• World Neurosurg · Jul 2024

    Detection of dural defect localization using four-dimensional dynamic computed tomography myelography for patients with superficial siderosis.

    • Motonori Hashimoto, Satoru Egawa, Takashi Hirai, Jun Hashimoto, Shingo Morishita, Kentaro Yamada, Yu Matsukura, Ryosuke Kaho, Hiroto Hada, Jun Oyama, and Toshitaka Yoshii.
    • Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
    • World Neurosurg. 2024 Jul 1; 187: e798e806e798-e806.

    BackgroundThere are cases of superficial siderosis (SS) with spinal ventral fluid-filled collection in the spinal canal. In our previous study, the balanced steady-state free precession sequence magnetic resonance imaging is useful in identifying the location of dural defects. However, because of its narrow scan area and long scan time, it cannot easily detect the defect location in some patients with small dural defect. In this study, we applied 4-dimensional (4D) dynamic computed tomography (CT) imaging, including time-axis imaging, to myelography using the latest CT imaging equipment, which can perform short-time continuous imaging, to identify the dural defect site.MethodsTwenty SS patients with ventral fluid-filled collection in the spinal canal (9 males, 11 females; mean age 61.6 years) underwent 4D dynamic CT myelography. A 192-row helical CT (SOMATOM Force, SIEMENS, Munich, Germany) with high-speed scanning capability was used to obtain 9-11 scans per minute at low dose while passing contrast medium into the subarachnoid space. Then, contrast leakage sites were identified.ResultsThe contrast leakage sites could be identified in all 20 cases: C7/Th1, 2 cases; Th1/2, 5 cases; Th2/3, 9 cases; Th3/4, 1 case; Th5/6, 1 case; Th7/8, 1 case; and Th8/9, 1 case. Eighteen cases underwent surgical operation, and actual dural defects were confirmed at the contrast leakage sites. The mean ± standard deviation of leakage time from contrast agent injection was 19.0 ± 9.2 s.ConclusionsThe 4D dynamic CT myelography can be used to reliably identify the location of spinal fluid leakage. In SS cases, dural defects could be visualized in an average of 19 seconds.Copyright © 2024 Elsevier Inc. All rights reserved.

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