Cryptogenic Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension: Role of Dynamic CT Myelography.

Dobrocky, Tomas; Mosimann, Pascal John; Zibold, Felix; Mordasini, Pasquale; Raabe, Andreas; Ulrich, Christian Thomas; Gralla, Jan; Beck, Jürgen; Piechowiak, Eike Immo (2018). Cryptogenic Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension: Role of Dynamic CT Myelography. Radiology, 289(3), pp. 766-772. Radiological Society of North America RSNA 10.1148/radiol.2018180732

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Purpose To propose a modified dynamic CT myelographic technique to locate cerebrospinal fluid (CSF) leaks, also known as cryptogenic leaks, in patients with spontaneous intracranial hypotension (SIH) in whom previous imaging did not show the dural breach. Materials and Methods This retrospective analysis included 74 consecutive patients with SIH and a myelographically proven CSF leak who were evaluated between February 2013 and October 2017. In 14 patients, dynamic CT myelography in the prone or lateral position showed the exact leakage point after unsuccessful previous imaging. During image analysis, the first time point showing extrathecal contrast material was defined as the site of dural breach point. Results Mean population age was 44 years (range, 25-65 years [nine women; mean age, 44 years; age range, 25-65 years] [five men; mean age, 46 years; age range, 29-61 years]). All patients had previously undergone spine MRI, conventional dynamic myelography, and CT myelography. Subsequent dynamic CT myelography covered a mean range of seven vertebral levels. The leak was caused by a calcified microspur in 10 patients and by a dural tear at the axilla of a spinal nerve root in the remaining four. The mean volume CT dose index of dynamic CT myelography was 107 mGy (range, 12-246 mGy), and the mean dose-length product was 1347 mGy·cm (range, 550-3750 mGy·cm). Conclusion Dynamic CT myelography is a valuable adjunctive tool with which to identify the precise location of a dural tear when other examinations are unsuccessful. © RSNA, 2018 See also the editorial by Dillon in this issue.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Dobrocky, Tomas; Mosimann, Pascal John; Zibold, Felix; Mordasini, Pasquale; Raabe, Andreas; Ulrich, Christian Thomas; Gralla, Jan; Beck, Jürgen and Piechowiak, Eike Immo

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0033-8419

Publisher:

Radiological Society of North America RSNA

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

24 Sep 2018 11:17

Last Modified:

21 Nov 2018 01:32

Publisher DOI:

10.1148/radiol.2018180732

PubMed ID:

30226459

URI:

https://boris.unibe.ch/id/eprint/120089

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