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Low-Dose CCT to Exclude Contraindications to Lumbar Puncture

Benefits and Limitations

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Abstract

Background

Low-dose cranial computed tomography (LD-CCT) based on iterative reconstruction has been shown to have sufficient image quality to assess cerebrospinal fluid spaces (CSF) and midline structures but not to exclude subtle parenchymal pathologies. Patients without focal neurological deficits often undergo CCT before lumbar puncture (LP) to exclude contraindications to LP including brain herniation or increased CSF pressure. We performed LD-CCT to assess if image quality is appropriate for this indication.

Methods

A total of 58 LD-CCT (220 mA/120 kV) of patients before LP were retrospectively evaluated and compared to 79 normal standard dose cranial computed tomography (SD-CCT) (350 mA/120 kV). Iterative reconstruction used for both dose levels was increased by one factor for LD-CCT. We assessed the signal-to-noise (SNR) and contrast-to-noise ratio (CNR), the dose estimates and scored diagnostic image quality by two raters independently. Significance level was set at p < 0.05.

Results

The inner and outer CSF spaces except the sulci were equally well depicted by the LD-CCT and SD-CCT; however, depiction of the subtle density differences of the brain parenchyma and the sulci was significantly worse in the LD-CCT (p < 0.0001). The SNR in the gray matter (9.35 vs. 10.61, p < 0.05) and white matter (7.23 vs. 8.15, p < 0.001) were significantly lower in LD-CCT than in SD-CCT with significantly lower dose estimates (1.04 vs. 1.69 mSv, respectively p < 0.0001).

Conclusion

The use of LD-CCT with a dose reduction of almost 50% is sufficient to exclude contraindications to LP; however, LD-CCT cannot exclude subtle parenchymal pathologies. Therefore, in patients with suspected parenchymal pathology, SD-CCT is still the method of choice.

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Acknowledgements

We declare no financial conflict of interests. The work was part of a scientific cooperation between our institute and Philips Healthcare (Hamburg, Germany). The authors state that this work has not received any funding by the company. We received constant technical support from Philips Healthcare.

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Authors and Affiliations

  1. Institute of Neuroradiology, Goethe-University Hospital Frankfurt, Schleusenweg 2–16, 60528, Frankfurt, Germany

    Stella Blasel, Sarah Alex, Joachim Berkefeld & Marlies Wagner

  2. Institute of Neurology, Goethe-University Hospital Frankfurt, Schleusenweg 2–16, 60528, Frankfurt, Germany

    Julia Tichy

  3. Institute of Biostatistics and mathematical Modelling, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany

    Hanns Ackermann

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  1. Stella Blasel
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Correspondence to Stella Blasel.

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S. Blasel, S. Alex, H. Ackermann, J. Tichy, J. Berkefeld and M. Wagner declare that they have no competing interests.

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Blasel, S., Alex, S., Ackermann, H. et al. Low-Dose CCT to Exclude Contraindications to Lumbar Puncture. Clin Neuroradiol 29, 117–123 (2019). https://doi.org/10.1007/s00062-017-0628-2

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  • DOI: https://doi.org/10.1007/s00062-017-0628-2

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