Prevalence of hyperdense paraspinal vein sign in patients with spontaneous intracranial hypotension without dural CSF leak on standard CT myelography

Clark, Michael; Diehn, Felix E.; Verdoorn, Jared T.; Lehman, Vance T.; Liebo, Greta B.; Morris, Jonathan M.; Thielen, Kent R.; Wald, John T.; Kumar, Neeraj; Luetmer, Patrick H.

doi:10.5152/dir.2017.17220

Cited by 35 publications

(39 citation statements)

References 7 publications

(9 reference statements)

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“…6 The presence of a hyperdense paraspinal vein was evaluated subjectively. In cases of a hyperdense paraspinal vein identified in prior retrospective review of CTMs initially interpreted as negative, 4 reviewers had been asked to look for a linear/curvilinear opacified structure extending from the thecal sac or a nerve root sleeve suggesting a hyperdense paraspinal vein. 3 Only cases with a high index of suspicion were graded as positive (ie, if the case would be or had been interpreted positive clinically), and any case deemed positive for a hyperdense paraspinal vein was confirmed by 2 additional neuroradiologists.…”

Section: Imaging Reviewmentioning

confidence: 99%

“…The prevalence of this standard CTM marker of CVF has subsequently been evaluated, occurring in 7% of patients with SIH who do not have evidence of a dural CSF leak. 4 In nuclear medicine indium-111 ( 111 In) DTPA cisternography, early renal collecting system activity before 4 hours after injection is considered a sign of CSF leak. 5 We have noticed the presence of renal collecting system contrast (referred to as "renal contrast" from this point forward) on CTM performed for SIH and have wondered whether it is of any clinical significance because it is presumably a CTM correlate to early radiotracer activity in the renal collecting system.…”

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confidence: 99%

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Renal Contrast on CT Myelography: Diagnostic Value in Patients with Spontaneous Intracranial Hypotension

Kinsman

Verdoorn

Luetmer

et al. 2019

AJNR Am J Neuroradiol

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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 (n ϭ 47). Patients in study group 1 had spontaneous intracranial hypotension but CT myelography negative for dural CSF leak and CSF venous fistula (n ϭ 83). Patients in study group 2 had spontaneous intracranial hypotension and CT myelography positive for dural CSF leak (n ϭ 44). Patients in study group 3 had spontaneous intracranial hypotension and CT myelography suggestive of CSF venous fistula due to a hyperdense paraspinal vein (n ϭ 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 (P ϭ .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.

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Section: Imaging Reviewmentioning

confidence: 99%

mentioning

confidence: 99%

Renal Contrast on CT Myelography: Diagnostic Value in Patients with Spontaneous Intracranial Hypotension

Kinsman

Verdoorn

Luetmer

et al. 2019

AJNR Am J Neuroradiol

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“…None of the SLEC(-) patients had a hyperdense paraspinal vein. In several studies the detection rate for CSFVF varied substantially depending on the imaging modality used and the time from contrast agent injection to PMCT [23][24][25]. Recently, Schievink et al reported a high yield for detection of CSFVF on digital subtraction myelography in lateral decubitus position [26].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…CVFs are typically found in the thoracic spine. The lower thoracic levels between T7 and T12 are the most common locations, although upper thoracic CVFs are frequently encountered as well [4][5][6][7]. Fistulas in the upper lumbar or lower cervical levels are less common but have also been reported [4,5,8].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Filling of paraspinal veins can be subtle, with only small areas of venous opacification seen or subtle differences in attenuation between veins draining a fistula and normal adjacent veins. One study examining CTMs performed on patients with SIH before widespread recognition of CVFs found that, in retrospect, 7 out of 101 myelograms thought at the time to show no abnormality actually showed evidence of a CVF that was not identified on the original interpretation [6].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

CSF–Venous Fistulas: Anatomy and Diagnostic Imaging

Kranz

Gray

Malinzak

et al. 2021

American Journal of Roentgenology

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The publication of this Accepted Manuscript is provided to give early visibility to the contents of the article, which will undergo additional copyediting, typesetting, and review before it is published in its final form. During the production process, errors may be discovered that could affect the content of the Accepted Manuscript. All legal disclaimers that apply to the journal pertain. The reader is cautioned to consult the definitive version of record before relying on the contents of this document.

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Prevalence of hyperdense paraspinal vein sign in patients with spontaneous intracranial hypotension without dural CSF leak on standard CT myelography

Cited by 35 publications

References 7 publications

Renal Contrast on CT Myelography: Diagnostic Value in Patients with Spontaneous Intracranial Hypotension

Renal Contrast on CT Myelography: Diagnostic Value in Patients with Spontaneous Intracranial Hypotension

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

CSF–Venous Fistulas: Anatomy and Diagnostic Imaging

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