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

Research ArticleSpine Imaging and Spine Image-Guided Interventions

Renal Contrast on CT Myelography: Diagnostic Value in Patients with Spontaneous Intracranial Hypotension

K.A. Kinsman, J.T. Verdoorn, P.H. Luetmer, M.S. Clark and F.E. Diehn
American Journal of Neuroradiology January 2019, DOI: https://doi.org/10.3174/ajnr.A5934
K.A. Kinsman
aFrom the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
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J.T. Verdoorn
aFrom the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
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P.H. Luetmer
aFrom the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
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M.S. Clark
aFrom the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
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F.E. Diehn
aFrom the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
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Abstract

BACKGROUND AND PURPOSE: The significance of renal contrast on CT myelography is uncertain. This project examined different patient populations undergoing CT myelography for the presence of renal contrast to determine whether this finding is of diagnostic value in spontaneous intracranial hypotension.

MATERIALS AND METHODS: Four groups of patients were analyzed for renal contrast on CT myelography. The control group underwent CT myelography for reasons other than spontaneous intracranial hypotension (n = 47). Patients in study group 1 had spontaneous intracranial hypotension but CT myelography negative for dural CSF leak and CSF venous fistula (n = 83). Patients in study group 2 had spontaneous intracranial hypotension and CT myelography positive for dural CSF leak (n = 44). Patients in study group 3 had spontaneous intracranial hypotension and CT myelography suggestive of CSF venous fistula due to a hyperdense paraspinal vein (n = 17, eleven surgically confirmed).

RESULTS: Renal contrast was present on the initial CT myelography in 0/47 patients in the control group, 10/83 patients in group one, 1/44 patients in group 2, and 7/17 patients in group 3. Renal contrast on initial CT myelography in patients with suspected or surgically confirmed CSF venous fistula was significantly more likely than in patients with a dural CSF leak (P = .0003).

CONCLUSIONS: Renal contrast on initial CT myelography was seen only in patients with spontaneous intracranial hypotension. This was more common in confirmed/suspected CSF venous fistulas compared with dural leaks. Early renal contrast in patients with spontaneous intracranial hypotension should prompt scrutiny for a hyperdense paraspinal vein, and, if none is found, potentially advanced diagnostic studies.

ABBREVIATIONS:

CTM
CT myelography
CVF
CSF venous fistula
SIH
spontaneous intracranial hypotension

Footnotes

  • Paper previously presented orally at: Annual Meeting of the American Society of Spine Radiology, February 23–26, 2017; San Diego, California.

  • © 2019 by American Journal of Neuroradiology
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Cite this article
K.A. Kinsman, J.T. Verdoorn, P.H. Luetmer, M.S. Clark, F.E. Diehn
Renal Contrast on CT Myelography: Diagnostic Value in Patients with Spontaneous Intracranial Hypotension
American Journal of Neuroradiology Jan 2019, DOI: 10.3174/ajnr.A5934

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Renal Contrast on CT Myelography: Diagnostic Value in Patients with Spontaneous Intracranial Hypotension
K.A. Kinsman, J.T. Verdoorn, P.H. Luetmer, M.S. Clark, F.E. Diehn
American Journal of Neuroradiology Jan 2019, DOI: 10.3174/ajnr.A5934
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