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Radiographics : a Review Publication of... Jan 2024
Topics: Humans; Myelography; Tomography, X-Ray Computed; Intervertebral Disc Displacement
PubMed: 38096111
DOI: 10.1148/rg.230088 -
Clinical Radiology Mar 2022Spontaneous intracranial hypotension (SIH) is a condition that results from leakage of cerebrospinal fluid (CSF) from the spine, and which typically presents with... (Review)
Review
Spontaneous intracranial hypotension (SIH) is a condition that results from leakage of cerebrospinal fluid (CSF) from the spine, and which typically presents with debilitating orthostatic headache, but can be associated with a wide range of other symptoms. The causes of spontaneous CSF leaks that lead to SIH include dural tears, leaking meningeal diverticula, and CSF-venous fistulas. Imaging plays a central role in the initial diagnosis of SIH and in its subsequent investigation and management. This article reviews the typical neuroimaging manifestations of SIH and discusses the utility of different myelographic techniques for localising spinal CSF leaks as well as the role of image-guided treatment.
Topics: Cerebrospinal Fluid Leak; Headache Disorders, Secondary; Humans; Intracranial Hypotension; Magnetic Resonance Imaging; Myelography; Tomography, X-Ray Computed
PubMed: 34949452
DOI: 10.1016/j.crad.2021.11.007 -
Asian Spine Journal Dec 2015Prospective comparative study.
STUDY DESIGN
Prospective comparative study.
PURPOSE
To compare the incidence and severity of adverse reactions associated with myelography performed in outpatients vs. in inpatients and report the safety and usefulness of outpatient myelography in Japanese patients.
OVERVIEW OF LITERATURE
Myelography is normally performed as an inpatient procedure in most hospitals in Japan. No studies have reported the usefulness and adverse effects of outpatient myelography in Japanese patients.
METHODS
We performed 221 myelography procedures. Eighty-five of the 221 patients underwent outpatient myelography using our new protocol. The incidence and severity of adverse reactions were compared with the other 136 patients, who underwent conventional inpatient myelography. We further compared the cost of outpatient and inpatient myelography.
RESULTS
The overall rate of adverse effects was 9.4% in outpatients, as compared with 7.4% in inpatients. Overall, 1.2% of outpatients and 0.74% inpatients experienced "severe" adverse effects (requiring hospitalization). There were no significant differences between the 2 groups in either the overall rate of adverse effects or the rate of "severe" adverse effects. Moreover, the average outpatient procedure cost was only one-third to one-half that of the inpatient procedure.
CONCLUSIONS
This was the first study to address the safety and usefulness of outpatient myelography in Japanese patients. If selected according to proper inclusion criteria for outpatient procedure, no significant differences were observed in the adverse effects between inpatients and outpatients. The outpatient procedure is more economical and has the added benefit of being more convenient and time-efficient for the patient.
PubMed: 26713127
DOI: 10.4184/asj.2015.9.6.928 -
Neurology Mar 2021
Topics: Brain; Humans; Intracranial Hypotension; Magnetic Resonance Imaging; Myelography; Neuroimaging
PubMed: 33472920
DOI: 10.1212/WNL.0000000000011518 -
Diagnostics (Basel, Switzerland) Sep 2021CT myelography (CTM) is a diagnostic technique for the evaluation of various spinal pathologies, and plays an important role in diagnosis of different diseases such as...
CT myelography (CTM) is a diagnostic technique for the evaluation of various spinal pathologies, and plays an important role in diagnosis of different diseases such as spontaneous intracranial hypotension and postoperative cerebrospinal fluid leaks. The aims of this study were to examine radiation exposure, establish diagnostic reference levels (DRLs) and compare radiation doses of single- and dual-source examinations and different CTM protocols. In this retrospective study, 183 CTMs comprising 155 single-source and 28 dual-source examinations, performed between May 2015 and December 2020, were analyzed. Dose data included 31 whole spine (A), 23 cervical (B), 10 thoracic (C), and 119 lumbar (D) CTMs. Radiation exposure was reported for volume-weighted CT dose index (CTDI) and dose-length product (DLP). Radiation doses for CTDI and DLP were distributed as follows (median, IQR): A: 7.44 mGy (6.01-11.17 mGy)/509.7 mGy·cm (382.4-682.9 mGy·cm), B: 9.31 mGy (7.20-14.64 mGy)/214.5 mGy·cm (153.7-308.2 mGy·cm), C: 6.80 mGy (6.14-8.26 mGy)/365.4 mGy·cm (222.8-432.4 mGy·cm), D: 11.02 mGy (7.97-14.89 mGy)/308.0 mGy·cm (224.7-413.7 mGy·cm). Local DRLs could be depicted as follows (CTDI/DLP): A: 11 mGy/683 mGy·cm, B: 15 mGy/308 mGy·cm, C: 8 mGy/432 mGy·cm, D: 15 mGy/414 mGy·cm. High image quality was achieved for all anatomical regions. Basically, radiation exposure of CTM differs according to anatomical location.
