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<meta name="DC.Title" content="Safety and Technical Performance of Bilateral Decubitus CT Myelography using Standard versus Increased Intrathecal Iodinated Contrast Volume" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8436" />
<meta name="DC.Date" content="2024-12-20" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2025 by American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Lateral decubitus CT myelography (LDCTM) is one of the main studies for the detection of CSF-venous fistulas, but detection of CSF-venous fistulas is dependent on intrathecal contrast attenuation. The purpose of this investigation was to assess the tolerability and technical performance of increased intrathecal doses of myelographic contrast compared with standard doses.

MATERIALS AND METHODS: This is a retrospective series of 24 patients who underwent LDCTM following administration of either 10 or 20 mL of intrathecal iodinated contrast media (300 or 320 mg/mL of iodine content). Patients were scanned in the initial lateral decubitus position and then turned to the contralateral side and re-scanned in the same session. The safety and tolerability of the 20 mL dose was assessed from clinical records. The technical performance of the studies was compared between groups (10 or 20 mL) by measuring attenuation values over the lateral thecal sac at standardized levels. Both the initial scan and the scan after turning the patient to the contralateral side were assessed.

RESULTS: No moderate or severe adverse event was recorded in either group. The 20-mL group showed higher attenuation values, which were statistically greater on the second side examined compared with the standard-dose group.

CONCLUSIONS: Increased volume of intrathecal contrast was well-tolerated and improved the technical performance of LDCTM in this limited series. Further assessment of the safety and impact on diagnostic yield using larger patient cohorts is warranted.

CVF
:   CSF-venous fistula
IOCM
:   iodinated contrast media
LDCTM
:   lateral decubitus CT myelography" />
<meta name="DC.Contributor" content="Diogo G.L. Edelmuth" />
<meta name="DC.Contributor" content="Renata V. Leão" />
<meta name="DC.Contributor" content="Eduardo N.K. Filho" />
<meta name="DC.Contributor" content="Marcio N.P. Souza" />
<meta name="DC.Contributor" content="Marcelo Calderaro" />
<meta name="DC.Contributor" content="Peter G. Kranz" />
<meta name="article:published_time" content="2025-12-19" />
<meta name="article:section" content="SPINE IMAGING AND SPINE IMAGE-GUIDED INTERVENTIONS" />
<meta name="citation_title" content="Safety and Technical Performance of Bilateral Decubitus CT Myelography using Standard versus Increased Intrathecal Iodinated Contrast Volume" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Lateral decubitus CT myelography (LDCTM) is one of the main studies for the detection of CSF-venous fistulas, but detection of CSF-venous fistulas is dependent on intrathecal contrast attenuation. The purpose of this investigation was to assess the tolerability and technical performance of increased intrathecal doses of myelographic contrast compared with standard doses.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;This is a retrospective series of 24 patients who underwent LDCTM following administration of either 10 or 20 mL of intrathecal iodinated contrast media (300 or 320 mg/mL of iodine content). Patients were scanned in the initial lateral decubitus position and then turned to the contralateral side and re-scanned in the same session. The safety and tolerability of the 20 mL dose was assessed from clinical records. The technical performance of the studies was compared between groups (10 or 20 mL) by measuring attenuation values over the lateral thecal sac at standardized levels. Both the initial scan and the scan after turning the patient to the contralateral side were assessed.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;No moderate or severe adverse event was recorded in either group. The 20-mL group showed higher attenuation values, which were statistically greater on the second side examined compared with the standard-dose group.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Increased volume of intrathecal contrast was well-tolerated and improved the technical performance of LDCTM in this limited series. Further assessment of the safety and impact on diagnostic yield using larger patient cohorts is warranted.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2025/12/19" />
<meta name="citation_mjid" content="ajnr;ajnr.A8436v2" />
<meta name="citation_id" content="ajnr.A8436v2" />
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<meta name="twitter:title" content="Safety and Technical Performance of Bilateral Decubitus CT Myelography using Standard versus Increased Intrathecal Iodinated Contrast Volume" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Lateral decubitus CT myelography (LDCTM) is one of the main studies for the detection of CSF-venous fistulas, but detection of CSF-venous fistulas is dependent on intrathecal contrast attenuation. The purpose of this investigation was to assess the tolerability and technical performance of increased intrathecal doses of myelographic contrast compared with standard doses.

