AJNR. American journal of neuroradiology
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AJNR Am J Neuroradiol · Jun 1999
Tortuous, engorged pial veins in intracranial dural arteriovenous fistulas: correlations with presentation, location, and MR findings in 122 patients.
Tortuous, engorged veins can be identified on the venous phase of the brain circulation in patients with venous congestion related to an intracranial dural arteriovenous fistula (DAVF). The term pseudophlebitic pattern (PPP) has been used to describe this finding. The purpose of this study was to determine the prevalence of PPP in patients with intracranial DAVF and to analyze the relationship of this sign to presentation, location of the fistula, presence of retrograde leptomeningeal venous drainage, and MR findings. ⋯ The PPP reflects venous congestion and is associated with an aggressive presentation with or without retrograde leptomeningeal venous drainage. PPP may be a useful prognostic indicator and should be considered in treatment decisions.
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AJNR Am J Neuroradiol · May 1999
Comparative StudyIntracranial stenoocclusive disease: double-detector helical CT angiography versus digital subtraction angiography.
To our knowledge, no large-scale studies comparing the accuracy of CT angiography (CTA) to intraarterial digital subtraction angiography (DSA) of intracranial stenosis have been reported. We attempted to determine the diagnostic value of intracranial CT angiography (CTA) of normal vasculature and variants as well as of stenoocclusive disease. ⋯ CTA with double-detector technology and advanced postprocessing algorithms, including MPR, is about as reliable as MRA in depicting the vasculature of the anterior and posterior circulation and in grading intracranial stenoocclusive lesions, with the exception of the petrous segment of the carotid artery. CTA might be superior to MRA in the evaluation of poststenotic low-flow segments.
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AJNR Am J Neuroradiol · Apr 1999
Comparative StudyEvaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography.
Radiologic evaluation of CSF leaks is a diagnostic challenge that often involves multiple imaging studies with the associated expense and patient discomfort. We evaluated the use of screening noncontrast high-resolution CT in identifying the presence and site of CSF rhinorrhea and otorrhea and compared it with contrast-enhanced CT cisternography and radionuclide cisternography. ⋯ Noncontrast high-resolution CT showed a defect in 70% of the patients with CSF leak. No radionuclide cisternography or CT cisternography study produced positive results without previous visualization of a defect on high-resolution CT. CT cisternography and radionuclide cisternography may be reserved for patients in whom initial high-resolution CT does not identify a bone defect or for patients with multiple fractures or postoperative defects.
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AJNR Am J Neuroradiol · Apr 1999
Epidurography and therapeutic epidural injections: technical considerations and experience with 5334 cases.
Even in experienced hands, blind epidural steroid injections result in inaccurate needle placement in up to 30% of cases. The use of fluoroscopy and radiologic contrast material provides confirmation of accurate needle placement within the epidural space. We describe our technique and experience with contrast epidurography and therapeutic epidural steroid injections, and review the frequency of systemic and neurologic complications. ⋯ Epidurography in conjunction with epidural steroid injections provides for safe and accurate therapeutic injection and is associated with an exceedingly low frequency of untoward sequelae. It can be performed safely on an outpatient basis and does not require sedation or special monitoring.