PubMed: 34679507
DOI: 10.3390/diagnostics11101809 -
Clinical Imaging May 2022A dorsal arachnoid web is a rare entity involving abnormal formation of arachnoid mater into a dense web which may result in ventral herniation of the spinal cord and...
A dorsal arachnoid web is a rare entity involving abnormal formation of arachnoid mater into a dense web which may result in ventral herniation of the spinal cord and significant neurologic symptoms. Back pain or a compressive myelopathy are two of the most common presenting symptoms. CT myelogram or MRI can aid in the diagnosis of arachnoid web, and management of includes surgical and conservative approaches. Herein, we describe two interesting cases of arachnoid webs highlighting the diagnostic approach and differences in the approach to management of each case.
Topics: Hernia; Humans; Magnetic Resonance Imaging; Myelography; Spinal Cord Compression; Spinal Cord Diseases; Tomography, X-Ray Computed
PubMed: 35217252
DOI: 10.1016/j.clinimag.2022.02.011 -
Open Veterinary Journal 2018Over the last decade, magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) have revolutionized diagnostic potential in small animal practice,... (Review)
Review
Usefulness of spinal unenhanced computed tomography and CT-myelography in the age of multidetector CT technology and magnetic resonance imaging - Preliminary considerations.
Over the last decade, magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) have revolutionized diagnostic potential in small animal practice, providing adequate assessment of spinal diseases at levels comparable to that achieved in human radiology. T2-weighted MRI images are extremely sensitive to intramedullary parenchymal disorders, while balanced steady-state free precession sequences provide high-quality myelographic images of the spine without the need of intrathecal contrast medium administration. Multidetector computed tomography, with its near-isotropic spatial resolution and multiplanar reformatting of the acquired datasets, provides sufficient stratigraphic details of the spinal cord and the epidural space, facilitating the detection of compressive pathologies without the need of subarachnoid opacification. Nowadays, MDCT and low-field (LF) MRI have become fairly standard and available in academic institutions and private veterinary facilities, appearing to be valuable, complementary, and non-invasive diagnostic tools for imaging the spine. In this scenario, this clinical communication provides a series of preliminary observations that may help to reconsider the usefulness of CT-myelography in the light of its invasiveness and actual diagnostic advantages compared to MRI and unenhanced MDCT for the assessment of compressive and non-compressive spinal diseases in small animals.
PubMed: 30148079
DOI: 10.4314/ovj.v8i3.6 -
AJNR. American Journal of Neuroradiology Dec 2023CSF-venous fistulas are a common cause of spontaneous intracranial hypotension. Lateral decubitus digital subtraction myelography and CT myelography are the diagnostic...
BACKGROUND AND PURPOSE
CSF-venous fistulas are a common cause of spontaneous intracranial hypotension. Lateral decubitus digital subtraction myelography and CT myelography are the diagnostic imaging standards to identify these fistulas. Photon-counting CT myelography has technological advantages that might improve CSF-venous fistula detection, though no large studies have yet assessed its diagnostic performance. We sought to determine the diagnostic yield of photon-counting detector CT myelography for detection of CSF-venous fistulas in patients with spontaneous intracranial hypotension.
