The Experts below are selected from a list of 2577 Experts worldwide ranked by ideXlab platform
Felix E Diehn - One of the best experts on this subject based on the ideXlab platform.
-
diagnostic yield of intrathecal gadolinium mr Myelography for csf leak localization
Clinical Neuroradiology-klinische Neuroradiologie, 2021Co-Authors: Ajay A Madhavan, Carrie M Carr, Waleed Brinjikji, Pearse P Morris, Felix E Diehn, Vance T Lehman, Greta B Liebo, John C Benson, Dong Kun Kim, Darya P ShlapakAbstract:Intrathecal gadolinium magnetic resonance (MR) Myelography can be used to localize various types of spinal cerebrospinal fluid (CSF) leaks; however, its diagnostic yield is not well known. We sought to determine the diagnostic yield of MR Myelography in patients with spontaneous intracranial hypotension. A retrospective review was performed on all patients who had undergone intrathecal gadolinium MR Myelography at our institution from 2002 to 2020 for suspected spinal CSF leak. The MR Myelography images were reviewed for the presence or absence of a spinal CSF leak site. Images were also evaluated for the presence an extradural fluid collection. A total of 97 patients were included in the final cohort. The average age was 52.6 years; 67.0% were female, 4 patients underwent 2 examinations each, yielding a total of 101 MR myelograms. The source of a spinal CSF leak was localized in 14 patients. The diagnostic yield for CSF leak localization on intrathecal gadolinium MR Myelography was 14/101 (13.9%) per GdM examination and 14/97 (14.4%) per patient. Among the subset of patients without extradural fluid collections, the yield was 15.7% per examination. All detected leaks were either CSF-venous fistulas or distal nerve root sleeve tears. Intrathecal gadolinium MR Myelography is capable of localizing CSF-venous fistulas and distal nerve root sleeve tears; however, our data show that it has a limited diagnostic yield. We suggest that other modalities may be a better first step before attempting intrathecal gadolinium MR Myelography.
-
lateral decubitus digital subtraction Myelography tips tricks and pitfalls
American Journal of Neuroradiology, 2020Co-Authors: D K Kim, Waleed Brinjikji, Pearse P Morris, Felix E Diehn, Vance T Lehman, Greta B Liebo, Jonathan M Morris, Jared T Verdoorn, Jeremy K Cutsforthgregory, Richard I FarbAbstract:Digital subtraction Myelography is a valuable diagnostic technique to detect the exact location of CSF leaks in the spine to facilitate appropriate diagnosis and treatment of spontaneous spinal CSF leaks. Digital subtraction Myelography is an excellent diagnostic tool for assessment of various types of CSF leaks, and lateral decubitus digital subtraction Myelography is increasingly being used to diagnose CSF-venous fistulas. Lateral decubitus digital subtraction Myelography differs from typical CT and fluoroscopy-guided myelograms in many ways, including equipment, supplies, and injection and image-acquisition techniques. Operators should be familiar with techniques, common pitfalls, and artifacts to improve diagnostic yield and prevent nondiagnostic examinations.
-
renal contrast on ct Myelography diagnostic value in patients with spontaneous intracranial hypotension
American Journal of Neuroradiology, 2019Co-Authors: Kristin A Kinsman, Patrick H Luetmer, Jared T Verdoorn, Michael S Clark, Felix E DiehnAbstract: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.
-
ultrafast dynamic computed tomography Myelography for the precise identification of high flow cerebrospinal fluid leaks caused by spiculated spinal osteophytes
Journal of Neurosurgery, 2015Co-Authors: Kent R Thielen, Felix E Diehn, Jonathan M Morris, John C Sillery, Joseph M Hoxworth, John T Wald, Richard E Rosebrock, Patrick H LuetmerAbstract:OBJECT Precise localization and understanding of the origin of spontaneous high-flow spinal CSF leaks is required prior to targeted treatment. This study demonstrates the utility of ultrafast dynamic CT Myelography for the precise localization of high-flow CSF leaks caused by spiculated spinal osteophytes. METHODS This study reports a series of 14 patients with high-flow CSF leaks caused by spiculated spinal osteophytes who underwent ultrafast dynamic CT Myelography between March 2009 and December 2010. There were 10 male and 4 female patients, with an average age of 49 years (range 37–74 years). The value of ultrafast dynamic CT Myelography in depicting the CSF leak site was qualitatively assessed. RESULTS In all 14 patients, ultrafast dynamic CT Myelography was technically successful at precisely demonstrating the site of the CSF leak, the causative spiculated osteophyte piercing the dura, and the relationship of the implicated osteophyte to adjacent structures. Leak sites included 3 cervical, 11 thorac...
