Among adjacent-level cases of the largest diverticula, there was a significant directional preference for the adjacent largest diverticulum to occur caudal to the CVF compared with a uniform distribution (P = .001). Three specific diverticular patterns were statistically significant: caudal and ipsilateral 1 level below the CVF (P < .001), contralateral same level (P < .001), and caudal and contralateral one level (P = .002). There was no significant correlation between the laterality of the largest diverticulum size nor the laterality of most of the diverticula compared with the laterality of the CVF.

Conclusions: Spinal CVFs most commonly arise at or adjacent to the largest meningeal diverticulum. The adjacent largest diverticulum was commonly within 1 level to the CVF and most commonly caudal 1 level to the CVF or at the same level contralateral side to the CVF. These MRI-based predictors may help guide myelography.

© 2026 by American Journal of Neuroradiology.

https://www.ajnr.org/content/early/2026/03/19/ajnr.A9042

Non-invasive biomarkers for spontaneous intracranial hypotension (SIH) through phase-contrast MRI

Abstract

Background and objective

Spontaneous intracranial hypotension (SIH) is an underdiagnosed disease. To depict the accurate diagnosis can be demanding; especially the detection of CSF–venous fistulas poses many challenges. Potential dynamic biomarkers have been identified through non-invasive phase-contrast MRI in a limited subset of SIH patients with evidence of spinal longitudinal extradural collection. This study aimed to explore these biomarkers related to spinal cord motion and CSF velocities in a broader SIH cohort.

Methods

A retrospective, monocentric pooled-data analysis was conducted of patients suspected to suffer from SIH who underwent phase-contrast MRI for spinal cord and CSF velocity measurements at segment C2/C3 referred to a tertiary center between February 2022 and June 2023. Velocity ranges (mm/s), total displacement (mm), and further derivatives were assessed and compared to data from the database of 70 healthy controls.

Results

In 117 patients, a leak was located (54% ventral leak, 20% lateral leak, 20% CSF–venous fistulas, 6% sacral leaks). SIH patients showed larger spinal cord and CSF velocities than healthy controls: e.g., velocity range 7.6 ± 3 mm/s vs. 5.6 ± 1.4 mm/s, 56 ± 21 mm/s vs. 42 ± 10 mm/s, p < 0.001, respectively. Patients with lateral leaks and CSF–venous fistulas exhibited an exceptionally heightened level of spinal cord motion (e.g., velocity range 8.4 ± 3.3 mm/s; 8.2 ± 3.1 mm/s vs. 5.6 ± 1.4 mm/s, p < 0.001, respectively).

Conclusion

Phase-contrast MRI might become a valuable tool for SIH diagnosis, especially in patients with CSF–venous fistulas without evidence of spinal extradural fluid collection.

https://link.springer.com/article/10.1007/s00415-024-12365-6

https://www.radiologyinfo.org/en/info/safety-xray

"So taking the radiation issue first – this is a nice paper from Farb’s group published recently. They were comparing the radiation dose to the patient from a DSM versus CTM. They found on average the dose for DSM was lower. The average for CTM was about 20 millisieverts, but you can see quite a wide range in the effective dose of the patient, all the way up to 80 millisieverts. And this is something we should all be aware of as physicians, but it is also something our patients are asking us about more."

https://spinalcsfleak.org/2025-chazen-amrhein-controversies-ebp/