-
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 -
The British Journal of Radiology May 2024Photon-counting CT (PCCT) uses a novel X-ray detection mechanism that confers many advantages over that used in traditional energy integrating CT. As PCCT becomes more... (Review)
Review
Photon-counting CT (PCCT) uses a novel X-ray detection mechanism that confers many advantages over that used in traditional energy integrating CT. As PCCT becomes more available, it is important to thoroughly understand its benefits and highest yield areas for improvements in diagnosis of various diseases. Based on our early experience, we have identified several areas of neurovascular imaging in which PCCT shows promise. Here, we describe the benefits in diagnosing arterial and venous diseases in the head, neck, and spine. Specifically, we focus on applications in head and neck CT angiography (CTA), spinal CT angiography, and CT myelography for detection of CSF-venous fistulas. Each of these applications highlights the technological advantages of PCCT in neurovascular imaging. Further understanding of these applications will not only benefit institutions incorporating PCCT into their practices but will also help guide future directions for implementation of PCCT for diagnosing other pathologies in neuroimaging.
Topics: Humans; Computed Tomography Angiography; Tomography, X-Ray Computed; Photons; Myelography; Cerebrovascular Disorders
PubMed: 38460543
DOI: 10.1093/bjr/tqae058 -
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 -
Open Veterinary Journal Jan 2021The techniques described for the identification of the lumbosacral (LS) epidural space in dogs do not guarantee the needle position or an accidental subarachnoid...
BACKGROUND
The techniques described for the identification of the lumbosacral (LS) epidural space in dogs do not guarantee the needle position or an accidental subarachnoid puncture, especially in small size dogs.
AIM
To determine the relationship between body weight and the location of the dural sac (DS) using myelography in dogs, and to determine the possibility of subarachnoid puncture during LS epidural based on the position of the DS.
METHODS
Four masked observers evaluated 70 myelographic studies of dogs, annotating the vertebrae where the DS ended, if it was localized before or after the LS space, and if accidental subarachnoid puncture during LS epidural injection was possible (yes/no). Body weight (kg) was categorized into: less than 10 kg, between 10 and 20 kg, and more than 20 kg and was also converted to body surface area (BSA) as a continuous variable.
RESULTS
The DS ended at the LS space or caudally in 50% of dogs. There was a statistically significant difference between the position of the DS and the dog's BSA ( = 0.001). The DS ended caudal to the LS space in 72.7% of dogs weighing <10 kg, in 25% of dogs between 10 and 20 kg and in 15% of dogs in the >20 kg category. The observers considered a possible subarachnoid puncture during LS epidural in 69.7% of patients <10 kg, 16.6% on those between 10 and 20 kg, and in 11.7% of the dogs >20 kg.
CONCLUSION
The DS ended caudal to the LS space in almost 3/4 dogs in the <10 kg category, so accidental subarachnoid puncture during LS epidural is highly possible in this weight range.
Topics: Animals; Dogs; Epidural Space; Female; Injections, Epidural; Lumbosacral Region; Male; Myelography; Needles; Punctures; Subarachnoid Space
PubMed: 33614431
DOI: 10.4314/ovj.v10i4.3 -
PloS One 2022Porcine models of spinal cord injury (SCI) have an irreplaceable role in the development of experimental therapies. There is little literature regarding CT myelogram...
Porcine models of spinal cord injury (SCI) have an irreplaceable role in the development of experimental therapies. There is little literature regarding CT myelogram (CTM) techniques in swine and morphometry in miniature swine has not been established. A CT-guided method for performing myelography as well as reference values for spinal morphometry in healthy Yucatan miniature swine is lacking. The goal of this study is to describe a CT-guided method of performing CTM in a porcine model of SCI and to establish spinal morphometric reference values in mature Yucatan pigs. Six healthy, Yucatan sows, 9 months of age, weighing between 39-57.7kg, with no history of spinal disease, spinal injury, or neurologic deficits on physical exam were used in this study. CT myelography was performed in each sow under general anesthesia. CT scout images were used to guide needle placement at the L3-L4 intervertebral site. Once correct needle placement was confirmed using a 1ml test injection, a full dose of iodinated contrast (0.3ml/kg) was injected slowly over a 2-minute time period. Morphometry was performed using area measurements of the spinal cord (SC), vertebral body (VB), dural sac (DS), and vertebral canal (VC) at the mid-body and the intervertebral disc space of each spinal segment. Of the quantitative measurements, the spinal cord surface area had the widest range of values and the greatest coefficient of variance (CV) while those parameters for the vertebral canal had a low CV. Of the morphometric ratios, the DS:VC, had the lowest CV while the spinal cord ratios to DS and VC had the highest (>30). The vertebral canal surface area and the dural space: vertebral canal ratio may serve as reference values in future studies using this animal model.
