Spine MRI in Spontaneous Intracranial Hypotension: A Survey of Current State of Practice

BACKGROUND: Spine MRI plays a central role in the diagnostic evaluation of spontaneous intracranial hypotension (SIH) by helping identify extradural fluid and guide subsequent myelographic technique. Despite its widespread use, the technical details of spine MRI protocols for SIH are often incompletely reported, and the extent of practice variation across specialized centers remains poorly characterized. In addition, ambiguous and inconsistent terminology, including variable use of terms such as "MR myelography" and "heavily T2-weighted MRI," may obscure important differences between non-contrast MRI techniques and examinations performed after intrathecal contrast administration. METHODS: This State of Practice was developed by neuroradiologists from 9 United States centers with expertise in SIH. Participating centers reviewed and reported their institutional whole-spine MRI protocols for SIH evaluation, including use of 2D and 3D T2-weighted imaging, fat suppression, and echo time. KEY MESSAGE: Current spine MRI protocols for SIH show substantial heterogeneity, particularly in fat-suppression technique and echo time, despite universal use of 3D T2-weighted imaging among surveyed centers. Ambiguous terminology further limits comparison across studies and may contribute to confusion regarding whether "MR myelography" refers to non-contrast heavily T2-weighted MRI or intrathecal contrast-enhanced MR myelography. Standardized terminology and more complete reporting of technical parameters are needed to improve interpretation of the literature and guide future protocol refinement.