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<meta name="category" content="research-article" />
<meta name="HW.identifier" content="/ajnr/early/2024/11/28/ajnr.A8435.atom" />
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<meta name="DC.Title" content="Diagnostic Performance of Renal Contrast Excretion on Early-Phase CT Myelography in Spontaneous Intracranial Hypotension" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8435" />
<meta name="DC.Date" content="2024-11-29" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2025 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Early opacification of the renal collecting system during CT myelography (CTM) performed for the evaluation of spontaneous intracranial hypotension (SIH) has been demonstrated in prior studies. However, these investigations often included CTMs scanned &gt;30 minutes after intrathecal contrast injection, a longer delay than the myelographic techniques used in current practice. The purpose of this study was to determine whether renal contrast excretion (RCE) measured during this earlier time period (≤30 minutes) can discriminate patients with SIH from patients without SIH.

MATERIALS AND METHODS: A single-center, retrospective cohort of consecutive patients presenting for evaluation of possible SIH between July 2021 and May 2022 was studied. RCE was measured in both renal hila by using standardized (5–15 mm3) ROIs. Receiver operating characteristic (ROC) curves were constructed by comparing RCE between patients with SIH and patients without SIH in the overall cohort and within the subgroup of patients with negative myelograms.

RESULTS: The study cohort included 190 subjects. Both unadjusted and adjusted models demonstrated a statistically significant increase in renal contrast attenuation among patients with SIH compared with those without SIH ( P values ≤.001). The ROC curve showed moderate discrimination between these groups (area under the ROC curves [AUC] 0.76). However, by using clinically meaningful test criteria of sensitivity &gt;90% or specificity &gt;90%, the 2 corresponding threshold hounsfield units (HU) values resulted in low specificity of 31.3% and sensitivity of 50.8%. Subgroup analysis of patients with negative myelograms showed poorer performance in discriminating SIH+ from SIH– (AUC 0.62). In this subgroup, using similar test criteria of sensitivity &gt;90% or specificity &gt;90 resulted in low specificities and sensitivities, at 26.0% and 37.5%, respectively.

CONCLUSIONS: We found a statistically significant positive association between RCE and SIH diagnosis during early-phase CTM; however, clinically useful thresholds based on cutoff values for renal HU resulted in poor sensitivities or specificities, with substantial false-positives or false-negatives, respectively. Thus, while we confirmed statistically significant differences in RCE in the ≤30-minute period, in keeping with prior investigations of more delayed time periods, overlap in renal attenuation values prevented the development of clinically useful threshold values for discriminating SIH+ from SIH– patients.

AUC
:   area under the ROC curve
CTM
:   CT myelography
CVF
:   CSF-venous fistula
eGFR
:   estimated glomerular filtration rate
HU
:   hounsfield units
ICHD-3
:   International Classification of Headache Disorders, 3rd edition
RCE
:   renal contrast excretion
ROC
:   receiver operating characteristic
SIH
:   spontaneous intracranial hypotension" />
<meta name="DC.Contributor" content="Derek S. Young" />
<meta name="DC.Contributor" content="Timothy J. Amrhein" />
<meta name="DC.Contributor" content="Jacob T. Gibby" />
<meta name="DC.Contributor" content="Jay Willhite" />
<meta name="DC.Contributor" content="Linda Gray" />
<meta name="DC.Contributor" content="Michael D. Malinzak" />
<meta name="DC.Contributor" content="Samantha Morrison" />
<meta name="DC.Contributor" content="Alaattin Erkanli" />
<meta name="DC.Contributor" content="Peter G. Kranz" />
<meta name="article:published_time" content="2024-11-28" />
<meta name="article:section" content="SPINE IMAGING AND SPINE IMAGE-GUIDED INTERVENTIONS" />
<meta name="citation_title" content="Diagnostic Performance of Renal Contrast Excretion on Early-Phase CT Myelography in Spontaneous Intracranial Hypotension" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Early opacification of the renal collecting system during CT myelography (CTM) performed for the evaluation of spontaneous intracranial hypotension (SIH) has been demonstrated in prior studies. However, these investigations often included CTMs scanned &amp;gt;30 minutes after intrathecal contrast injection, a longer delay than the myelographic techniques used in current practice. The purpose of this study was to determine whether renal contrast excretion (RCE) measured during this earlier time period (≤30 minutes) can discriminate patients with SIH from patients without SIH.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;A single-center, retrospective cohort of consecutive patients presenting for evaluation of possible SIH between July 2021 and May 2022 was studied. RCE was measured in both renal hila by using standardized (5–15 mm&lt;sup&gt;3&lt;/sup&gt;) ROIs. Receiver operating characteristic (ROC) curves were constructed by comparing RCE between patients with SIH and patients without SIH in the overall cohort and within the subgroup of patients with negative myelograms.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The study cohort included 190 subjects. Both unadjusted and adjusted models demonstrated a statistically significant increase in renal contrast attenuation among patients with SIH compared with those without SIH (&lt;i&gt;P&lt;/i&gt; values ≤.001). The ROC curve showed moderate discrimination between these groups (area under the ROC curves [AUC] 0.76). However, by using clinically meaningful test criteria of sensitivity &amp;gt;90% or specificity &amp;gt;90%, the 2 corresponding threshold hounsfield units (HU) values resulted in low specificity of 31.3% and sensitivity of 50.8%. Subgroup analysis of patients with negative myelograms showed poorer performance in discriminating SIH+ from SIH– (AUC 0.62). In this subgroup, using similar test criteria of sensitivity &amp;gt;90% or specificity &amp;gt;90 resulted in low specificities and sensitivities, at 26.0% and 37.5%, respectively.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;We found a statistically significant positive association between RCE and SIH diagnosis during early-phase CTM; however, clinically useful thresholds based on cutoff values for renal HU resulted in poor sensitivities or specificities, with substantial false-positives or false-negatives, respectively. Thus, while we confirmed statistically significant differences in RCE in the ≤30-minute period, in keeping with prior investigations of more delayed time periods, overlap in renal attenuation values prevented the development of clinically useful threshold values for discriminating SIH+ from SIH– patients.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_author" content="Derek S. Young" />
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<meta name="twitter:title" content="Diagnostic Performance of Renal Contrast Excretion on Early-Phase CT Myelography in Spontaneous Intracranial Hypotension" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Early opacification of the renal collecting system during CT myelography (CTM) performed for the evaluation of spontaneous intracranial hypotension (SIH) has been demonstrated in prior studies. However, these investigations often included CTMs scanned &gt;30 minutes after intrathecal contrast injection, a longer delay than the myelographic techniques used in current practice. The purpose of this study was to determine whether renal contrast excretion (RCE) measured during this earlier time period (≤30 minutes) can discriminate patients with SIH from patients without SIH.

