Dual Energy CT Myelography Used to Detect Spontaneous Spinal Cerebrospinal Fluid Leaks

Qiao-wei Zhang, MD, Prof. Shi-zheng Zhang, MD
Department of Radiology SIR Run Run SHAW Institute of Clinical Medicine of Zhejiang University
Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China

A 35-year-old female patient was referred to the Department of Radiology complaining of headaches and neck stiffness for the past 17 days. The headaches were relatively mild in the supine position and became severe in an upright position. She denied any history of recent trauma and had received two weeks of conservative treatment in the local hospital with no relief. Neurological exams were normal at admission. Contrast-enhanced cerebral MRI showed bilateral dural thickening (Fig. 1). The lumbar puncture revealed a low cerebrospinal fluid (CSF) pressure of 40 mmH2O in lateral decubitus position. 10 ml Omnipaque (300 mg J/ml) was then injected and a Dual Energy CT myelography (DECTM) of the entire spine was performed. In accordance with the DECTM results, targeted epidural blood patch followed and the patient was discharged 3 days later with total pain relief.