Inconsistent venous opacification: a pitfall of epidural venography

Area of Science:

• Radiology
• Neurosurgery
• Vascular Imaging

Background:

• Lumbar epidural venography is used to evaluate spinal conditions.
• Myelography is a common diagnostic tool for spinal issues.
• Accurate interpretation of epidural venography is crucial for patient diagnosis.

Purpose of the Study:

• To assess the reliability of lumbar epidural venography in detecting spinal abnormalities.
• To identify potential sources of diagnostic error in epidural venography.
• To evaluate the incidence of false venous occlusions in lumbar epidural venography.

Main Methods:

• Review of lumbar epidural venograms from 45 patients with prior normal or equivocal myelography.
• Utilized transfemoral double-catheter technique with abdominal compression and Valsalva maneuver.
• Employed serial filming for 12 seconds to capture venous opacification dynamics.

Main Results:

• A 30% incidence of false "occlusions" in epidural veins was observed.
• These false occlusions mimicked compression from herniated intervertebral discs.
• Repeat venography confirmed spurious findings by demonstrating altered venous opacification patterns.

Conclusions:

• Lumbar epidural venography can produce false positive findings suggestive of disc herniation.
• The incidence of spurious venous occlusions necessitates cautious interpretation of single-injection studies.
• Normal lumbar epidural venograms are reliable, but abnormal findings require careful validation.