MATERIALS AND METHODS
We retrospectively searched our database for all decubitus photon-counting detector CT myelograms performed at our institution since the introduction of the technique in our practice. Per our institutional workflow, all patients had prior contrast-enhanced brain MR imaging and spine MR imaging showing no extradural CSF. Two neuroradiologists reviewed preprocedural brain MRIs, assessing previously described findings of intracranial hypotension (Bern score). Additionally, 2 different neuroradiologists assessed each myelogram for a definitive or equivocal CSF-venous fistula. The yield of photon-counting detector CT myelography was calculated and stratified by the Bern score using low-, intermediate-, and high-probability tiers.
RESULTS
Fifty-seven consecutive photon-counting detector CT myelograms in 57 patients were included. A single CSF-venous fistula was definitively present in 38/57 patients. After we stratified by the Bern score, a definitive fistula was seen in 56.0%, 73.3%, and 76.5% of patients with low-, intermediate-, and high-probability brain MR imaging, respectively.
CONCLUSIONS
Decubitus photon-counting detector CT myelography has an excellent diagnostic performance for the detection of CSF-venous fistulas. The yield for patients with intermediate- and high-probability Bern scores is at least as high as previously reported yields of decubitus digital subtraction myelography and CT myelography using energy-integrating detector scanners. The yield for patients with low-probability Bern scores appears to be greater compared with other modalities. Due to the retrospective nature of this study, future prospective work will be needed to compare the sensitivity of photon-counting detector CT myelography with other modalities.
Topics: Humans; Intracranial Hypotension; Cerebrospinal Fluid Leak; Retrospective Studies; Myelography; Tomography, X-Ray Computed; Fistula
PubMed: 37945523
DOI: 10.3174/ajnr.A8040 -
AJR. American Journal of Roentgenology Aug 2022Spontaneous intracranial hypotension (SIH) is a disorder of CSF dynamics that causes a complex clinical syndrome and severe disability. SIH is challenging to diagnose... (Review)
Review
Spontaneous intracranial hypotension (SIH) is a disorder of CSF dynamics that causes a complex clinical syndrome and severe disability. SIH is challenging to diagnose because of the variability of its presenting clinical symptoms, the potential for subtle imaging findings to be easily overlooked, and the need for specialized diagnostic testing. Once SIH is suggested by clinical history and/or supported by initial neuroim-aging, many patients may undergo initial nontargeted epidural blood patching with variable and indefinite benefit. However, data suggest that precise localization of the CSF leak or CSF-venous fistula (CVF) can lead to more effective and durable treatment strategies. Leak localization can be achieved using a variety of advanced diagnostic imaging techniques, although these may not be widely performed at nontertiary medical centers, leaving many patients with the potential for inadequate workup or treatment. This review describes imaging techniques including dynamic fluoroscopic and CT myelography as well as delayed MR myelography and treatment options including percutaneous, endovascular, and surgical approaches for SIH. These are summarized by an algorithmic framework for radiologists to approach the workup and treatment of patients with suspected SIH. The importance of a multidisciplinary approach is emphasized.
Topics: Cerebrospinal Fluid Leak; Fistula; Humans; Intracranial Hypotension; Magnetic Resonance Imaging; Myelography; Tomography, X-Ray Computed
PubMed: 35261281
DOI: 10.2214/AJR.22.27485 -
AJNR. American Journal of Neuroradiology Jan 2021Decubitus CT myelography is a reported method to identify CSF-venous fistulas in patients with spontaneous intracranial hypotension. One of the main advantages of...
Decubitus CT myelography is a reported method to identify CSF-venous fistulas in patients with spontaneous intracranial hypotension. One of the main advantages of decubitus CT myelography in detecting CSF-venous fistulas is using gravity to dependently opacify the CSF-venous fistula, which can be missed on traditional myelographic techniques. Most of the CSF-venous fistulas in the literature have been identified in patients receiving general anesthesia and digital subtraction myelography, a technique that is not performed at all institutions. In this article, we discuss the decubitus CT myelography technique and how to implement it in daily practice.
Topics: Adult; Aged; Aged, 80 and over; Cerebrospinal Fluid Leak; Female; Fistula; Humans; Image Interpretation, Computer-Assisted; Intracranial Hypotension; Male; Middle Aged; Myelography; Patient Positioning; Tomography, X-Ray Computed
PubMed: 33122215
DOI: 10.3174/ajnr.A6844