MRI in the localization of CSF fistulae: is it of any value?

Coronal T2-weighted magnetic resonance imaging (MRI) has been reported to be a useful technique for the localization of both spontaneous and traumatic CSF (cerebro spinal fluid) fistulae. We reviewed the magnetic resonance imaging (MRI) scans of 50 patients with temporal lobe epilepsy in whom such sequences were routinely acquired to determine if this asymptomatic population fulfilled any of the criteria for the diagnosis of a CSF fistula. We found that a large proportion did and conclude that using MRI as the initial radiological investigation in the localization of CSF fistulae is of such low specificity that it is of little or no value.