D K Kim - One of the best experts on this subject based on the ideXlab platform.
-
safety of consecutive bilateral decubitus digital subtraction Myelography in patients with spontaneous intracranial hypotension and occult csf leak
American Journal of Neuroradiology, 2020Co-Authors: M C Pope, Carrie M Carr, Waleed Brinjikji, D K KimAbstract:BACKGROUND AND PURPOSE: Digital subtraction Myelography performed with the patient in the lateral decubitus position has the potential for increased sensitivity over prone-position Myelography in the detection of spinal CSF-venous fistulas, a well-established cause of spontaneous intracranial hypotension. We report on the safety of performing routine, consecutive-day right and left lateral decubitus digital subtraction Myelography in these patients. MATERIALS AND METHODS: In this retrospective case series, all patients undergoing consecutive-day lateral decubitus digital subtraction Myelography for suspected spinal CSF leak between September 2018 and September 2019 were identified. Chart review was performed to identify any immediate or delayed adverse effects associated with the procedures. Procedural parameters were also analyzed due to inherent variations associated with the positive-pressure Myelography technique that was used. RESULTS: A total of 60 patients underwent 68 pairs of consecutive-day lateral decubitus digital subtraction myelographic examinations during the study period. No major adverse effects were recorded. Various minor adverse effects were observed, including pain requiring analgesics (27.2%), nausea/vomiting requiring antiemetics (8.1%), and transient neurologic effects such as syncope, vertigo, altered mental status, and autonomic dysfunction (5.1%). Minor transient neurologic effects were correlated with increasing volumes of intrathecal saline injectate used for thecal sac prepressurization. CONCLUSIONS: In patients with spontaneous intracranial hypotension and suspected spontaneous spinal CSF leak, consecutive-day lateral decubitus digital subtraction Myelography demonstrates an acceptable risk profile without evidence of neurotoxic effects from cumulative intrathecal contrast doses. Higher intrathecal saline injectate volumes may correlate with an increased incidence of minor transient periprocedural neurologic effects.
-
lateral decubitus digital subtraction Myelography tips tricks and pitfalls
American Journal of Neuroradiology, 2020Co-Authors: D K Kim, Waleed Brinjikji, Pearse P Morris, Felix E Diehn, Vance T Lehman, Greta B Liebo, Jonathan M Morris, Jared T Verdoorn, Jeremy K Cutsforthgregory, Richard I FarbAbstract:Digital subtraction Myelography is a valuable diagnostic technique to detect the exact location of CSF leaks in the spine to facilitate appropriate diagnosis and treatment of spontaneous spinal CSF leaks. Digital subtraction Myelography is an excellent diagnostic tool for assessment of various types of CSF leaks, and lateral decubitus digital subtraction Myelography is increasingly being used to diagnose CSF-venous fistulas. Lateral decubitus digital subtraction Myelography differs from typical CT and fluoroscopy-guided myelograms in many ways, including equipment, supplies, and injection and image-acquisition techniques. Operators should be familiar with techniques, common pitfalls, and artifacts to improve diagnostic yield and prevent nondiagnostic examinations.
J L Chazen - One of the best experts on this subject based on the ideXlab platform.
-
mr Myelography for the detection of csf venous fistulas
American Journal of Neuroradiology, 2020Co-Authors: J L Chazen, Matthew S Robbins, S B Strauss, Andrew D Schweitzer, Jeffrey P GreenfieldAbstract:CSF-venous fistula is an important treatable cause of spontaneous intracranial hypotension that is often difficult to detect using traditional imaging techniques. Herein, we describe the technical aspects and diagnostic performance of MR Myelography when used for identifying CSF-venous fistulas. We report 3 cases in which the CSF-venous fistula was occult on CT Myelography but readily detected using MR Myelography.
