ArticleJournal of clinical neurology (Seoul, Korea)2026
Diagnostic Value of Flow-Void Sign for Localizing Ventral Dural Defects in Spine MRI.
Article in Journal of clinical neurology (Seoul, Korea), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
background and purposeUltrafast dynamic CT myelography and digital subtraction myelography are used to localize dural defects in spontaneous intracranial hypotension; however, their invasiveness and technical demands limit widespread availability. The "flow-void sign" on T2-weighted spine MRI has been proposed as a potential non-invasive marker of the ventral dural defect, but its clinical value remains unclear. This study aimed to evaluate the utility of the flow-void sign for predicting dural defect sites in ventral cerebrospinal fluid leaks.
methodsThis retrospective cohort study, using data from the headache registry at Seoul National University Hospital (March 2022-April 2025), included patients with ventral dural defects confirmed by ultrafast dynamic CT myelography or surgery. Three neurologists assessed the flow-void sign on T2-weighted spine magnetic resonance sequences and evaluated the spinal CT images for causative structural lesions. The concordance between the flow-void sign and ventral dural defect was analyzed using kappa statistics. Logistic regression analysis was performed to identify factors associated with this concordance.
resultsAmong 64 patients (57.8% female; median age, 40.0 years), the flow-void sign was observed in 43 (67.2%) patients. In the flow-void-positive group, 32 (74.4%) patients demonstrated concordance with the ventral dural defect level (κ=0.660, 95% confidence interval [CI], 0.476-0.825). The presence of a causative spinal lesion was significantly associated with the concordance (odds ratio, 6.48; 95% CI, 1.41-29.71;
conclusionsThe flow-void sign may provide an indirect clue for localizing a ventral dural defect and supplement the definitive imaging modalities.
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