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Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Fibrin sealant became the first modern era material approved as a hemostat in the United States in 1998. It is the only agent presently approved as a.Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Department of Radiology, Konyang University College of Medicine, Chungnam, South Korea. Please address correspondence to Sang Joon Kim, MD, Asan Medical Center, University of Ulsan College of Medicine, 3. Pungnap 2- dong; Songpa- gu, Seoul, 1. Korea; e- mail: sjkimjb. In this study, we attempted to determine whether. MR myelography (MRM) can detect the leakage site in the spine. Patients were included. CSF opening pressure, and. MR imaging. For comparison, we performed MRM in 1. CSF leak syndrome. MRM was performed with the 2. D turbo spin- echo technique in the entire spine by using a 1. T scanner. RIC was performed only in the patient group and was assessed. The diagnostic performance of MRM and RIC was evaluated on. Delayed Symptoms of CSF Leak After Back Surgery. Where a dural tear (durotomy) is not recognized early and properly addressed, however, symptoms such as a headache. WebMD looks at the causes of spinal headaches and how they are treated. Craniofacial and Skull Base Trauma By J. Timothy Katzen M.D., Reza Jarrahy M.D., Joseph B. Mathiasen M.D., Daniel R. Margulies M.D., FACS, Hrayr K. Sinoe medical association. SEE ALSO CSF 1 LINK Cerebrospinal fluid (CSF) is. BACKGROUND AND PURPOSE: Spinal CSF leak syndrome is a unique disorder caused by spinal CSF leak. In this study, we attempted to determine whether. Journal of Neuroradiology - Vol. 175-177 - Detection of CSF leaks with magnetic resonance imaging in intracranial hypotension syndrome - EM CSF leak syndrome. The sensitivity of RIC was 9. Agreement between. CSF leak was substantial in reader 1 and moderate in reader 2 (. It is currently accepted that the major causative factor of spinal CSF leak syndrome is the release of CSF in the spinal. The diagnosis of spinal CSF leak syndrome may be challenging because various manifestations of this syndrome can be encountered. The syndrome is generally considered to be benign, and most patients improve spontaneously or with conservative management. Among these treatment modalities, autologous EBP is considered the treatment of choice. Detection of the leakage site is important for the use of a targeted EBP because placing this patch at the level of the leak. Localization of a CSF leak can be attempted by invasive diagnostic techniques such as radioisotope cisternography (RIC) or. CT cisternography (CTC). Spontaneous cerebrospinal fluid leak syndrome (SCSFLS) is a medical condition in which the cerebrospinal fluid (CSF) held in and around a human brain and spinal cord. Pathophysiology of dural puncture Anatomy of the spinal dura mater. The spinal dura mater is a tube extending from the foramen magnum to the second segment of the sacrum. MR myelography (MRM) is a noninvasive method that can also be used for demonstrating CSF leak. It. has no radiation hazard and can be performed without intrathecal administration of contrast media or radioisotopes, unlike. CTC or RIC. There have been sporadic case reports in which MRM was used for the detection of a CSF leak. We tested to see if MRM could detect the leakage site in 1. CSF leak syndrome and compared. MRM with those of RIC. For comparison, we performed MRM in 1. CSF leak. syndrome. Patient inclusion in this study depended on their fulfilling at least. CSF pressure, and 3) diffuse pachymeningeal enhancement on. MR imaging. 1. The average patient was 3. There were 5 men and 1. Both MRM and RIC were performed. The mean interval between the MRM and RIC was 2 days (range, 1–5 days). MRM was performed before RIC in 7. RIC in 8 patients. Follow- up MRM was performed in 6 of the 1. EBP. Images were obtained 3. The entire spine was scanned in 2 separate levels (ie, the cervicothoracic area. The scanning parameters were as follows: TR, 8. TE, 1. 00. 0 ms; FOV, 2. The acquisition time for each level. The mean age of the control group was 3. RIC was not performed in this control group. Written permission. MRM or RIC in all patients or members of the control group. Two radiologists. J. W. C., K. S. J.), who were blinded to the clinical information, independently assessed the MRM. One of the authors (S. J. K.). made criteria for CSF leak on MRM after reviewing MRM and RIC findings of the patient and control groups. CSF leak was graded. Grade zero refers to absence of CSF leak; grade 1 refers to possible leakage showing a triangular- shaped. CSF space column around the nerve root sleeves; grade 2 refers to probable leakage showing high signal intensity. CSF leak showing profuse extraspinal high signal intensity. Fig 1). Leakage was assessed at each level of the spine separately (ie, cervical, thoracic, and lumbar level); the cervicothoracic. MRM was considered positive. Evaluation was performed on our PACS with a window width. A, Our grading scale on MRM is depicted as follows: grade zero, no leak (normal findings on MR myelogram); grade 1, possible. CSF space column around the nerve root sleeve); grade 2, probable leak (streaky hyperintensity lateral. However, actual grading of the case is determined. B, Grade of CSF leak on RIC is depicted as follows: grade zero, no paraspinal activity; grade 1, possible leak (faint paraspinal. RIC was evaluated by the consensus of 3 physicians who were experienced in nuclear medicine. CSF leak was assessed at each. MRM from grade zero for no leakage (no paraspinal activity) to. Fig 1). RIC was considered positive when there was grade 1 or higher leakage of CSF at any 1 level or more. RIC was performed only in the patient group, so the evaluation was not. RIC was calculated. Interobserver agreement of the evaluation results of MRM between. Agreement between MRM and RIC findings was also analyzed. The Statistical. Package for the Social Sciences for Windows (Version 1. SPSS, Chicago, Ill) was used for statistical analyses. On RIC, 1. 