Resisted Inspiration Improves Visualization of CSF-Venous Fistulas in Spontaneous Intracranial Hypotension

Kranz, Peter G.; Malinzak, Michael; Gray, Linda; Willhite, Jay P; Amrhein, Timothy J.

doi:10.3174/ajnr.a7927

Cited by 11 publications

(1 citation statement)

References 14 publications

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“…The investigator then instructed the patient to stop moving and inhale slowly through a straw (3 mm diameter) to ensure continuous inspiration during LD-CTM, which has previously been reported to promote CVF outflow. [12][13][14] Immediately after injection of the second half of the contrast agent of 7-8 mL (the maximum dose of 15 mL per examination was not exceeded), a single CT scan was performed in the caudocranial direction covering an area from the spinal needle to the upper cervical spine.…”

Section: Patient Transport To the Ct Scannermentioning

confidence: 99%

Direct comparison of digital subtraction myelography versus CT myelography in lateral decubitus position: evaluation of diagnostic yield for cerebrospinal fluid-venous fistulas

Lützen,

Demerath,

Würtemberger

et al. 2023

J NeuroIntervent Surg

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BackgroundCerebrospinal fluid (CSF)-venous fistulas (CVFs) are increasingly identified as a cause of spontaneous intracranial hypotension (SIH). Lateral decubitus digital subtraction myelography (LD-DSM) and CT myelography (LD-CTM) are mainly used for detection, but the most sensitive method is yet unknown.ObjectiveTo compare LD-DSM with LD-CTM for diagnostic yield of CVFs.MethodsPatients with SIH diagnosed with a CVF between January 2021 and December 2022 in which the area of CVF(s) was covered by both diagnostic modalities were included. LD-CTM immediately followed LD-DSM without repositioning the spinal needle, and the second half of the contrast agent was injected at the CT scanner. Patients were awake or mildly sedated. Retrospectively, two neuroradiologists evaluated data independently and blinded for the presence of CVF.ResultsTwenty patients underwent a total of 27 combined LD-DSM/LD-CTM examinations (4/20 with follow-up and 3/20 with bilateral examinations). Both raters identified significantly more CVFs with LD-CTM than with LD-DSM (rater 1: 39 vs 9, P<0.001; rater 2: 42 vs 12, P<0.001). Inter-rater agreement was substantial for LD-DSM (κ=0.732) and LD-CTM (κ=0.655). The results remained significant after considering the senior rating for cases of disagreement (39 vs 10; P<0.001), and no CVF detected on LD-DSM was missed on LD-CTM.ConclusionIn this study, LD-CTM has a higher diagnostic yield for the detection of CVFs than LD-DSM and should supplement LD-DSM, but further studies are needed. LD-CTM can be easily acquired in awake or mildly sedated patients with the second half of contrast injected just before CT scanning, or it may be considered as a stand-alone investigation.

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Section: Patient Transport To the Ct Scannermentioning

confidence: 99%