MATERIALS AND METHODS: A single-center, retrospective cohort of consecutive patients presenting for evaluation of possible SIH between July 2021 and May 2022 was studied. RCE was measured in both renal hila by using standardized (5–15 mm3) ROIs. Receiver operating characteristic (ROC) curves were constructed by comparing RCE between patients with SIH and patients without SIH in the overall cohort and within the subgroup of patients with negative myelograms.

RESULTS: The study cohort included 190 subjects. Both unadjusted and adjusted models demonstrated a statistically significant increase in renal contrast attenuation among patients with SIH compared with those without SIH ( P values ≤.001). The ROC curve showed moderate discrimination between these groups (area under the ROC curves [AUC] 0.76). However, by using clinically meaningful test criteria of sensitivity &gt;90% or specificity &gt;90%, the 2 corresponding threshold hounsfield units (HU) values resulted in low specificity of 31.3% and sensitivity of 50.8%. Subgroup analysis of patients with negative myelograms showed poorer performance in discriminating SIH+ from SIH– (AUC 0.62). In this subgroup, using similar test criteria of sensitivity &gt;90% or specificity &gt;90 resulted in low specificities and sensitivities, at 26.0% and 37.5%, respectively.

CONCLUSIONS: We found a statistically significant positive association between RCE and SIH diagnosis during early-phase CTM; however, clinically useful thresholds based on cutoff values for renal HU resulted in poor sensitivities or specificities, with substantial false-positives or false-negatives, respectively. Thus, while we confirmed statistically significant differences in RCE in the ≤30-minute period, in keeping with prior investigations of more delayed time periods, overlap in renal attenuation values prevented the development of clinically useful threshold values for discriminating SIH+ from SIH– patients.

AUC
:   area under the ROC curve
CTM
:   CT myelography
CVF
:   CSF-venous fistula
eGFR
:   estimated glomerular filtration rate
HU
:   hounsfield units
ICHD-3
:   International Classification of Headache Disorders, 3rd edition
RCE
:   renal contrast excretion
ROC
:   receiver operating characteristic
SIH
:   spontaneous intracranial hypotension" />
<meta name="og-title" property="og:title" content="Diagnostic Performance of Renal Contrast Excretion on Early-Phase CT Myelography in Spontaneous Intracranial Hypotension" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/11/28/ajnr.A8435" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Early opacification of the renal collecting system during CT myelography (CTM) performed for the evaluation of spontaneous intracranial hypotension (SIH) has been demonstrated in prior studies. However, these investigations often included CTMs scanned &gt;30 minutes after intrathecal contrast injection, a longer delay than the myelographic techniques used in current practice. The purpose of this study was to determine whether renal contrast excretion (RCE) measured during this earlier time period (≤30 minutes) can discriminate patients with SIH from patients without SIH.

