Swiss Researcher Captures RSNA Chynn Award for Neuroradiology Research

For Eike Piechowiak, MD, capturing the 2020 Kuo York Chynn Neuroradiology Research Award came as a surprise — so much so that he didn’t believe it when the news arrived via email.

“My topic is very specialized, so I was amazed, but ultimately positively surprised and pleased by the honor,” Dr. Piechowiak said. “The award is a nice confirmation that we are working on an exciting topic and not just a highly specialized area of interest to two or three people in the world.”

The RSNA Kuo York Chynn Neuroradiology Research Award honors the author of the top neuroradiology research paper presented during the RSNA annual meeting, determined by the Scientific Programming Committee. Launched in 2015, the award is funded through an endowment from Dr. Chynn, an internationally renowned neuroradiology expert. The researcher who captures the award receives a $3,000 prize.

Spontaneous Intracranial Hypotension Not Fully Understood

Dr. Piechowiak, a neuroradiologist at Bern University Hospital in Bern, Switzerland, was awarded for his research, “Early Renal Pelvis Opacification on Post-myelography CT as an Indicator for Increased CSF Resorption in Spontaneous Intracranial Hypotension,” which was presented at RSNA 2020.

The paper focuses on spontaneous intracranial hypotension (SIH), a condition characterized by a loss of cerebrospinal fluid (CSF) from the dura, the tough protective membrane that covers the brain and spinal cord. This reduces fluid pressure inside the skull, causing severe headaches that worsen when a person stands up. Other symptoms can include nausea, vomiting and vertigo. Diagnosis is typically based on symptoms or MRI findings.

The causes of SIH are not fully understood. CSF venous fistulas, abnormal channels between the spinal subarachnoid space and epidural veins that allow for the loss of CSF directly into the circulation, have recently been identified as one possible source.

In the study, Dr. Piechowiak and colleagues assessed early renal pelvis opacification on post-myelography CT as a marker for CSF loss in patients with SIH.

The study group was comprised of 111 SIH patients including 71 who were positive for spinal longitudinal epidural CSF (SLEC) on imaging and 40 who were negative for SLEC. The researchers analyzed CT scans from the patients and compared them with those from 20 nonSIH patients.

Results showed significant differences in density between the SIH patients and the controls. There were no significant differences between the SLEC-positive and negative groups when compared with each other.

“SIH patients with and without epidural CSF collection demonstrate increased renal pelvis opacification on post-myelogram CT compared to nonSIH patients,” Dr. Piechowiak said.

None of the patients in the study had CSF venous fistulas. The researchers postulate that in patients without epidural CSF collection, SIH could be caused by increased spinal resorption or CSF venous fistulas that are not visible on direct imaging.

“The pathomechanism of a specific cause of SIH remains unclear,” Dr. Pechowiak said. “Our work should provide possible concepts, which could then help in the development of targeted diagnostics and therapy.”

A Developing Interest in Neuroradiology

Dr. Piechowiak specializes in diagnostic and interventional procedures, with a research focus on CSF leak syndromes. While living in Germany, he began his career in general radiology before developing an interest in neuroradiology and switching departments for his specialization after moving to Switzerland.

“As a resident I was increasingly involved in research projects, but it was only after moving to Bern to work in the Department of Neuroradiology that I found a team that ultimately motivated me to want to participate,” he said. “The colleagues, the support and the infrastructure were optimal and that was my motivation to be part of the research team.”

For More Information

Access Dr. Piechowiak’s RSNA 2020 presentation, “Early Renal Pelvis Opacification on Post-myelography CT as an Indicator for Increased CSF Resorption in Spontaneous Intracranial Hypotension.”