To the Editor In an article in JAMA Neurology, Papadopoulou et al1 demonstrated that intrathecal gadolinium–enhanced magnetic resonance (MR) myelography provided clear evidence of dural leaks along 2 lumbar roots in a case of spontaneous intracranial hypotension. Results from a previous radioisotope cisternography had been inconclusive in revealing these leaks, while an MR image of the spinal cord showed a small lumbar perineural cyst with no evidence of cerebrospinal fluid (CSF) leak.1 The authors concluded that the application of intrathecal gadolinium in MR myelography, as described by Zeng et al,2 although it is still an off-label use, may be a valuable alternative to radioisotope cisternography or computed tomographic myelography for the detection of spinal CSF leaks, avoiding ionizing radiation.1
Parissis D, Ioannidis P, Karacostas D. Intrathecal Gadolinium for Magnetic Resonance Myelography in Spontaneous Intracranial Hypotension: Valuable But May Be Risky. JAMA Neurol. 2014;71(6):802. doi:https://doi.org/10.1001/jamaneurol.2014.224
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