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Comparative Study
. 2025 Feb 3;46(2):401-407.
doi: 10.3174/ajnr.A8436.

Safety and Technical Performance of Bilateral Decubitus CT Myelography Using Standard versus Increased Intrathecal Iodinated Contrast Volume

Diogo G L Edelmuth  1   2   3 , Renata V Leão  4   2 , Eduardo N K Filho  2   3 , Marcio N P Souza  4   3 , Marcelo Calderaro  4   3 , Peter G Kranz  5
Affiliations
Comparative Study

Safety and Technical Performance of Bilateral Decubitus CT Myelography Using Standard versus Increased Intrathecal Iodinated Contrast Volume

Diogo G L Edelmuth et al. AJNR Am J Neuroradiol. .

Abstract

Background and purpose: Lateral decubitus CT myelography (LDCTM) is one of the main studies for the detection of CSF-venous fistulas, but detection of CSF-venous fistulas is dependent on intrathecal contrast attenuation. The purpose of this investigation was to assess the tolerability and technical performance of increased intrathecal doses of myelographic contrast compared with standard doses.

Materials and methods: This is a retrospective series of 24 patients who underwent LDCTM following administration of either 10 or 20 mL of intrathecal iodinated contrast media (300 or 320 mg/mL of iodine content). Patients were scanned in the initial lateral decubitus position and then turned to the contralateral side and re-scanned in the same session. The safety and tolerability of the 20 mL dose was assessed from clinical records. The technical performance of the studies was compared between groups (10 or 20 mL) by measuring attenuation values over the lateral thecal sac at standardized levels. Both the initial scan and the scan after turning the patient to the contralateral side were assessed.

Results: No moderate or severe adverse event was recorded in either group. The 20-mL group showed higher attenuation values, which were statistically greater on the second side examined compared with the standard-dose group.

Conclusions: Increased volume of intrathecal contrast was well-tolerated and improved the technical performance of LDCTM in this limited series. Further assessment of the safety and impact on diagnostic yield using larger patient cohorts is warranted.

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References

    1. Kranz PG, Gray L, Malinzak MD, et al. . CSF-venous fistulas: anatomy and diagnostic imaging. AJR Am J Roentgenol 2021;217:1418–29 10.2214/AJR.21.26182 - DOI - PubMed
    1. Kranz PG, Gray L, Amrhein T. Decubitus CT myelography for detecting subtle CSF leaks in spontaneous intracranial hypotension. AJNR Am J Neuroradiol 2019;40:754–56 10.3174/ajnr.A5995 - DOI - PMC - PubMed
    1. Schievink W, Maya M, Moser F, et al. . Lateral decubitus digital subtraction myelography to identify spinal CSF-venous fistulas in spontaneous intracranial hypotension. J Neurosurg Spine 2019;13:1–4 10.3171/2019.6.SPINE19487 - DOI - PubMed
    1. Kim D, Brinjikji W, Morris P, et al. . Lateral decubitus digital subtraction myelography: tips, tricks, and pitfalls. AJNR Am J Neuroradiol 2020;41:21–28 10.3174/ajnr.A6368 - DOI - PMC - PubMed
    1. Carlton Jones L, Butteriss D, Scoffings D. Spontaneous intracranial hypotension: the role of radiology in diagnosis and management. Clin Radiol 2022;77:e181–94 10.1016/j.crad.2021.11.007 - DOI - PubMed

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