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Reply: REPLY: system is occurring would likely result in submaximal opacification of intrathecal CSF and markedly decrease the diagnostic yield. hank you very much for such a thoughtful and timely let- Thank you again for the letter and great efforts to optimize Tter. It brings up the important topic of CSF dynamics patient care in a difficult time for the medical community. within the “subdural” space, which has not been fully eluci- D. Shlapak dated. Diffusion of subdural contrast into the thecal sac is cer- Department of Radiology Mayo Clinic tainly interesting; we do not yet know if it is from the Rochester, Minnesota disruption of the inner layer at the puncture site, or if intrathe- D.K. Kim cal distribution results from the natural egress passage of any Department of Radiology Mayo Clinic subdural fluid. Rochester, Minnesota In a typical CT myelogram for spinal stenosis evaluation, F.E. Diehn rescanning patients after an hour in cases of subdural injection to Department of Radiology see whether the contrast diffuses intrathecally is a very acceptable Mayo Clinic Rochester, Minnesota option. This is especially true during the current pandemic set- J.C. Benson ting, as the authors mentioned. Department of Radiology While most CT myelograms performed for spinal stenosis can Mayo Clinic Rochester, Minnesota be diagnostic if the CSF is appreciably denser than the neural ele- V.T. Lehman ments, the evaluation of spinal CSF leaks on CT myelogram is Department of Radiology extremely dependent on a high concentration of intrathecal con- Mayo Clinic Rochester, Minnesota trast. This is especially true with CSF-venous fistulas, where the G.B. Liebo findings are often subtle even with maximal contrast attenuation. Department of Radiology Therefore, waiting an hour for subdural injections to become intra- Mayo Clinic Rochester, Minnesota thecal while contrast resorption from the CSF to the venous J.M. Morris Department of Radiology Mayo Clinic Rochester, Minnesota P.P. Morris Department of Radiology Mayo Clinic Rochester, Minnesota J.T. Verdoom Department of Radiology Mayo Clinic Rochester, Minnesota C.M. Carr Department of Radiology Mayo Clinic http://dx.doi.org/10.3174/ajnr.A7126 Rochester, Minnesota AJNR Am J Neuroradiol 42:E45 Jul 2021 www.ajnr.org E45 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

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Publisher
American Journal of Neuroradiology
Copyright
© 2021 by American Journal of Neuroradiology
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A7126
Publisher site
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Abstract

REPLY: system is occurring would likely result in submaximal opacification of intrathecal CSF and markedly decrease the diagnostic yield. hank you very much for such a thoughtful and timely let- Thank you again for the letter and great efforts to optimize Tter. It brings up the important topic of CSF dynamics patient care in a difficult time for the medical community. within the “subdural” space, which has not been fully eluci- D. Shlapak dated. Diffusion of subdural contrast into the thecal sac is cer- Department of Radiology Mayo Clinic tainly interesting; we do not yet know if it is from the Rochester, Minnesota disruption of the inner layer at the puncture site, or if intrathe- D.K. Kim cal distribution results from the natural egress passage of any Department of Radiology Mayo Clinic subdural fluid. Rochester, Minnesota In a typical CT myelogram for spinal stenosis evaluation, F.E. Diehn rescanning patients after an hour in cases of subdural injection to Department of Radiology see whether the contrast diffuses intrathecally is a very acceptable Mayo Clinic Rochester, Minnesota option. This is especially true during the current pandemic set- J.C. Benson ting, as the authors mentioned. Department of Radiology While most CT myelograms performed for spinal stenosis can Mayo Clinic Rochester, Minnesota be diagnostic if the CSF is appreciably denser than the neural ele- V.T. Lehman ments, the evaluation of spinal CSF leaks on CT myelogram is Department of Radiology extremely dependent on a high concentration of intrathecal con- Mayo Clinic Rochester, Minnesota trast. This is especially true with CSF-venous fistulas, where the G.B. Liebo findings are often subtle even with maximal contrast attenuation. Department of Radiology Therefore, waiting an hour for subdural injections to become intra- Mayo Clinic Rochester, Minnesota thecal while contrast resorption from the CSF to the venous J.M. Morris Department of Radiology Mayo Clinic Rochester, Minnesota P.P. Morris Department of Radiology Mayo Clinic Rochester, Minnesota J.T. Verdoom Department of Radiology Mayo Clinic Rochester, Minnesota C.M. Carr Department of Radiology Mayo Clinic http://dx.doi.org/10.3174/ajnr.A7126 Rochester, Minnesota AJNR Am J Neuroradiol 42:E45 Jul 2021 www.ajnr.org E45

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Jul 1, 2021

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