MRI Findings after Recent Image-Guided Lumbar Puncture: The Rate of Dural Enhancement and Subdural Collections

American Journal of Neuroradiology

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FIG 1.
A 42-year-old woman (patient 2) with B-cell acute lymphoblastic leukemia who had an LP for intrathecal chemotherapy followed by MR imaging 4 days later. CSF did not show signs of infection, inflammation, or malignancy. A, T1-weighted postcontrast coronal MR imaging shows smooth, diffuse dural enhancement. B, FLAIR coronal MR imaging shows small bilateral subdural fluid collections without mass effect.
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FIG 2.
A 69-year-old man (patient 5) with a history of multiple myeloma underwent an LP followed by MR imaging 3 days later. Coronal T1-weighted postcontrast (A) and FLAIR (B) images 1 month before LP do not show subdural collections or dural enhancement. However, 3 days after the LP, MR images show smooth diffuse dural enhancement on coronal T1-weighted postcontrast imaging (C) and a left frontal convexity subdural fluid collection on coronal FLAIR imaging (D) but no morphologic findings of brain sag on T1-weighted sagittal imaging (E). F, Coronal reformatted CT 1 month after LP shows resolution of the subdural fluid collection.

Table 1:

Contrast-enhanced MR imaging findings of patients who underwent imaging within 7 days of an image-guided LP^{^a}

	Subdural Collections	Dural Enhancement	Brain Sag	Venous Distension
All patients	5.2% (8/153)	3.9% (6/153)	0.6% (1/159)	1.3% (2/158)
MR imaging <2 days of LP	2.5% (2/80)	0% (0/85)	0% (0/85)	2.4% (2/83)
Large-volume LP (>30 mL)	0% (0/6)	0% (0/6)	0% (0/6)	0% (0/6)

↵a Imaging findings present on pre-LP imaging were not included in this analysis.

Table 2:

Eight patients who had subdural collections on MR imaging within 7 days after LP^{^a}

	Presenting Diagnosis/Reason for Procedure	Age (yr)	Days between LP and MR Imaging	CSF Removed (mL)	CSF Opening Pressure (cm H₂O)	Brain Sag	Venous Distension	Diffuse Dural Enhancement
Patient 1	Mycosis fungoides	35	4	9	NA	Yes	Yes	Yes
Patient 2	Leukemia	42	4	8	NA	No	Yes	Yes
Patient 3	AMS	54	3	16	NA	No	No	Yes
Patient 4	AMS	61	0	14	NA	No	No	No
Patient 5	Multiple myeloma	69	3	16	NA	No	No	Yes
Patient 6	Leukemia	69	1	6	NA	No	No	No
Patient 7	Pulmonary adenocarcinoma	69	6	15	13	No	No	Yes
Patient 8	AMS	71	4	14	14	No	No	Yes

Note:—NA indicates not available; AMS, altered mental status.
↵a None of the patients had a definite etiology on CSF analysis to explain dural enhancement. Each patient underwent an LP with a 22-ga Quincke tip spinal needle.