-
mr Myelography for identification of spinal csf leak in spontaneous intracranial hypotension
American Journal of Neuroradiology, 2014Co-Authors: J L Chazen, Jason F Talbott, Joshua E Lantos, William P. DillonAbstract:BACKGROUND AND PURPOSE: CT Myelography has historically been the test of choice for localization of CSF fistula in patients with spontaneous intracranial hypotension. This study evaluates the additional benefits of intrathecal gadolinium MR Myelography in the detection of CSF leak. MATERIALS AND METHODS: We performed a retrospective review of patients with spontaneous intracranial hypotension who underwent CT Myelography followed by intrathecal gadolinium MR Myelography. All patients received intrathecal iodine and off-label gadolinium-based contrast followed by immediate CT Myelography and subsequent intrathecal gadolinium MR Myelography with multiplanar T1 fat-suppressed sequences. CT Myelography and intrathecal gadolinium MR Myelography images were reviewed by an experienced neuroradiologist to determine the presence of CSF leak. Patient records were reviewed for demographic data and adverse events following the procedure. RESULTS: Twenty-four patients met both imaging and clinical criteria for spontaneous intracranial hypotension and underwent CT Myelography followed by intrathecal gadolinium MR Myelography. In 3/24 patients (13%), a CSF leak was demonstrated on both CT Myelography and intrathecal gadolinium MR Myelography, and in 9/24 patients (38%), a CSF leak was seen on intrathecal gadolinium MR Myelography (P = .011). Four of 6 leaks identified independently by intrathecal gadolinium MR Myelography related to meningeal diverticula. CT Myelography did not identify any leaks independently. There were no reported adverse events. CONCLUSIONS: Present data demonstrate a higher rate of leak detection with intrathecal gadolinium MR Myelography when investigating CSF leaks in our cohort of patients with spontaneous intracranial hypotension. Although intrathecal gadolinium is an FDA off-label use, all patients tolerated the medication without evidence of complications. Our data suggest that intrathecal gadolinium MR Myelography is a well-tolerated examination with significant benefit in the evaluation of CSF leak, particularly for patients with leak related to meningeal diverticula.
Joseph M Hoxworth - One of the best experts on this subject based on the ideXlab platform.
-
ultrafast dynamic computed tomography Myelography for the precise identification of high flow cerebrospinal fluid leaks caused by spiculated spinal osteophytes
Journal of Neurosurgery, 2015Co-Authors: Kent R Thielen, Felix E Diehn, Jonathan M Morris, John C Sillery, Joseph M Hoxworth, John T Wald, Richard E Rosebrock, Patrick H LuetmerAbstract:OBJECT Precise localization and understanding of the origin of spontaneous high-flow spinal CSF leaks is required prior to targeted treatment. This study demonstrates the utility of ultrafast dynamic CT Myelography for the precise localization of high-flow CSF leaks caused by spiculated spinal osteophytes. METHODS This study reports a series of 14 patients with high-flow CSF leaks caused by spiculated spinal osteophytes who underwent ultrafast dynamic CT Myelography between March 2009 and December 2010. There were 10 male and 4 female patients, with an average age of 49 years (range 37–74 years). The value of ultrafast dynamic CT Myelography in depicting the CSF leak site was qualitatively assessed. RESULTS In all 14 patients, ultrafast dynamic CT Myelography was technically successful at precisely demonstrating the site of the CSF leak, the causative spiculated osteophyte piercing the dura, and the relationship of the implicated osteophyte to adjacent structures. Leak sites included 3 cervical, 11 thorac...
-
the role of digital subtraction Myelography in the diagnosis and localization of spontaneous spinal csf leaks
American Journal of Roentgenology, 2012Co-Authors: Joseph M Hoxworth, Kent R Thielen, Terrence L Trentman, Amy L Kotsenas, Kent D Nelson, David W DodickAbstract:OBJECTIVE. The objective of our study was to review the clinical utility of digital subtraction Myelography for the diagnosis of spinal CSF leaks in patients with spontaneous intracranial hypotension (SIH) and those with superficial siderosis. MATERIALS AND METHODS. Procedure logs from 2007 to 2011 were reviewed to identify cases in which digital subtraction Myelography was performed to diagnose spinal CSF leaks. Electronic medical records were reviewed to obtain information regarding diagnosis and outcome. For patients to be included in the study, preprocedural spinal MRI had to show an extradural fluid collection spanning more than one vertebral level and postmyelographic CT had to confirm the presence of an active CSF leak. If digital subtraction Myelography successfully showed the site of the CSF leak, the location was documented. RESULTS. Eleven patients (seven men and four women; mean age, 49.0 years) underwent digital subtraction Myelography during the study period. Six patients had SIH and five pa...
Waleed Brinjikji - One of the best experts on this subject based on the ideXlab platform.