MATERIALS AND METHODS: A single-center, retrospective cohort of consecutive patients presenting for evaluation of possible SIH between July 2021 and May 2022 was studied. RCE was measured in both renal hila by using standardized (5–15 mm3) ROIs. Receiver operating characteristic (ROC) curves were constructed by comparing RCE between patients with SIH and patients without SIH in the overall cohort and within the subgroup of patients with negative myelograms.

RESULTS: The study cohort included 190 subjects. Both unadjusted and adjusted models demonstrated a statistically significant increase in renal contrast attenuation among patients with SIH compared with those without SIH ( P values ≤.001). The ROC curve showed moderate discrimination between these groups (area under the ROC curves [AUC] 0.76). However, by using clinically meaningful test criteria of sensitivity &gt;90% or specificity &gt;90%, the 2 corresponding threshold hounsfield units (HU) values resulted in low specificity of 31.3% and sensitivity of 50.8%. Subgroup analysis of patients with negative myelograms showed poorer performance in discriminating SIH+ from SIH– (AUC 0.62). In this subgroup, using similar test criteria of sensitivity &gt;90% or specificity &gt;90 resulted in low specificities and sensitivities, at 26.0% and 37.5%, respectively.

CONCLUSIONS: We found a statistically significant positive association between RCE and SIH diagnosis during early-phase CTM; however, clinically useful thresholds based on cutoff values for renal HU resulted in poor sensitivities or specificities, with substantial false-positives or false-negatives, respectively. Thus, while we confirmed statistically significant differences in RCE in the ≤30-minute period, in keeping with prior investigations of more delayed time periods, overlap in renal attenuation values prevented the development of clinically useful threshold values for discriminating SIH+ from SIH– patients.

