2023 Volume 60 Issue 4 Pages 161-171
Cerebrospinal fluid hypovolemia is diagnostic challenge, partly owing to its diverse presentation on imaging findings. The development of magnetic resonance imaging (MRI) has led to the production of detailed images and significantly advanced our understanding of this entity. However, the complexity of imaging manifestations makes interpretations of the findings difficult. This review paper attempts to summarize the conventional and novel MRI findings of this disease in two main categories, spinal and head MRI findings. Spinal MRI primarily evaluates cerebrospinal fluid leakage, while head MRI can assess secondary changes caused by the leakage. The characteristic signs of spinal cerebrospinal fluid leakage include the floating dural sac sign and Narwhal sign. Emerging MRI sequences such as 3D and FLAIR can be applied to evaluate the two categories. Appropriate selection of MRI sequences is essential to produce appropriate images for interpretation. In fact, however, some patients may receive inappropriate MRI in unsuspected cerebrospinal fluid hypovolemia. This review aims to explain principles behind diagnostic procedures used to make an accurate diagnosis under difficult circumstances.
