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. 2025 May:121:110457.
doi: 10.1016/j.clinimag.2025.110457. Epub 2025 Mar 17.

Use of Spinosum Roentgen Index (S.R.I.) to determine candidacy for middle meningeal artery embolization

Stephen J Sozio  1 , Brian Holliday  2 , Erica Hallman  2 , Vance Cantrell  2 , Hussein Nasser  2 , Robert Williams  2 , Darryn Shaff  2 , Sri Hari Sundararajan  3
Affiliations

Use of Spinosum Roentgen Index (S.R.I.) to determine candidacy for middle meningeal artery embolization

Stephen J Sozio et al. Clin Imaging. 2025 May.

Abstract

Introduction: Middle meningeal artery embolization (MMAe) is a minimally-invasive approach for the treatment of subdural hematomas (SDH). Small vessel caliber and ectopic origin of the middle meningeal artery (MMA) may lead to unsuccessful embolization and/or serious morbidity. Thus, use of an objective scale to pre-procedurally assess candidacy for MMA embolization is an essential component of operative planning.

Methods: A retrospective analysis of all patients having undergone MMAe across 4 years at a single institution was performed.

Results: 169 MMAe procedures were performed for SDH, of which 3 were found to have a foramen spinosum diameter, termed the "Spinosum Roentgen Index" (SRI), measuring <2 mm on pre-procedure non-contrast CT Head. A statistically-significant correlation was found between foramen spinosum diameter <2 mm and unsuccessful embolization.

Conclusion: Assessment of foramen spinosum diameter (Spinosum Roentgen Index (SRI)) may increase suspicion for aberrant MMA anatomy when measuring <2 mm, which can serve as valuable data in assessing risk versus benefit of MMA embolization, and ultimately minimize unexpected intraprocedural or immediate postprocedural complications.

Keywords: CT; Embolization; Middle meningeal artery.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.