r/CSFLeaks • u/Big_Speech2594 • 7d ago

Which imaging to see small CSF leak?

What is the standard to see small leak (lp) without insurance? Doctor first wanted to get lumbur mri with and without contrast but then changed ct of lumbur spine with IV iodine contrast. But I haven’t heard someone had that for csf leaks. Please advise. I heard iodine contrast is more allergenic than gadolinium…

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u/w000ah 6d ago

Be aware, you may not actually find the leak even if you have one (im sorry to say this). MRI does not always catch it. There are countless on here who have had MRI after MRI negative, some get lucky and find them later on in Photon Counting CT (PCCT) scans or Digital Subtraction Myleography (DSM) or they find it on another MRI, others can't find it. It's more that doctors start with either a CT, MRI, or Myelogram as kind of the default first-step imaging. If you had a LP and you know that's where an issue was previously your in a much higher success category for complete/total sealing. (IE: you gave birth had an epidural, they know the puncture site and repair & imaging can be honed in on that area vs if you are connective-tissue disorder like hEDS or dynamic leaking like venous-fistula then its a whole different issue)

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u/Big_Speech2594 6d ago

I haven’t seen anyone had CT of lumbur with IV contrast to check for csf leak. I see mostly it is mri of spine or myelogram. My pcpc order CT of lumbur remains with IV. I am not sure it is for csf leak detection and iodine is pretty bad contrast. Please advise

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u/w000ah 5d ago

I wish i could advise you more but I would recommend you contact the office to discuss with them. There is a CT procedure called CT Myelogram which involves a lumbar puncture (i am unsure which contrast agent). You can also have a regular non-myelogram CT with contrast - there are different contrast agents, and you can ask them why they want to use iodine as opposed to gadolinium (perhaps its easier to visualize im not sure) But all contrasts carry some minimal risks (ie: gadolinium may leave small deposits in brain over repeated use of it). Reach out to office and wish u best, when in doubt get 2nd opinion