Artikel
Cryptogenic cerebrospinal fluid leaks in spontaneous intracranial hypotension – role of dynamic CT myelography
Komplexe Lokalisationsdiagnostik spinaler Liquorlecks bei spontaner intrakranieller Hypertension – die Rolle der dynamischen CT-Myelographie
Suche in Medline nach
Autoren
Veröffentlicht: | 8. Mai 2019 |
---|
Gliederung
Text
Objective: 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.
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.
Figure 1 [Fig. 1]
Figure 2 [Fig. 2]