Topics: Animals; Female; Myelography; Spinal Canal; Spinal Cord Injuries; Spine; Swine; Swine, Miniature; Tomography, X-Ray Computed
PubMed: 35482719
DOI: 10.1371/journal.pone.0266396 -
Radiologic Clinics of North America Mar 2024Cerebrospinal fluid (CSF) leak can cause spontaneous intracranial hypotension (SIH) which can lead to neurologic symptoms, such as orthostatic headache. Over time,... (Review)
Review
Cerebrospinal fluid (CSF) leak can cause spontaneous intracranial hypotension (SIH) which can lead to neurologic symptoms, such as orthostatic headache. Over time, imaging techniques for detecting and localizing CSF leaks have improved. These techniques include computed tomography (CT) myelography, dynamic CT myelography, cone-beam CT, MRI, MR myelography, and digital subtraction myelography (DSM). DSM provides the highest sensitivity for identifying leak sites and has comparable radiation exposure to CT myelography. The introduction of the lateral decubitus DSM has proven invaluable in localizing leaks when other imaging tests have been inconclusive.
Topics: Humans; Cerebrospinal Fluid Leak; Intracranial Hypotension; Myelography; Tomography, X-Ray Computed; Magnetic Resonance Imaging
PubMed: 38272624
DOI: 10.1016/j.rcl.2023.10.004 -
AJNR. American Journal of Neuroradiology Oct 2014CT myelography has historically been the test of choice for localization of CSF fistula in patients with spontaneous intracranial hypotension. This study evaluates the...
BACKGROUND AND PURPOSE
CT myelography has historically been the test of choice for localization of CSF fistula in patients with spontaneous intracranial hypotension. This study evaluates the additional benefits of intrathecal gadolinium MR myelography in the detection of CSF leak.
MATERIALS AND METHODS
We performed a retrospective review of patients with spontaneous intracranial hypotension who underwent CT myelography followed by intrathecal gadolinium MR myelography. All patients received intrathecal iodine and off-label gadolinium-based contrast followed by immediate CT myelography and subsequent intrathecal gadolinium MR myelography with multiplanar T1 fat-suppressed sequences. CT myelography and intrathecal gadolinium MR myelography images were reviewed by an experienced neuroradiologist to determine the presence of CSF leak. Patient records were reviewed for demographic data and adverse events following the procedure.
RESULTS
Twenty-four patients met both imaging and clinical criteria for spontaneous intracranial hypotension and underwent CT myelography followed by intrathecal gadolinium MR myelography. In 3/24 patients (13%), a CSF leak was demonstrated on both CT myelography and intrathecal gadolinium MR myelography, and in 9/24 patients (38%), a CSF leak was seen on intrathecal gadolinium MR myelography (P = .011). Four of 6 leaks identified independently by intrathecal gadolinium MR myelography related to meningeal diverticula. CT myelography did not identify any leaks independently. There were no reported adverse events.
CONCLUSIONS
Present data demonstrate a higher rate of leak detection with intrathecal gadolinium MR myelography when investigating CSF leaks in our cohort of patients with spontaneous intracranial hypotension. Although intrathecal gadolinium is an FDA off-label use, all patients tolerated the medication without evidence of complications. Our data suggest that intrathecal gadolinium MR myelography is a well-tolerated examination with significant benefit in the evaluation of CSF leak, particularly for patients with leak related to meningeal diverticula.
Topics: Adult; Cerebrospinal Fluid Leak; Female; Gadolinium; Humans; Injections, Spinal; Intracranial Hypotension; Magnetic Resonance Imaging; Male; Middle Aged; Myelography; Off-Label Use; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 24852289
DOI: 10.3174/ajnr.A3975 -
Neuro-ophthalmology (Aeolus Press) 2022A 68-year-old woman with controlled hypertension, and degenerative joint disease of the spine for which she had undergone several myelograms and three surgeries...
