Background and objectives <p>The precise site of dural leaks in patients with spontaneous intracranial hypotension (SIH) is challenging to identify. We investigated for the first time the ability of the dural displacement sign seen on 3D T2 FIESTA (Fast Imaging Employing Steady-state Acquisition) weighted MR imaging to depict epidural collections and show the leakage site in type 1 leaks in patients with SIH.</p> Materials and methods <p>In a retrospective study, 23 patients with confirmed type 1 leakage received an MR of the spine with 3D T2 FIESTA-weighted imaging and ultrafast dynamic CT myelography. The two modalities were compared in 22 patients in relation to the leakage site. In one patient, conventional CT myelography (CTM) was used at our site, but an ultrafast dynamic CT myelography was later conducted at another site and confirmed the leakage location. Two neuroradiologists performed the evaluations while blinded.</p> Results <p>Dural displacement sign in the upper thoracic spine was identified in 12 of 13 patients (92%) in the upper thoracic spine, whereas it was not identified in the remaining 10 patients with leaks in the cervical, lower thoracic or lumbar regions. A Type 1 leakage in the upper thoracic region was at the exact same level as the dural displacement sign in 9 (72%) patients and in the remaining 3 the leakage level was located at one level below the dural displacement sign. In one of the 3 patients where the leakage was located at the level below the visible dural displacement sign, a dural tear at the leakage level in the form of discontinuity of the dura was identified.</p> Conclusions <p>3D FIESTA sequences and the dural displacement sign show the potential site of type 1 leakage in the upper thoracic spine. We find that the 3D FIESTA sequence and the dural displacement sign can be valuable when planning ultrafast dynamic CT myelography. This may reduce the investigation time and the radiation doses.</p>