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Research ArticleSPINE IMAGING AND SPINE IMAGE-GUIDED INTERVENTIONS

Diagnostic Yield of Decubitus CT Myelography for Detection of CSF-Venous Fistulas

Jacob T. Gibby, Timothy J. Amrhein, Derek S. Young, Jessica L. Houk and Peter G. Kranz
American Journal of Neuroradiology August 2024, DOI: https://doi.org/10.3174/ajnr.A8330
Jacob T. Gibby
aFrom the Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Timothy J. Amrhein
aFrom the Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Derek S. Young
aFrom the Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Jessica L. Houk
aFrom the Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Peter G. Kranz
aFrom the Department of Radiology, Duke University Medical Center, Durham, North Carolina
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    FIG 1.

    Illustration of the hips elevated with the assistance of a foam wedge, and the head elevated on pillows, allowing contrast to pool in the thoracic spine.

  • FIG 2.
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    FIG 2.

    Examples of CVFs seen on CTM. Axial image from CTM obtained with the patient in the right lateral decubitus position (A) shows venous contrast opacification, indicating the presence of a CVF in a segmental spinal vein (white arrow). Axial image from CTM performed with the patient in the prone position (B) shows contrast opacification of the internal epidural venous plexus within the spinal canal (white arrow), also diagnostic of a CVF.

  • FIG 3.
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    FIG 3.

    Examples of equivocal CVFs requiring adjudication. Axial (A) and sagittal (B) images from CTM in a single subject show subtle increased attenuation of a foraminal vein and adjacent segmental spinal vein (white arrows); this increased attenuation was judged to represent a CVF after a consensus read. Axial (C) and sagittal (D) images from CTM in a second subject whose faint increased attenuation posterior to the perineural diverticulum (black arrowhead) and anterior to the same diverticulum (white arrowhead) was judged to be not definitive enough to diagnose as a CVF following consensus read.

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    FIG 4.

    Flow chart of patient selection.

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    FIG 5.

    Results of diagnostic yield of prone and decubitus myelography for CVF detection.

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Cite this article
Jacob T. Gibby, Timothy J. Amrhein, Derek S. Young, Jessica L. Houk, Peter G. Kranz
Diagnostic Yield of Decubitus CT Myelography for Detection of CSF-Venous Fistulas
American Journal of Neuroradiology Aug 2024, DOI: 10.3174/ajnr.A8330

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Diagnostic Yield of Decubitus CT Myelography for Detection of CSF-Venous Fistulas
Jacob T. Gibby, Timothy J. Amrhein, Derek S. Young, Jessica L. Houk, Peter G. Kranz
American Journal of Neuroradiology Aug 2024, DOI: 10.3174/ajnr.A8330
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  • Additional Diagnostic Value of Conebeam CT Myelography Performed after Digital Subtraction Myelography for Detecting CSF-Venous Fistulas
  • Assessing the Diagnostic Value of Brain White Matter Hyperintensities and Clinical Symptoms in Predicting the Detection of CSF-Venous Fistula in Patients with Suspected Spontaneous Intracranial Hypotension
  • Density and Time Characteristics of CSF-Venous Fistulas on CT Myelography in Patients with Spontaneous Intracranial Hypotension
  • Spinal CSF Leaks: The Neuroradiologist Transforming Care
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