MATERIALS AND METHODS: This is a retrospective series of 24 patients who underwent LDCTM following administration of either 10 or 20 mL of intrathecal iodinated contrast media (300 or 320 mg/mL of iodine content). Patients were scanned in the initial lateral decubitus position and then turned to the contralateral side and re-scanned in the same session. The safety and tolerability of the 20 mL dose was assessed from clinical records. The technical performance of the studies was compared between groups (10 or 20 mL) by measuring attenuation values over the lateral thecal sac at standardized levels. Both the initial scan and the scan after turning the patient to the contralateral side were assessed.

RESULTS: No moderate or severe adverse event was recorded in either group. The 20-mL group showed higher attenuation values, which were statistically greater on the second side examined compared with the standard-dose group.

CONCLUSIONS: Increased volume of intrathecal contrast was well-tolerated and improved the technical performance of LDCTM in this limited series. Further assessment of the safety and impact on diagnostic yield using larger patient cohorts is warranted.

CVF
:   CSF-venous fistula
IOCM
:   iodinated contrast media
LDCTM
:   lateral decubitus CT myelography" />
<meta name="og-title" property="og:title" content="Safety and Technical Performance of Bilateral Decubitus CT Myelography using Standard versus Increased Intrathecal Iodinated Contrast Volume" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/12/20/ajnr.A8436" />
<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: Lateral decubitus CT myelography (LDCTM) is one of the main studies for the detection of CSF-venous fistulas, but detection of CSF-venous fistulas is dependent on intrathecal contrast attenuation. The purpose of this investigation was to assess the tolerability and technical performance of increased intrathecal doses of myelographic contrast compared with standard doses.

MATERIALS AND METHODS: This is a retrospective series of 24 patients who underwent LDCTM following administration of either 10 or 20 mL of intrathecal iodinated contrast media (300 or 320 mg/mL of iodine content). Patients were scanned in the initial lateral decubitus position and then turned to the contralateral side and re-scanned in the same session. The safety and tolerability of the 20 mL dose was assessed from clinical records. The technical performance of the studies was compared between groups (10 or 20 mL) by measuring attenuation values over the lateral thecal sac at standardized levels. Both the initial scan and the scan after turning the patient to the contralateral side were assessed.

RESULTS: No moderate or severe adverse event was recorded in either group. The 20-mL group showed higher attenuation values, which were statistically greater on the second side examined compared with the standard-dose group.

CONCLUSIONS: Increased volume of intrathecal contrast was well-tolerated and improved the technical performance of LDCTM in this limited series. Further assessment of the safety and impact on diagnostic yield using larger patient cohorts is warranted.

