학술논문
Renal Pelvis Opacification on Postmyelography Computed Tomography as an Indicator for Cerebrospinal Fluid Loss in Spontaneous Intracranial Hypotension
Original Article
Original Article
Document Type
Academic Journal
Author
Source
Clinical Neuroradiology. June 2022, Vol. 32 Issue 2, p529, 8 p.
Subject
Language
English
ISSN
1869-1439
Abstract
Author(s): Eike I. Piechowiak [sup.1], Laura Bär [sup.1], Levin Häni [sup.2], Mattia Branca [sup.3], Johannes Kaesmacher [sup.1] [sup.4], Pasquale Mordasini [sup.1], Andreas Raabe [sup.2], Christian T. Ulrich [sup.2], Jan Gralla [...]
Purpose To assess early renal pelvis opacification on postmyelography computed tomography (CT) as a marker for cerebrospinal fluid (CSF) loss in patients with spontaneous intracranial hypotension (SIH). Methods The SIH patients referred to our hospital between January 2012 and May 2018 were retrospectively reviewed and divided into 2 groups based on the presence of spinal longitudinal extrathecal CSF collection (SLEC): (1) SLEC(+) with, and (2) SLEC(-) without proof of SLEC on multimodal imaging. Non-SIH patients (nâ¯= 20) undergoing CT myelography served as controls. The renal pelvis density on postmyelography CT was measured in all patients. Mean difference in renal pelvis density between the groups was calculated. Results In total, 111 SIH patients (mean age 48⯱ 13 years; 60% female) were included, 71 (64%) SLEC(+) and 40 (36%) SLEC(-). The adjusted renal pelvis density in the SLEC(+), SLEC(-), and the non-SIH group was 108â¯Hounsfield unit (HU), 83â¯HU, and 32â¯HU, respectively, resulting in a significant difference between SLEC(+) vs. control group 1 (75â¯HU, pâ¯< 0.001), SLEC(-) vs. control group 1 (50â¯HU, pâ¯< 0.001), and a tendency for higher density in SLEC(+) than SLEC(-) (25â¯HU, pâ¯= 0.16). Conclusion Increased renal pelvis opacification on postmyelography CT was observed in SIH patients, even in the absence of a CSF leak or a CSF venous fistula, when compared to non-SIH patients. Although the provenance of early renal opacification in SLEC (-) SIH patients remains unclear, our results suggest that it may be a surrogate for increased spinal CSF resorption via spinal arachnoid granulations and along spinal nerve sheaths occult to direct imaging.
Purpose To assess early renal pelvis opacification on postmyelography computed tomography (CT) as a marker for cerebrospinal fluid (CSF) loss in patients with spontaneous intracranial hypotension (SIH). Methods The SIH patients referred to our hospital between January 2012 and May 2018 were retrospectively reviewed and divided into 2 groups based on the presence of spinal longitudinal extrathecal CSF collection (SLEC): (1) SLEC(+) with, and (2) SLEC(-) without proof of SLEC on multimodal imaging. Non-SIH patients (nâ¯= 20) undergoing CT myelography served as controls. The renal pelvis density on postmyelography CT was measured in all patients. Mean difference in renal pelvis density between the groups was calculated. Results In total, 111 SIH patients (mean age 48⯱ 13 years; 60% female) were included, 71 (64%) SLEC(+) and 40 (36%) SLEC(-). The adjusted renal pelvis density in the SLEC(+), SLEC(-), and the non-SIH group was 108â¯Hounsfield unit (HU), 83â¯HU, and 32â¯HU, respectively, resulting in a significant difference between SLEC(+) vs. control group 1 (75â¯HU, pâ¯< 0.001), SLEC(-) vs. control group 1 (50â¯HU, pâ¯< 0.001), and a tendency for higher density in SLEC(+) than SLEC(-) (25â¯HU, pâ¯= 0.16). Conclusion Increased renal pelvis opacification on postmyelography CT was observed in SIH patients, even in the absence of a CSF leak or a CSF venous fistula, when compared to non-SIH patients. Although the provenance of early renal opacification in SLEC (-) SIH patients remains unclear, our results suggest that it may be a surrogate for increased spinal CSF resorption via spinal arachnoid granulations and along spinal nerve sheaths occult to direct imaging.