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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Video ArticleSpine Imaging and Spine Image-Guided Interventions
Open Access

Introduction to Digital Subtraction Myelography for CSF-Venous Fistula Detection

Ian T. Mark, Ajay A. Madhavan, John Benson, Jared Verdoorn and Waleed Brinjikji
American Journal of Neuroradiology January 2025, 46 (1) 219; DOI: https://doi.org/10.3174/ajnr.A8587
Ian T. Mark
aFrom the Mayo Clinic, Department of Radiology, Rochester, Minnesota
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Ajay A. Madhavan
aFrom the Mayo Clinic, Department of Radiology, Rochester, Minnesota
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John Benson
aFrom the Mayo Clinic, Department of Radiology, Rochester, Minnesota
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Jared Verdoorn
aFrom the Mayo Clinic, Department of Radiology, Rochester, Minnesota
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Waleed Brinjikji
aFrom the Mayo Clinic, Department of Radiology, Rochester, Minnesota
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ABSTRACT

The purpose of this video is to introduce digital subtraction myelography for CSF-venous fistula (CVF) detectection.1⇓-3 CVF is the most recently identified and likely the most prevalent type of spinal CSF leak that leads to spontaneous intracranial hypotension4,5 CVFs are occult on conventional MRI and CT, necessitating the use of myelography for the diagnosis. This video highlights one such technique, which is important because an increasing number of centers are starting to diagnose CVF.

Video 1.

The purpose of this video is to introduce digital subtraction myelography for CSF-venous fistula (CVF) detectection.1⇓-3 CVF is the most recently identified and likely the most prevalent type of spinal CSF leak that leads to spontaneous intracranial hypotension4,5 CVFs are occult on conventional MRI and CT, necessitating the use of myelography for the diagnosis. This video highlights one such technique, which is important because an increasing number of centers are starting to diagnose CVF.

Footnotes

  • Disclosure forms provided by the authors are available with the full text and PDF of this article at www.ajnr.org.

Indicates open access to non-subscribers at www.ajnr.org

References

  1. 1.
    1. Kim DK,
    2. Brinjikji W,
    3. Morris PP, et al
    . Lateral decubitus digital subtraction myelography: tips, tricks, and pitfalls. AJNR Am J Neuroradiol 2020;41:21–28 doi:10.3174/ajnr.A6368 pmid:31857327
  2. 2.
    1. Hoxworth JM,
    2. Trentman TL,
    3. Kotsenas AL, et al
    . The role of digital subtraction myelography in the diagnosis and localization of spontaneous spinal CSF leaks. AJR Am J Roentgenol 2012;199:649–53 doi:10.2214/AJR.11.8238 pmid:22915407
  3. 3.
    1. Mark I,
    2. Madhavan A,
    3. Oien M, et al
    . Temporal characteristics of CSF-venous fistulas on digital subtraction myelography. AJNR Am J Neuroradiol 2023;44:492–95 doi:10.3174/ajnr.A7809 pmid:36894299
  4. 4.
    1. Schievink WI,
    2. Moser FG,
    3. Maya MM
    . CSF-venous fistula in spontaneous intracranial hypotension. Neurology 2014;83:472–73 doi:10.1212/WNL.0000000000000639 pmid:24951475
  5. 5.
    1. Mamlouk MD,
    2. Callen AL,
    3. Madhavan AA, et al
    . Spinal CSF leaks: the neuroradiologist transforming care. AJNR Am J Neuroradiol 2024;45:1613–20 doi:10.3174/ajnr.A8484 pmid:39209484
  • Received October 6, 2024.
  • Accepted after revision November 4, 2024.
  • © 2025 by American Journal of Neuroradiology
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Print ISSN: 0195-6108 Online ISSN: 1936-959X

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