A 68-year-old woman with controlled hypertension, and degenerative joint disease of the spine for which she had undergone several myelograms and three surgeries 30-32 years earlier, presented with a 2 year history of painless, oblique, binocular diplopia. Her prior ophthalmic evaluations were consistent with an isolated left trochlear nerve paresis. She had magnetic resonance imaging (MRI) showing multiple foci of T1-weighted hyperintensities around the midbrain and brainstem thought to represent subarachnoid fat from a ruptured dermoid cyst. An extensive evaluation revealed a left trochlear nerve paresis as well as diminished sensation in the distributions of the first and second divisions of the left trigeminal nerve. Review of her MRI and history of myelograms raised the possibility of focal inflammation from intrathecal iophendylate (Pantopaque®). Repeat MRI was obtained that showed T1-weighted hyperintensities similar to her previous MRI, but in this study, T1-weighted fat suppression imaging also was performed and revealed these foci to be of low signal intensity, consistent with retained iophendylate.
PubMed: 36544579
DOI: 10.1080/01658107.2022.2046110 -
Zhurnal Voprosy Neirokhirurgii Imeni N.... 2022Syndrome of spontaneous intracranial hypotension is increasingly described in the literature as a multifactorial disease with impairment of the quality of life and risk... (Review)
Review
UNLABELLED
Syndrome of spontaneous intracranial hypotension is increasingly described in the literature as a multifactorial disease with impairment of the quality of life and risk of mortality. CSF-venous fistula as a cause of intracranial hypotension syndrome is extremely rare and requires complex diagnosis and timely surgical treatment.
OBJECTIVE
We present a 55-year-old patient with acute spontaneous intracranial hypotension and spinal CSF-venous fistula. Literature data are also analyzed.
RESULTS
Algorithm for diagnosis and efficacy of microsurgical resection of CSF-venous fistula is demonstrated.
CONCLUSION
Intracranial hypotension following spinal fistula requires careful examination. Accurate understanding of pathophysiological and anatomical features of this disease is necessary to select an effective treatment method.
Topics: Cerebrospinal Fluid Leak; Fistula; Humans; Intracranial Hypotension; Magnetic Resonance Imaging; Middle Aged; Myelography; Quality of Life; Syndrome
PubMed: 35758077
DOI: 10.17116/neiro20228603141 -
AJNR. American Journal of Neuroradiology Feb 2019The significance of renal contrast on CT myelography is uncertain. This project examined different patient populations undergoing CT myelography for the presence of...
BACKGROUND AND PURPOSE
The significance of renal contrast on CT myelography is uncertain. This project examined different patient populations undergoing CT myelography for the presence of renal contrast to determine whether this finding is of diagnostic value in spontaneous intracranial hypotension.
MATERIALS AND METHODS
Four groups of patients were analyzed for renal contrast on CT myelography. The control group underwent CT myelography for reasons other than spontaneous intracranial hypotension ( = 47). Patients in study group 1 had spontaneous intracranial hypotension but CT myelography negative for dural CSF leak and CSF venous fistula ( = 83). Patients in study group 2 had spontaneous intracranial hypotension and CT myelography positive for dural CSF leak ( = 44). Patients in study group 3 had spontaneous intracranial hypotension and CT myelography suggestive of CSF venous fistula due to a hyperdense paraspinal vein ( = 17, eleven surgically confirmed).
RESULTS
Renal contrast was present on the initial CT myelography in 0/47 patients in the control group, 10/83 patients in group one, 1/44 patients in group 2, and 7/17 patients in group 3. Renal contrast on initial CT myelography in patients with suspected or surgically confirmed CSF venous fistula was significantly more likely than in patients with a dural CSF leak ( = .0003).
CONCLUSIONS
Renal contrast on initial CT myelography was seen only in patients with spontaneous intracranial hypotension. This was more common in confirmed/suspected CSF venous fistulas compared with dural leaks. Early renal contrast in patients with spontaneous intracranial hypotension should prompt scrutiny for a hyperdense paraspinal vein, and, if none is found, potentially advanced diagnostic studies.
Topics: Adult; Cerebrospinal Fluid Leak; Female; Humans; Intracranial Hypotension; Kidney Tubules, Collecting; Male; Middle Aged; Myelography; Tomography, X-Ray Computed
PubMed: 30655256
DOI: 10.3174/ajnr.A5934