-
diagnostic yield of intrathecal gadolinium mr Myelography for csf leak localization
Clinical Neuroradiology-klinische Neuroradiologie, 2021Co-Authors: Ajay A Madhavan, Carrie M Carr, Waleed Brinjikji, Pearse P Morris, Felix E Diehn, Vance T Lehman, Greta B Liebo, John C Benson, Dong Kun Kim, Darya P ShlapakAbstract:Intrathecal gadolinium magnetic resonance (MR) Myelography can be used to localize various types of spinal cerebrospinal fluid (CSF) leaks; however, its diagnostic yield is not well known. We sought to determine the diagnostic yield of MR Myelography in patients with spontaneous intracranial hypotension. A retrospective review was performed on all patients who had undergone intrathecal gadolinium MR Myelography at our institution from 2002 to 2020 for suspected spinal CSF leak. The MR Myelography images were reviewed for the presence or absence of a spinal CSF leak site. Images were also evaluated for the presence an extradural fluid collection. A total of 97 patients were included in the final cohort. The average age was 52.6 years; 67.0% were female, 4 patients underwent 2 examinations each, yielding a total of 101 MR myelograms. The source of a spinal CSF leak was localized in 14 patients. The diagnostic yield for CSF leak localization on intrathecal gadolinium MR Myelography was 14/101 (13.9%) per GdM examination and 14/97 (14.4%) per patient. Among the subset of patients without extradural fluid collections, the yield was 15.7% per examination. All detected leaks were either CSF-venous fistulas or distal nerve root sleeve tears. Intrathecal gadolinium MR Myelography is capable of localizing CSF-venous fistulas and distal nerve root sleeve tears; however, our data show that it has a limited diagnostic yield. We suggest that other modalities may be a better first step before attempting intrathecal gadolinium MR Myelography.
-
safety of consecutive bilateral decubitus digital subtraction Myelography in patients with spontaneous intracranial hypotension and occult csf leak
American Journal of Neuroradiology, 2020Co-Authors: M C Pope, Carrie M Carr, Waleed Brinjikji, D K KimAbstract:BACKGROUND AND PURPOSE: Digital subtraction Myelography performed with the patient in the lateral decubitus position has the potential for increased sensitivity over prone-position Myelography in the detection of spinal CSF-venous fistulas, a well-established cause of spontaneous intracranial hypotension. We report on the safety of performing routine, consecutive-day right and left lateral decubitus digital subtraction Myelography in these patients. MATERIALS AND METHODS: In this retrospective case series, all patients undergoing consecutive-day lateral decubitus digital subtraction Myelography for suspected spinal CSF leak between September 2018 and September 2019 were identified. Chart review was performed to identify any immediate or delayed adverse effects associated with the procedures. Procedural parameters were also analyzed due to inherent variations associated with the positive-pressure Myelography technique that was used. RESULTS: A total of 60 patients underwent 68 pairs of consecutive-day lateral decubitus digital subtraction myelographic examinations during the study period. No major adverse effects were recorded. Various minor adverse effects were observed, including pain requiring analgesics (27.2%), nausea/vomiting requiring antiemetics (8.1%), and transient neurologic effects such as syncope, vertigo, altered mental status, and autonomic dysfunction (5.1%). Minor transient neurologic effects were correlated with increasing volumes of intrathecal saline injectate used for thecal sac prepressurization. CONCLUSIONS: In patients with spontaneous intracranial hypotension and suspected spontaneous spinal CSF leak, consecutive-day lateral decubitus digital subtraction Myelography demonstrates an acceptable risk profile without evidence of neurotoxic effects from cumulative intrathecal contrast doses. Higher intrathecal saline injectate volumes may correlate with an increased incidence of minor transient periprocedural neurologic effects.
-
lateral decubitus digital subtraction Myelography tips tricks and pitfalls
American Journal of Neuroradiology, 2020Co-Authors: D K Kim, Waleed Brinjikji, Pearse P Morris, Felix E Diehn, Vance T Lehman, Greta B Liebo, Jonathan M Morris, Jared T Verdoorn, Jeremy K Cutsforthgregory, Richard I FarbAbstract:Digital subtraction Myelography is a valuable diagnostic technique to detect the exact location of CSF leaks in the spine to facilitate appropriate diagnosis and treatment of spontaneous spinal CSF leaks. Digital subtraction Myelography is an excellent diagnostic tool for assessment of various types of CSF leaks, and lateral decubitus digital subtraction Myelography is increasingly being used to diagnose CSF-venous fistulas. Lateral decubitus digital subtraction Myelography differs from typical CT and fluoroscopy-guided myelograms in many ways, including equipment, supplies, and injection and image-acquisition techniques. Operators should be familiar with techniques, common pitfalls, and artifacts to improve diagnostic yield and prevent nondiagnostic examinations.
