数字减影脊髓造影术后行锥束CT脊髓造影对检测脑脊液-静脉瘘的额外诊断价值。

Additional Diagnostic Value of Conebeam CT Myelography Performed after Digital Subtraction Myelography for Detecting CSF-Venous Fistulas.

作者信息

Madhavan Ajay A, Lutzen Niklas, Cutsforth-Gregory Jeremy K, Schievink Wouter I, Kodet Michelle L, Mark Ian T, Morris Pearse P, Messina Steven A, Wald John T, Brinjikji Waleed

机构信息

From the Division of Neuroradiology, Department of Radiology (A.A.M., M.L.K., I.T.M., P.P.M., S.A.M., J.T.W., W.B.), Mayo Clinic, Rochester, Minnesota

Department of Neurology (N.L.), Mayo Clinic, Rochester, Minnesota.

出版信息

AJNR Am J Neuroradiol. 2025 May 2;46(5):1044-1049. doi: 10.3174/ajnr.A8535.

DOI:10.3174/ajnr.A8535

PMID:39406513

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12091977/

Abstract

BACKGROUND AND PURPOSE

CSF-venous fistulas (CVFs) are a common cause of spontaneous intracranial hypotension. The diagnosis and precise localization of these fistulas hinges on specialized myelographic techniques, which mainly include decubitus digital subtraction myelography and decubitus CT myelography (by using either energy-integrating or photon-counting detector CT). A previous case series showed that conebeam CT myelography (CB-CTM), performed as an adjunctive tool with digital subtraction myelography, increased the detection of CVFs. Here, we sought to determine the additive yield of CB-CTM for CVF detection in a consecutive series of patients with spontaneous intracranial hypotension who underwent concurrent decubitus digital subtraction myelography and CB-CTM.

MATERIALS AND METHODS

We retrospectively searched our institutional database for all consecutive patients who underwent decubitus digital subtraction myelography with adjunctive CB-CTM between August 5, 2021 and August 5, 2024. We excluded any patients harboring extradural CSF on spine imaging, not meeting International Classification of Headache Disorders, 3rd edition criteria for spontaneous intracranial hypotension, or not having undergone technically successful CB-CTM in combination with digital subtraction myelography. All myelographic images were independently reviewed by 2 neuroradiologists. We calculated the diagnostic yield of both myelographic tests for localizing a CVF.

RESULTS

We identified 100 patients who underwent decubitus digital subtraction myelography with adjunctive conebeam CT. We excluded 15 patients based on above criteria. Fifty-nine of 85 patients had a single definitive CVF. Among positive cases, the fistula was visible on digital subtraction myelography in 38 of 59 patients and visible on CB-CTM in 59 of 59 patients. In 26 of 85 patients, no definitive fistula was identified by either technique.

CONCLUSIONS

CB-CTM increased the diagnostic yield for CVF detection and may be a useful addition to digital subtraction myelography.

摘要

背景与目的

脑脊液-静脉瘘（CVF）是自发性颅内低压的常见原因。这些瘘的诊断和精确定位依赖于专门的脊髓造影技术，主要包括卧位数字减影脊髓造影和卧位CT脊髓造影（使用能量积分或光子计数探测器CT）。先前的病例系列表明，作为数字减影脊髓造影的辅助工具进行的锥束CT脊髓造影（CB-CTM）增加了CVF的检出率。在此，我们试图确定在一系列连续的自发性颅内低压患者中，CB-CTM对CVF检测的附加价值，这些患者同时接受了卧位数字减影脊髓造影和CB-CTM。

材料与方法

我们回顾性检索了机构数据库中2021年8月5日至2024年8月5日期间所有接受辅助CB-CTM的卧位数字减影脊髓造影的连续患者。我们排除了脊柱成像显示硬膜外脑脊液、不符合《国际头痛疾病分类》第三版自发性颅内低压标准或未成功进行CB-CTM联合数字减影脊髓造影的任何患者。所有脊髓造影图像均由2名神经放射科医生独立审查。我们计算了两种脊髓造影检查对CVF定位的诊断率。