4 cases of CSF leak were detected. The results are summarized in Table 1. Among 1. 5 subjects of the control group, reader 1 reported grade 1 leakage in 2 subjects and reader 2, in 1. In the remaining. The sensitivity, specificity, and accuracy of MRM for detecting CSF leak were 8. The sensitivity of RIC was 9. Table 2). Specificity and accuracy were not calculated in RIC because RIC was not performed in the control group. Agreement between. CSF leak was substantial in reader 1 and moderate in reader 2 (. A, Anterior projection of RIC shows diffusion of the radioisotope into the extra- arachnoidal space in the region of the bilateral. B, On MR myelography, triangular- shaped CSF space expansion at multiple nerve root sleeves with reticular and streaky hyperintensities. C, Normal MRM findings in a 5. Note incidental perineurial cysts in cervicothoracic. They appear as round discrete hyperintensities at the nerve root sleeves in contrast to CSF leak noted on B. D, A presumed false- positive finding on MRM of a CSF leak in a 4. The patient did not. CSF leak syndrome. Both readers 1 and 2 reported grade 1 CSF leak at the thoracic level in this patient. However, the shape is round, and there is no accompanying expansion at the nerve root sleeve. This may represent a perineurial. On MRM, the thoracic spine, in which we included the cervicothoracic junction, was the most frequent location of CSF leak. RIC, n = 1. 1) followed by the lumbar spine (reader 1, n = 6; reader 2, n = 7; and RIC, n = 4). All patients who were considered to have CSF leak showed multiple sites of CSF leakage. In 7 patients, repeated. EBPs were used due to persistent headache. All 1. 3 patients improved clinically after a single or repeated EBP. In 6 patients. follow- up MRM was performed between 1. EBP placement. In all 6 patients, high signal intensities around. CSF leak on follow- up MRM (Fig 3). A and B, Posterior projection of RIC shows diffusion of the radioisotope into the extra- arachnoidal space in the region of the upper. A) and in the lumbar spine (B). C and D, MRM shows hyperintensities along multiple nerve root sleeves in the upper thoracic spine (arrows, C) and in the lumbar spine (arrows, D). E and F, On 1- month follow- up MRM, multiple hyperintensities around the nerve root sleeves disappeared. CSF leak was. detected in 1. RIC and in 1. 2–1. MRM, depending on the different readers. In the control group, there were 1–2. In our study, clinical criteria were used for the diagnosis of the disease. The sensitivity. specificity, and accuracy of MRM for detecting CSF leak were 8. However. symptoms persist in some patients, and occlusion of the CSF leak is therefore required for symptomatic control. EBP is considered. The mechanism of symptom relief by EBP has not yet been established. There are 2 hypotheses for effective pain relief. One. proposes that the blood volume injected by EBP leads to increasing pressure in the subarachnoid space. The other hypothesis proposes that a rapid coagulation response stops CSF leak. Although some authors reported that the location of injection in EBP is not important,1. CSF leak. 1. 3,1. We agree that, if at all possible, blood should be injected at the site of leakage. For this reason, we consider identification. CSF leak syndrome. Spinal MR. imaging in spinal CSF leak syndrome usually reveals extradural fluid collections, spinal meningeal enhancement, and dilation. In most cases, the search for the point of CSF leak is difficult and unsuccessful by using spinal MR imaging. CTC can provide evidence of meningeal anatomic defects, the precise location of extradural collections, and the relationship. However, it is usually difficult to detect the exact leakage site, and screening of the whole spine may require a large amount. CSF leak can be directly visualized if there is an accumulation of radioactivity. The radiotracer may ascend slowly over the convexities or may quickly disappear from the subarachnoid. If there is no active leakage or if the size of the leakage is smaller than the resolution, no direct evidence of the leak. RIC offers a more panoramic view of the entire spine, even though the sensitivity of RIC is not very high. Recent studies have reported the improved sensitivity of RIC in detecting CSF leak. In our series, the sensitivity of RIC appeared quite high compared with that in the previous reports. This improved detection. CSF leak syndrome. The inherent drawback of RIC includes. Inaccuracy caused by postpuncture radioisotope. 