Thien J. Huynh, Donna Parizadeh, Ahmed K. Ahmed, Christopher T. Gandia, Hal C. Davison, John V. Murray, Ian T. Mark, Ajay A. Madhavan, Darya Shlapak, Todd D. Rozen, Waleed Brinjikji, Prasanna Vibhute, Vivek Gupta, Kacie Brewer, Olga Fermo
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引用次数: 0
Abstract
BACKGROUND AND PURPOSE:
CSF-venous fistulas (CVFs) associated with spontaneous intracranial hypotension (SIH) may have a transient appearance, relative to contrast arrival, which may influence the diagnostic performance of lateral decubitus CT myelography (CTM). We developed a dynamic CTM protocol using real-time bolus-tracking (dCTM-BT) to improve the temporal resolution and standardize the timing of CTM acquisitions post-intrathecal contrast administration. The purpose of our study was to evaluate the feasibility of the dCTM-BT technique and evaluate its diagnostic yield for CVF detection, stratified by brain MRI SIH findings.
MATERIALS AND METHODS:
Patients with suspected SIH without extradural fluid collection on spine MRI who underwent dCTM-BT were retrospectively reviewed. CT bolus monitoring was performed at the upper thoracic level. Following the visualization of dense intrathecal contrast, at least 3 CTM acquisitions of the spine were obtained and reviewed by 2 neuroradiologists. The Bern SIH score was calculated on the brain MRI. The diagnostic yield for CVF detection was evaluated, stratified by Bern score categories and a receiver operating characteristic (ROC) analysis.
RESULTS:
Out of 48 patients, 23 (48%) had a CVF on dCTM-BT, located at T1–5 (n = 4), T6–12 (n = 18), L1 (n = 1), with 70% on the right. CVF was identified in 22/22 (100%) of patients who had a high Bern score, 1/7 (14%) of those who had an intermediate score, and 0/19 (0%) of those who had a low score. The area under the ROC curve was 0.99 (95% CI, 0.98–1.00). The optimal cutoff was a Bern score of ≥5 (96% sensitivity, 100% specificity).
CONCLUSIONS:
dCTM-BT is feasible and has excellent diagnostic performance for CVF identification/localization. The Bern score is strongly associated with CVF detection and may help inform who will benefit from dCTM-BT.
期刊介绍：
The mission of AJNR is to further knowledge in all aspects of neuroimaging, head and neck imaging, and spine imaging for neuroradiologists, radiologists, trainees, scientists, and associated professionals through print and/or electronic publication of quality peer-reviewed articles that lead to the highest standards in patient care, research, and education and to promote discussion of these and other issues through its electronic activities.
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