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Research ArticleSPINE IMAGING AND SPINE IMAGE-GUIDED INTERVENTIONS

Safety and Technical Performance of Bilateral Decubitus CT Myelography using Standard versus Increased Intrathecal Iodinated Contrast Volume

Diogo G.L. Edelmuth, Renata V. Leão, Eduardo N.K. Filho, Marcio N.P. Souza, Marcelo Calderaro and Peter G. Kranz
American Journal of Neuroradiology December 2024, DOI: https://doi.org/10.3174/ajnr.A8436
Diogo G.L. Edelmuth
aFrom the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (D.G.L.E., R.V.L., M.N.P.S., M.C.), São Paulo, SP, Brazil
bDepartment of Radiology (D.G.L.E., R.V.L., E.N.K.F.), Hospital Sírio-Libanês, São Paulo, SP, Brazil
cHospital Israelita Albert-Einstein (D.G.L.E., E.N.K.F., M.N.P.S., M.C.), São Paulo, SP, Brazil
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  • ORCID record for Diogo G.L. Edelmuth
Renata V. Leão
aFrom the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (D.G.L.E., R.V.L., M.N.P.S., M.C.), São Paulo, SP, Brazil
bDepartment of Radiology (D.G.L.E., R.V.L., E.N.K.F.), Hospital Sírio-Libanês, São Paulo, SP, Brazil
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Eduardo N.K. Filho
bDepartment of Radiology (D.G.L.E., R.V.L., E.N.K.F.), Hospital Sírio-Libanês, São Paulo, SP, Brazil
cHospital Israelita Albert-Einstein (D.G.L.E., E.N.K.F., M.N.P.S., M.C.), São Paulo, SP, Brazil
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Marcio N.P. Souza
aFrom the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (D.G.L.E., R.V.L., M.N.P.S., M.C.), São Paulo, SP, Brazil
cHospital Israelita Albert-Einstein (D.G.L.E., E.N.K.F., M.N.P.S., M.C.), São Paulo, SP, Brazil
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Marcelo Calderaro
aFrom the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (D.G.L.E., R.V.L., M.N.P.S., M.C.), São Paulo, SP, Brazil
cHospital Israelita Albert-Einstein (D.G.L.E., E.N.K.F., M.N.P.S., M.C.), São Paulo, SP, Brazil
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Peter G. Kranz
dDepartment of Radiology (P.G.K.), Duke University Hospital, Durham, North Carolina
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Figures

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  • FIG 1.
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    FIG 1.

    Technique for measurement of attenuation in the lateral thecal sac. A, CT scout image indicating the levels assessed on each scan. B, Axial CT image shows representative placement of an ROI immediately caudal to the dural emergence of the nerve root.

  • FIG 2.
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    FIG 2.

    Box-and-whisker plots summarizing the technical performance of the 10-mL control and 20-mL study groups. The distribution of average attenuation within the lateral-most part of the thecal sac on the total (A), central (B), and peripheral (C) portions of the thoracic spine is shown. The number of levels adequately opacified by contrast (D) is also shown. Boxplots highlighted using bold lines, Asterisks in A, B, and D indicate groups showing statistically significant differences.

  • FIG 3.
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    FIG 3.

    Cases in which a CVF was found on the second side examined. A, Axial CT image shows a left T8 CVF in a patient who had received 20 mL of contrast. B, Axial CT MIP image shows a right T7 CVF in a patient who had received 10 mL of contrast. C, Axial CT image shows a right T9 CVF in a patient who had received 20 mL of contrast. Arrows in all images point to opacified draining veins from the CVFs.

  • FIG 4.
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    FIG 4.

    Coronal CT reformats showing the cranial and caudal margins of an IOCM bolus on the first side examined (A) and on the second side examined (B) of a patient who had received 20 mL of IOCM. Notice that a peripheral level may have very poor opacification even if a large and dense bolus of contrast is still present adjacently.

  • FIG 5.
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    FIG 5.

    Anterior-posterior scout images of a patient who had received 20 mL of IOCM, demonstrating that the residual contrast bolus stays dense, even after the patient is repositioned a few times. Patient positioning is shown as follows: right decubitus, hips neutral (A); right decubitus, hips elevated (B); left decubitus, hips neutral (C); and left decubitus, hips elevated (D).

Tables

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  • General characteristics of the population under study

    AgeSexOpening PressureContrast VolumeContrast TypeIodine DoseFirst DecubitusCVFBern Score
    141F1320Iodixanol 3206.4LeftL T84
    259F520Iodixanol 3206.4RightL T87
    364F1120Iodixanol 3206.4RightR T28
    420M2520Iodixanol 3206.4RightNone4
    534M1820Iodixanol 3206.4RightNone0
    652F1620Iodixanol 3206.4RightNone0
    742F–20Iodixanol 3206.4RightNone0
    840F1820Iodixanol 3206.4LeftNone0
    915M1420Iodixanol 3206.4RightNone2
    1064F–20Iodixanol 3206.4LeftR T96
    1163M820Iodixanol 3206.4RightNone0
    1231M2720Iodixanol 3206.4RightNone0
    1341F1120Iodixanol 3206.4LeftNone0
    1451M720Iodixanol 3206.4RightR T76
    1551F1020Iodixanol 3206.4RightR T104
    1668M120Iodixanol 3206.4RightNone0
    1770M720Iodixanol 3206.4RightR T67
    1846F1120Iodixanol 3206.4RightR T116
    1965F2810Iohexol 3003.0RightNone1
    2044F1010Iohexol 3003.0LeftNone2
    2140F1210Iodixanol 3203.2LeftR T79
    2230M1610Iohexol 3003.0RightR C89
    2329F1510Iohexol 3003.0RightNone0
    2461M1310Iodixanol 3203.2RightNone0
    • Note:—R indicates right; L, left; en dash, information not available or not measured; M, male; F, female.

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Diogo G.L. Edelmuth, Renata V. Leão, Eduardo N.K. Filho, Marcio N.P. Souza, Marcelo Calderaro, Peter G. Kranz
Safety and Technical Performance of Bilateral Decubitus CT Myelography using Standard versus Increased Intrathecal Iodinated Contrast Volume
American Journal of Neuroradiology Dec 2024, DOI: 10.3174/ajnr.A8436

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Safety and Technical Performance of Bilateral Decubitus CT Myelography using Standard versus Increased Intrathecal Iodinated Contrast Volume
Diogo G.L. Edelmuth, Renata V. Leão, Eduardo N.K. Filho, Marcio N.P. Souza, Marcelo Calderaro, Peter G. Kranz
American Journal of Neuroradiology Dec 2024, DOI: 10.3174/ajnr.A8436
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