Renal Pelvis Opacification on Postmyelography Computed Tomography as an Indicator for Cerebrospinal Fluid Loss in Spontaneous Intracranial Hypotension.

Piechowiak, Eike I.; Bär, Laura; Häni, Levin; Branca, Mattia; Kaesmacher, Johannes; Mordasini, Pasquale; Raabe, Andreas; Ulrich, Christian T.; Gralla, Jan; Beck, Jürgen; Dobrocky, Tomas (2022). Renal Pelvis Opacification on Postmyelography Computed Tomography as an Indicator for Cerebrospinal Fluid Loss in Spontaneous Intracranial Hypotension. Clinical neuroradiology, 32(2), pp. 529-536. Springer-Verlag 10.1007/s00062-021-01042-0

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PURPOSE

To assess early renal pelvis opacification on postmyelography computed tomography (CT) as a marker for cerebrospinal fluid (CSF) loss in patients with spontaneous intracranial hypotension (SIH).

METHODS

The SIH patients referred to our hospital between January 2012 and May 2018 were retrospectively reviewed and divided into 2 groups based on the presence of spinal longitudinal extrathecal CSF collection (SLEC): (1) SLEC(+) with, and (2) SLEC(-) without proof of SLEC on multimodal imaging. Non-SIH patients (n = 20) undergoing CT myelography served as controls. The renal pelvis density on postmyelography CT was measured in all patients. Mean difference in renal pelvis density between the groups was calculated.

RESULTS

In total, 111 SIH patients (mean age 48 ± 13 years; 60% female) were included, 71 (64%) SLEC(+) and 40 (36%) SLEC(-). The adjusted renal pelvis density in the SLEC(+), SLEC(-), and the non-SIH group was 108 Hounsfield unit (HU), 83 HU, and 32 HU, respectively, resulting in a significant difference between SLEC(+) vs. control group 1 (75 HU, p < 0.001), SLEC(-) vs. control group 1 (50 HU, p < 0.001), and a tendency for higher density in SLEC(+) than SLEC(-) (25 HU, p = 0.16).

CONCLUSION

Increased renal pelvis opacification on postmyelography CT was observed in SIH patients, even in the absence of a CSF leak or a CSF venous fistula, when compared to non-SIH patients. Although the provenance of early renal opacification in SLEC (-) SIH patients remains unclear, our results suggest that it may be a surrogate for increased spinal CSF resorption via spinal arachnoid granulations and along spinal nerve sheaths occult to direct imaging.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)
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:

Piechowiak, Eike Immo, Häni, Levin, Branca, Mattia, Kaesmacher, Johannes, Mordasini, Pasquale Ranato, Raabe, Andreas, Ulrich, Christian Thomas (A), Gralla, Jan, Beck, Jürgen, Dobrocky, Tomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1869-1447

Publisher:

Springer-Verlag

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

29 Jun 2021 17:12

Last Modified:

20 Feb 2024 14:16

Publisher DOI:

10.1007/s00062-021-01042-0

PubMed ID:

34170368

Additional Information:

Open Access funding by University of Bern (Read and Publish Agreement with SpringerNature)

Uncontrolled Keywords:

CSF leak CSF resorption CSF venous fistula Orthostatic headache Spine

BORIS DOI:

10.48350/157159

URI:

https://boris.unibe.ch/id/eprint/157159

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