Article Figures & Data
Figures
- FIG 1.
Ventral dural tear localized on PC-CTM after negative prone DSM and negative prone dynamic EID CTM. Sagittal low-energy threshold (T3D) reconstructions from the first scan during dynamic PC-CTM demonstrate a ventral leak at T2–T3 (A, arrow). The leak remained visible on the second scan obtained 4 seconds later (not shown) but was barely visible on the third scan obtained after another 4 seconds (B, arrow), largely because of dense contrast that had already leaked into the epidural space. An axial 0.4-mm image from the first scan (C) clearly shows the precise site of the dural tear, which is slightly to the left of midline (C, arrow). This leak was occult on prone DSM (unsubtracted image D, arrow), as well as on prone dynamic EID CTM (not shown), both of which were performed before the PC-CTM.
- FIG 2.
Benefits of high spatial resolution in 2 patients with ventral dural tears. In the first patient (A and B), axial low-energy threshold (T3D) images from a prone dynamic PC-CTM demonstrate a thin column of epidural contrast that had leaked ventrally at T5–T6 (A and B, arrows). The contrast column is more exquisitely delineated from the vertebral body cortex when the same image is reconstructed at 0.2 mm compared with 0.4 mm. In the second patient, a ventral leak at T11 was diagnosed on prone DSM. A postmyelographic EID CT image at 0.6 mm (C) shows a questionable osseous excrescence at the level of the leak (C, arrow) without a definite spicule. Subsequent PCCT image at 0.2 mm (D) shows that this lesion is, in fact, a sharp osseous spicule arising from the vertebral cortex (D, arrow), confirming the presumed cause of the leak, which was later identified and repaired at surgery.
