Malvea Anahita, Chung Emily, Nasralla Mehran, Hendriks Eef J, Farb Richard I
Department of Medical Imaging, University of Toronto, Canada.
Department of Medical Imaging, Division of Neuroradiology, University of Toronto, Canada.
Interv Neuroradiol. 2025 Sep 16:15910199251375541. doi: 10.1177/15910199251375541.
Dynamic myelography, performed as digital subtraction myelography or dynamic computed tomography myelography, is crucial in diagnosing intracranial hypotension resulting from a cerebrospinal fluid-venous fistula (CVF). The quality of the myelogram is paramount for accurate diagnosis. Using a phantom, the impact of needle type (Quincke vs. Whitacre), caliber, side-hole position, and rate of injection on the quality of the myelogram was determined. The ideal decubitus myelogram would provide a large volume of a hyperdense contrast within the lateral dependent aspect of the thecal sac, optimally flooding the mouths of the neural foramina and root sleeves where the vast majority of CVFs originate. The results of this study suggest it is exclusively the rate of injection that most predictably dictates the quality of the myelogram in this regard. Specifically, a slow injection rate, on the order of 0.1 mL/s, should be opted for to decrease turbulence, optimize myelogram quality, and thus improve CVF detection in clinical practice.
动态脊髓造影，以数字减影脊髓造影或动态计算机断层扫描脊髓造影的形式进行，对于诊断由脑脊液 - 静脉瘘（CVF）引起的颅内低压至关重要。脊髓造影的质量对于准确诊断至关重要。使用体模，确定了针型（昆克针与惠塔克针）、口径、侧孔位置和注射速率对脊髓造影质量的影响。理想的卧位脊髓造影应在硬膜囊外侧下垂部位提供大量高密度造影剂，最佳地充盈绝大多数CVF起源处的神经孔和神经根袖的开口。这项研究的结果表明，在这方面，最可预测地决定脊髓造影质量的完全是注射速率。具体而言，应选择约0.1 mL/s的缓慢注射速率，以减少湍流，优化脊髓造影质量，从而在临床实践中改善CVF的检测。
