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Dinosaur Tail Sign: A Useful Spinal MRI Finding Indicative of Cerebrospinal Fluid Leakage
Author(s) -
Sakurai Keita,
Kanoto Masafumi,
Nakagawa Motoo,
Shimohira Masashi,
Tokumaru Aya M.,
Kameyama Masashi,
Shimoji Keigo,
Morimoto Satoru,
Matsukawa Noriyuki,
Nishio Minoru,
Shibamoto Yuta
Publication year - 2017
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.13075
Subject(s) - magnetic resonance imaging , cerebrospinal fluid , medicine , hyperintensity , spinal cord , myelography , cerebrospinal fluid leakage , radiology , nuclear medicine , anatomy , pathology , psychiatry
Objective To evaluate the imaging characteristics and diagnostic utility of the “Dinosaur tail sign” in the diagnosis of cerebrospinal fluid (CSF) leakage. Background The authors propose the “Dinosaur tail sign,” defined as a combination of the dorsal epidural hyperintensities, fat tissue, spinal cord, and cauda equine on lumbosacral sagittal fat‐suppressed T2‐weighted image (FST2WI), as a sensitive indicator for diagnosing CSF leakage. Methods Imaging characteristics of the “Dinosaur tail sign” was evaluated in seven spontaneous intracranial hypotension (SIH) and 23 iatrogenic CSF leakage (ICSFL) patients. Additionally, the diagnostic index was compared between the “Dinosaur tail sign” and other previously reported useful magnetic resonance imaging (MRI) and magnetic resonance myelography (MRM) findings. Results In contrast to other imaging findings including the epidural expansion, floating dural sac sign, and distension of the spinal epidural veins on MRI, and paraspinal fluid collections (PFC) on MRM, the “Dinosaur tail sign” was found equally in both SIH and ICSFL patients (6 SIH and 19 ICSFL; 83% of all patients with CSF leakage). The “Dinosaur tail sign” showed sufficient diagnostic utility (sensitivity 83%, specificity 94%, accuracy 89%) that was comparable to that of PFC. Conclusion The “Dinosaur tail sign” is a useful imaging finding suggestive of CSF leakage. Evaluation of subtle interspinous arched hyperintensities on spinal MRI is mandatory for the diagnosis of SIH and ICSFL.