AUC
:   area under the ROC curve
CTM
:   CT myelography
CVF
:   CSF-venous fistula
eGFR
:   estimated glomerular filtration rate
HU
:   hounsfield units
ICHD-3
:   International Classification of Headache Disorders, 3rd edition
RCE
:   renal contrast excretion
ROC
:   receiver operating characteristic
SIH
:   spontaneous intracranial hypotension" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node112013--5" data-node-nid="112013" id="top-node-112013--6983099696" data-pisa="ajnr;ajnr.A8435v2" data-pisa-master="ajnr;ajnr.A8435" data-apath="/ajnr/early/2024/11/28/ajnr.A8435.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">SPINE IMAGING AND SPINE IMAGE-GUIDED INTERVENTIONS</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Diagnostic Performance of Renal Contrast Excretion on Early-Phase CT Myelography in Spontaneous Intracranial Hypotension</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Derek S. Young</span>, <span class="highwire-citation-author" data-delta="1">Timothy J. Amrhein</span>, <span class="highwire-citation-author" data-delta="2">Jacob T. Gibby</span>, <span class="highwire-citation-author" data-delta="3">Jay Willhite</span>, <span class="highwire-citation-author" data-delta="4">Linda Gray</span>, <span class="highwire-citation-author" data-delta="5">Michael D. Malinzak</span>, <span class="highwire-citation-author" data-delta="6">Samantha Morrison</span>, <span class="highwire-citation-author" data-delta="7">Alaattin Erkanli</span> and <span class="highwire-citation-author" data-delta="8">Peter G. Kranz</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">November 2024,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8435 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-112013--6983099696" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Derek S. Young </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (D.S.Y., T.J.A., T.G., J.W., L.G., M.D.M., G.K.), Duke University Medical Center, Durham, North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Derek%2BS.%2BYoung%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Young%20DS&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3ADerek%2BS.%2BYoung%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0009-0004-4852-0117" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Derek S. Young</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Timothy J. Amrhein </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (D.S.Y., T.J.A., T.G., J.W., L.G., M.D.M., G.K.), Duke University Medical Center, Durham, North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Timothy%2BJ.%2BAmrhein%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Amrhein%20TJ&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3ATimothy%2BJ.%2BAmrhein%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9354-9486" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Timothy J. Amrhein</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Jacob T. Gibby </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (D.S.Y., T.J.A., T.G., J.W., L.G., M.D.M., G.K.), Duke University Medical Center, Durham, North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Jacob%2BT.%2BGibby%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Gibby%20JT&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJacob%2BT.%2BGibby%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Jay Willhite </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (D.S.Y., T.J.A., T.G., J.W., L.G., M.D.M., G.K.), Duke University Medical Center, Durham, North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Jay%2BWillhite%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Willhite%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJay%2BWillhite%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6501-2171" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Jay Willhite</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Linda Gray </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (D.S.Y., T.J.A., T.G., J.W., L.G., M.D.M., G.K.), Duke University Medical Center, Durham, North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Linda%2BGray%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Gray%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3ALinda%2BGray%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-5947-9552" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Linda Gray</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">Michael D. Malinzak </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (D.S.Y., T.J.A., T.G., J.W., L.G., M.D.M., G.K.), Duke University Medical Center, Durham, North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Michael%2BD.%2BMalinzak%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Malinzak%20MD&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AMichael%2BD.%2BMalinzak%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6007-6520" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Michael D. Malinzak</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">Samantha Morrison </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Biostatistics and Bioinformatics (S.M., A.E.), Duke University School of Medicine, Durham, North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Samantha%2BMorrison%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Morrison%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3ASamantha%2BMorrison%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-0787-8505" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Samantha Morrison</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">Alaattin Erkanli </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Biostatistics and Bioinformatics (S.M., A.E.), Duke University School of Medicine, Durham, North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Alaattin%2BErkanli%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Erkanli%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AAlaattin%2BErkanli%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">Peter G. Kranz </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (D.S.Y., T.J.A., T.G., J.W., L.G., M.D.M., G.K.), Duke University Medical Center, Durham, North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Peter%2BG.%2BKranz%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kranz%20PG&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3APeter%2BG.%2BKranz%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-5410-7135" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Peter G. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> Early opacification of the renal collecting system during CT myelography (CTM) performed for the evaluation of spontaneous intracranial hypotension (SIH) has been demonstrated in prior studies. However, these investigations often included CTMs scanned &gt;30 minutes after intrathecal contrast injection, a longer delay than the myelographic techniques used in current practice. The purpose of this study was to determine whether renal contrast excretion (RCE) measured during this earlier time period (≤30 minutes) can discriminate patients with SIH from patients without SIH.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>MATERIALS AND METHODS:</strong> A single-center, retrospective cohort of consecutive patients presenting for evaluation of possible SIH between July 2021 and May 2022 was studied. RCE was measured in both renal hila by using standardized (5–15 mm<sup>3</sup>) ROIs. Receiver operating characteristic (ROC) curves were constructed by comparing RCE between patients with SIH and patients without SIH in the overall cohort and within the subgroup of patients with negative myelograms.</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>RESULTS:</strong> The study cohort included 190 subjects. Both unadjusted and adjusted models demonstrated a statistically significant increase in renal contrast attenuation among patients with SIH compared with those without SIH (<em>P</em> values ≤.001). The ROC curve showed moderate discrimination between these groups (area under the ROC curves [AUC] 0.76). However, by using clinically meaningful test criteria of sensitivity &gt;90% or specificity &gt;90%, the 2 corresponding threshold hounsfield units (HU) values resulted in low specificity of 31.3% and sensitivity of 50.8%. Subgroup analysis of patients with negative myelograms showed poorer performance in discriminating SIH+ from SIH– (AUC 0.62). In this subgroup, using similar test criteria of sensitivity &gt;90% or specificity &gt;90 resulted in low specificities and sensitivities, at 26.0% and 37.5%, respectively.</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>CONCLUSIONS:</strong> We found a statistically significant positive association between RCE and SIH diagnosis during early-phase CTM; however, clinically useful thresholds based on cutoff values for renal HU resulted in poor sensitivities or specificities, with substantial false-positives or false-negatives, respectively. Thus, while we confirmed statistically significant differences in RCE in the ≤30-minute period, in keeping with prior investigations of more delayed time periods, overlap in renal attenuation values prevented the development of clinically useful threshold values for discriminating SIH+ from SIH– patients.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">AUC<span class="def-item-dt-sep"></span></dt><dd>area under the ROC curve<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">CTM<span class="def-item-dt-sep"></span></dt><dd>CT myelography<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">CVF<span class="def-item-dt-sep"></span></dt><dd>CSF-venous fistula<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">eGFR<span class="def-item-dt-sep"></span></dt><dd>estimated glomerular filtration rate<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">HU<span class="def-item-dt-sep"></span></dt><dd>hounsfield units<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">ICHD-3<span class="def-item-dt-sep"></span></dt><dd>International Classification of Headache Disorders, 3rd edition<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">RCE<span class="def-item-dt-sep"></span></dt><dd>renal contrast excretion<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">ROC<span class="def-item-dt-sep"></span></dt><dd>receiver operating characteristic<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">SIH<span class="def-item-dt-sep"></span></dt><dd>spontaneous intracranial hypotension</dd></dl></div><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-financial-disclosure" id="fn-1"><p id="p-49"><a href="https://www.ajnr.org/sites/default/files/additional-assets/Disclosures/January%202025/0530.pdf">Disclosure forms</a> provided by the authors are available with the full text and PDF of this article at <a href="http://www.ajnr.org">www.ajnr.org</a>.</p></li></ul></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2025 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/early/2024/11/28/ajnr.A8435.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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