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Software License Management RayVentory in association with SmartTrack from ASPERA. With RaySAMi, a clever combination of Raynet’s RayVentory inventory solution and Aspera’s SmartTrack license management tool, companies are. Over 16 years ago, when license management was just a twinkle in the IT world’s eye, Aspera developed the SmartTrack platform. It’s the foundation of our technology, giving you automatic, accurate license management for. Aspera Technologies - Strategic License Management, Boston, Massachusetts. At Aspera, we simplify the complexity of. Aspera is a highly specialized provider of software asset management solutions. Hundreds of enterprises worldwide rely on Aspera, including more than 35 Fortune Global 500 companies. Since 2000, our award-winning software and. Also participating in this review: A full comparison and Group Test results can be found here: http: //www. Executive Summary. Elevator pitch. Aspera has SKU catalogue- centric license management offering called Smart. Track. No complex pricing for different publishers. Weaknesses. Global presence and partner network not as extensive as competitors, being addressed by Aspera. Learn about working at Aspera. Join LinkedIn today for free. See who you know at Aspera, leverage your professional network, and get hired. No in- house inventory, but exhaustive list of inventory sources and enterprise data sources to connect with. Primary Market Focus. Size: Medium to very large global enterprises. Use: License Management for larger enterprises with complex and disparate environments. Environment: desktop, datacentre and virtual. Commercial Summary. Vendor. Aspera. Product. Smart. Track. Version Reviewed. Date of version release. April 2nd 2. 01. 4Year founded. Customers. 14. 0 with average size of 3. Pricing structure. Qualified desktops in use. Rating. Microsoft License Management Features. Rating. General features that aid Microsoft license management. Microsoft software recognition. Microsoft product family and suite recognition. Management of Microsoft licensing types. Efficient Microsoft spend (low risk, low waste)Microsoft contracts management Key to Ratings Strong. Market leader. Good. Well executed and competitive offering. OKAdequate, meets requirements. Weak. Poorly or partially executed. Absent. Missing key requirements. Independent Review. Aspera has SKU catalogue- centric license management offering called Smart. Track. Aspera Smart. Track has extensive capabilities for managing Microsoft license models, agreements types and managing the nuances and complexity of Microsoft Licensing across desktop, datacentre and virtual environments. We liked the fact that Aspera simply charge per qualified desktop. Some other suppliers competing in the license management for large enterprises charge per publisher blade or vendor. Software Asset Managers are investing in License Management tooling to help them with some of the heavy lifting and make things easier – not further complicate things! The heart of Smart. Track is the . Smart. Track uses SKUs as the unique identifier and best way to marry the diverse languages of configuration and procurement. Aspera was a pioneer in the use of SKUs for maintaining SAM accuracy and now has a strong catalogue updated by the Aspera team. Learn more about SKUs here: “How SKU catalogues save time and money”. The use of the Master Catalog within Smart. Track allows organizations to identify the product use rights and licensing rules that are applicable for every single Microsoft line item in their estate such as second use or parallel usage rights, Affinity or virtualization rules, user based licensing such as MSDN, upgrade and downgrade rights, client access licenses, software assurance and so on. The immediate business benefits of this are two fold: Ensuring organizations are operating within the terms of their agreements with Microsoft and. Ensuring they are squeezing every last drop of value out of every product use right and entitlement they own. Smart. Track includes a . For example organizations can explore changing the license metric used for Microsoft SQL in the datacentre and simulate both the financial consequences and impact on product use rights. This is particularly useful for those organizations that have reached sufficient maturity in their SAM function to converse with the likes of Enterprise Architects and IT planners to identify optimal long- term strategies for licensing with Microsoft. Smart. Track also has a Contracts Management Module (CMM) that is ideally suited for managing the multi- tier, multi- country nature of Microsoft contracts, enrolments and agreements. The CMM module includes a number of important Financial Management features such as budgeting, forecasting and internal cost allocation of Microsoft spend – very useful during a Microsoft true up. Aspera Managed Services were reviewed as part of our SAM Managed Service providers review back in January 2. SAM MSP Group Test – The Results”. It should be noted that Aspera has no in- house inventory sources but instead uses an exhaustive list connections to existing inventory sources and configuration data necessary to satisfy audit requirements with Microsoft. Whilst Aspera can highlight to organizations where their inventory sources may have holes using Smart. Track, ultimately a SAM tool is only as good as the data you put in it. So whilst Aspera is a strong offering for Microsoft license management organizations will need to ensure they have inventory of sufficient quality to support use of the solution. There is no point putting a Ferrari engine on a scooter. Overall The ITAM Review considers Aspera a leader in the field of license management. One weakness to mention is not a technological one but related to implementation partners; competitors to Aspera typically have a broader partner channel and global presence. Aspera are addressing this with the opening of a US office to further expansion in the Americas. Screenshots. In their own words“Smart. Track is designed to manage all types of software licenses based on clients, as well as server- , virtual- and cluster- environments including (but not limited to) Microsoft products. A vital part is taking contracts into consideration as product usage and commercial article data alone are not enough to calculate the effective license situation e. Smart. Track enables your company to manage all of these situations – and even optimize them on top of the actual situation.”Further Reading. |