CVF
:   CSF-venous fistula
IOCM
:   iodinated contrast media
LDCTM
:   lateral decubitus CT myelography" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node112423--5" data-node-nid="112423" id="top-node-112423--6323841792" data-pisa="ajnr;ajnr.A8436v2" data-pisa-master="ajnr;ajnr.A8436" data-apath="/ajnr/early/2024/12/20/ajnr.A8436.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">Safety and Technical Performance of Bilateral Decubitus CT Myelography using Standard versus Increased Intrathecal Iodinated Contrast Volume</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Diogo G.L. Edelmuth</span>, <span class="highwire-citation-author" data-delta="1">Renata V. Leão</span>, <span class="highwire-citation-author" data-delta="2">Eduardo N.K. Filho</span>, <span class="highwire-citation-author" data-delta="3">Marcio N.P. Souza</span>, <span class="highwire-citation-author" data-delta="4">Marcelo Calderaro</span> and <span class="highwire-citation-author" data-delta="5">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">December 2024,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8436 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-112423--6323841792" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Diogo G.L. Edelmuth </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From 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</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (D.G.L.E., R.V.L., E.N.K.F.), Hospital Sírio-Libanês, São Paulo, SP, Brazil</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Hospital Israelita Albert-Einstein (D.G.L.E., E.N.K.F., M.N.P.S., M.C.), São Paulo, SP, Brazil</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=Diogo%2BG.L.%2BEdelmuth%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=Edelmuth%20DG&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%3ADiogo%2BG.L.%2BEdelmuth%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/0000-0003-0567-0823" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Diogo G.L. Edelmuth</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Renata V. Leão </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From 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</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (D.G.L.E., R.V.L., E.N.K.F.), Hospital Sírio-Libanês, São Paulo, SP, Brazil</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=Renata%2BV.%2BLe%C3%A3o%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=Le%C3%A3o%20RV&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%3ARenata%2BV.%2BLe%25C3%25A3o%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-2"><div class="author-tooltip-name">Eduardo N.K. Filho </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (D.G.L.E., R.V.L., E.N.K.F.), Hospital Sírio-Libanês, São Paulo, SP, Brazil</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Hospital Israelita Albert-Einstein (D.G.L.E., E.N.K.F., M.N.P.S., M.C.), São Paulo, SP, Brazil</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=Eduardo%2BN.K.%2BFilho%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=Filho%20EN&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%3AEduardo%2BN.K.%2BFilho%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">Marcio N.P. Souza </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From 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</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Hospital Israelita Albert-Einstein (D.G.L.E., E.N.K.F., M.N.P.S., M.C.), São Paulo, SP, Brazil</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=Marcio%2BN.P.%2BSouza%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=Souza%20MN&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%3AMarcio%2BN.P.%2BSouza%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-4"><div class="author-tooltip-name">Marcelo Calderaro </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From 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</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Hospital Israelita Albert-Einstein (D.G.L.E., E.N.K.F., M.N.P.S., M.C.), São Paulo, SP, Brazil</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=Marcelo%2BCalderaro%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=Calderaro%20M&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%3AMarcelo%2BCalderaro%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-5"><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'>d</span>Department of Radiology (P.G.K.), Duke University Hospital, 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> Lateral decubitus CT myelography (LDCTM) is one of the main studies for the detection of CSF-venous fistulas, but detection of CSF-venous fistulas is dependent on intrathecal contrast attenuation. The purpose of this investigation was to assess the tolerability and technical performance of increased intrathecal doses of myelographic contrast compared with standard doses.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>MATERIALS AND METHODS:</strong> This is a retrospective series of 24 patients who underwent LDCTM following administration of either 10 or 20 mL of intrathecal iodinated contrast media (300 or 320 mg/mL of iodine content). Patients were scanned in the initial lateral decubitus position and then turned to the contralateral side and re-scanned in the same session. The safety and tolerability of the 20 mL dose was assessed from clinical records. The technical performance of the studies was compared between groups (10 or 20 mL) by measuring attenuation values over the lateral thecal sac at standardized levels. Both the initial scan and the scan after turning the patient to the contralateral side were assessed.</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>RESULTS:</strong> No moderate or severe adverse event was recorded in either group. The 20-mL group showed higher attenuation values, which were statistically greater on the second side examined compared with the standard-dose group.</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>CONCLUSIONS:</strong> Increased volume of intrathecal contrast was well-tolerated and improved the technical performance of LDCTM in this limited series. Further assessment of the safety and impact on diagnostic yield using larger patient cohorts is warranted.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">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-2">IOCM<span class="def-item-dt-sep"></span></dt><dd>iodinated contrast media<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">LDCTM<span class="def-item-dt-sep"></span></dt><dd>lateral decubitus CT myelography</dd></dl></div><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-financial-disclosure" id="fn-2"><p id="p-49"><a href="https://www.ajnr.org/sites/default/files/additional-assets/Disclosures/February%202025/0595.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/2024/12/20/ajnr.A8436.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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    	<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">Dec 2024, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8436 </span></div>
  
  
  
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    	<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">Dec 2024, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8436 </span></div>
  
  
  
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