CT Myelography Dynamic Complete Spine There is no relevant literature to support the use of dynamic CT myelography complete spine as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. Dynamic CT myelography plays an important role in the subsequent imaging workup of SIH after initial brain and spine imaging [37,38]. Results from an initial spine MRI or conventional CT myelogram provide useful information on how a subsequent dynamic CT myelogram will be performed, such as prone positioning for suspected ventral dural defect or decubitus positioning for suspected leaking meningeal diverticulum or CSF-venous fistula [24,37- 39]. Dynamic CT myelography involves an initial scan followed by delayed phase scans in immediate succession and, when performed in the decubitus position, may require 2 separate contrast injections due to the transient temporal characteristics associated with CSF-venous fistula visualization as well as limitations in contrast dosing [40-44]. DTPA Cisternography Although DTPA cisternography can detect epidural collections suggestive of dural defect or leaking meningeal diverticulum, MRI complete spine optimized with fluid sensitive sequences is typically the preferred initial imaging option over DTPA cisternography complete spine because it avoids the need for lumbar puncture and has superior spatial resolution for lesion localization [45,46]. MR Myelography Complete Spine There is no relevant literature to support the use of MR myelography complete spine as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. An MR myelogram with intrathecal gadolinium administration has been used in several studies as a subsequent follow-up imaging examination after initial spine imaging to increase the sensitivity for detection of slow leaking dural and meningeal diverticular defects [47-49].
Imaging of Suspected Intracranial Hypotension PCAs. CT Myelography Dynamic Complete Spine There is no relevant literature to support the use of dynamic CT myelography complete spine as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. Dynamic CT myelography plays an important role in the subsequent imaging workup of SIH after initial brain and spine imaging [37,38]. Results from an initial spine MRI or conventional CT myelogram provide useful information on how a subsequent dynamic CT myelogram will be performed, such as prone positioning for suspected ventral dural defect or decubitus positioning for suspected leaking meningeal diverticulum or CSF-venous fistula [24,37- 39]. Dynamic CT myelography involves an initial scan followed by delayed phase scans in immediate succession and, when performed in the decubitus position, may require 2 separate contrast injections due to the transient temporal characteristics associated with CSF-venous fistula visualization as well as limitations in contrast dosing [40-44]. DTPA Cisternography Although DTPA cisternography can detect epidural collections suggestive of dural defect or leaking meningeal diverticulum, MRI complete spine optimized with fluid sensitive sequences is typically the preferred initial imaging option over DTPA cisternography complete spine because it avoids the need for lumbar puncture and has superior spatial resolution for lesion localization [45,46]. MR Myelography Complete Spine There is no relevant literature to support the use of MR myelography complete spine as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. An MR myelogram with intrathecal gadolinium administration has been used in several studies as a subsequent follow-up imaging examination after initial spine imaging to increase the sensitivity for detection of slow leaking dural and meningeal diverticular defects [47-49].