Decubitus CT Myelography for Detecting Subtle CSF Leaks in Spontaneous Intracranial Hypotension.

P.G Kranz,T.J Amrhein,L Gray

doi:10.3174/ajnr.a5995

P.G Kranz, T.J Amrhein + Show 1 more

Open Access

https://doi.org/10.3174/ajnr.a5995

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Abstract

Spontaneous intracranial hypotension is caused by spinal CSF leaks, but the site of the leak is not always detected on spinal imaging. We report on the additional value of decubitus positioning during CT myelography in enhancing the detection of subtle leaks.

Highlights

MATERIALS AND METHODSSubjects This is a retrospective series of 5 patients with Spontaneous intracranial hypotension (SIH) treated between February 2016 and February 2018 in which an etiology of CSF leak was identified on CT myelography (CTM) performed with the patient in the lateral decubitus position
Spontaneous intracranial hypotension (SIH) is a condition caused by spinal CSF leaks, either into the epidural space or into an adjacent vein, known as a CSF venous fistula (CVF).[1,2] Detection of CSF leakage on spinal imaging helps confirm the diagnosis and is critical to guiding treatment.[3]
The mean number of CT myelography (CTM) examinations performed before the decubitus myelogram was 1.6

Summary

MATERIALS AND METHODS

Subjects This is a retrospective series of 5 patients with SIH treated between February 2016 and February 2018 in which an etiology of CSF leak was identified on CTM performed with the patient in the lateral decubitus position. Decubitus CTM of the spine was performed because previous prone CT myelograms had been unrevealing. In this case, bilateral decubitus scans were obtained immediately after the initial prone CTM did not show a leak. Axial MIP image (C) from that scan shows increased intravascular contrast with the patient in the decubitus position, suggestive of a CSF venous fistula (arrow). Axial MIP image (D) from a CTM performed after dynamic myelography on a subsequent day with the patient maintained in the decubitus position after contrast injection shows extensive filling of a paraspinal vein distal to the fistula (arrows)

RESULTS

DISCUSSION

CONCLUSIONS