Incidence and clinical significance of epidural fluid signal on spinal magnetic resonance imaging after image-guided lumbar puncture in adults

Purpose: We determined the incidence of epidural fluid signal on spinal magnetic resonance imaging (MRI) after image-guided lumbar puncture (LP) in adults. We correlated those imaging findings with clinical status. Methods: We searched our institution's medical records from January 2013 through April 2020 to identify adult patients who underwent image-guided LP and postdural puncture MRI. We examined the incidence of epidural fluid signal intensity in adults after image-guided dural puncture, characterized its imaging features, and evaluated its associated clinical factors. Results: Of 91 patients who underwent image-guided dural puncture and subsequent spinal MRI within 7 days, 18 (20%) demonstrated epidural fluid signal on postdural puncture MRI. Univariate analysis showed that larger needle size correlated with signal presence (4/8 [50%] LP with a 20-gauge needle vs 13/82 [16%] with a 22-gauge needle, P = 0.03). The odds of observing epidural fluid signal on postdural puncture MRI decreased by 8% per 1-year increase in age (P < 0.001). Postdural puncture symptoms did not differ between those with and without epidural fluid signal intensity. Conclusion: Epidural fluid signal on MRI in adults may be an incidental finding more commonly observed in younger patients after dural puncture with larger needles, without a significant correlation with symptomatology.

Automated summary

The purpose of this study was to determine the incidence of epidural fluid signal on spinal MRI after image-guided lumbar puncture in adults and to correlate these findings with clinical status. The results showed that younger patients with larger needle size were more likely to have epidural fluid signal, but this signal did not significantly correlate with symptoms.