Lateral decubitus dynamic CT myelography for fast cerebrospinal fluid leak localization

Ajay A. Madhavan, Jared T. Verdoorn, Darya P. Shlapak, Matt C. Pope, John C. Benson, Felix Diehn, Greta B. Liebo, Vance T. Lehman, Dong Kun Kim, Michael P. Oien, Jeremy K. Cutsforth-Gregory, Carrie Carr

Research output: Contribution to journalArticlepeer-review

Abstract

Dynamic CT myelography is used to precisely localize fast spinal CSF leaks. The procedure is most commonly performed in the prone position, which successfully localizes most fast ventral leaks. We have recently encountered a small subset of patients in whom prone dynamic CT myelography is unsuccessful in localizing leaks. We sought to determine the added value of lateral decubitus dynamic CT myelography, which is occasionally attempted in our practice, in localizing the leak after failed prone dynamic CT myelography. We retrospectively identified 6 patients who underwent lateral decubitus dynamic CT myelography, which was performed in each case because their prone dynamic CT myelogram was unrevealing. Two neuroradiologists independently reviewed preprocedural spine MRI and all dynamic CT myelograms for each patient. Lateral decubitus positioning allowed for precise leak localization in all 6 patients. Five of six patients were noted to have dorsal and/or lateral epidural fluid collections on spine MRI. One patient had a single prominent diverticulum on spine MRI (larger than 6 mm), whereas the others had no prominent diverticula. Our study suggests that institutions performing dynamic CT myelography to localize fast leaks should consider a lateral decubitus study if performing the study in the prone position is unrevealing. Furthermore, the presence of dorsal and/or lateral epidural fluid collections on spine MRI may suggest that a lateral decubitus study is of higher yield and could be considered initially.

Original languageEnglish (US)
JournalNeuroradiology
DOIs
StateAccepted/In press - 2022

Keywords

  • Dynamic CT myelography
  • Extradural fluid collection
  • Fast CSF leak
  • High flow CSF leak
  • Lateral decubitus

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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