CT Myelography More Accurately Detects CSF Leakage

In spontaneous intracranial hypotension, CTM better than radioisotope cisternography

MONDAY, Feb. 20 (HealthDay News) -- Cerebrospinal fluid (CSF) leakage may be detected more accurately in patients with spontaneous intracranial hypotension (SIH) using epidural collection on computed tomography myelography (CTM) rather than paraspinal radioisotope (RI) accumulation on radioisotope cisternography (RIC), according to a study published in the Feb. 15 issue of Spine.

To compare the usefulness of RIC and CTM for detecting CSF leakage in SIH, Keiji Hashizume, M.D., of Nara Medical University in Kashihara, Japan, and associates conducted a retrospective study of 12 patients (average age, 37.9 years) treated for complaints of typical postural headache.

The researchers found that, on RIC, the detection rate of leakage, including indirect signs (early vesicular RI accumulation and delayed ascent of the RI to the cerebral convexity), was seen in 100 percent of patients, but leakage based on the direct sign (paraspinal RI accumulation) was seen in 67 percent of patients. On CTM, epidural collection of intraspinally administered contrast medium was seen in 100 percent of patients, and in most cases, the collection site was located in the cervical or thoracic vertebral regions. Paraspinal accumulation in the cervical and thoracic regions on RIC correlated with the entire or a part of the findings on CTM, whereas in four of five patients with paraspinal accumulation in the lumbrosacral region, epidural collection was not seen in this region on CTM.

"In patients with SIH, epidural collection on CTM may more accurately demonstrate CSF leakage compared with paraspinal RI accumulation on RIC," the authors write.

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