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Research ArticleSPINE

Utility of Photon-Counting Detector CT Myelography for the Detection of CSF-Venous Fistulas

A.A. Madhavan, L. Yu, W. Brinjikji, J.K. Cutsforth-Gregory, F.R. Schwartz, I.T. Mark, J.C. Benson and T.J. Amrhein
American Journal of Neuroradiology May 2023, DOI: https://doi.org/10.3174/ajnr.A7887
A.A. Madhavan
aFrom the Division of Neuroradiology (A.A.M., L.Y., W.B., I.T.M., J.C.B.)
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  • ORCID record for A.A. Madhavan
L. Yu
aFrom the Division of Neuroradiology (A.A.M., L.Y., W.B., I.T.M., J.C.B.)
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W. Brinjikji
aFrom the Division of Neuroradiology (A.A.M., L.Y., W.B., I.T.M., J.C.B.)
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J.K. Cutsforth-Gregory
bDepartment of Radiology and Department of Neurology (J.K.C.-G.), Mayo Clinic, Rochester, Minnesota
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F.R. Schwartz
cDivision of Neuroradiology (F.R.S., T.J.A.), Department of Radiology, Duke University Medical Center, Durham, North Carolina
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I.T. Mark
aFrom the Division of Neuroradiology (A.A.M., L.Y., W.B., I.T.M., J.C.B.)
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J.C. Benson
aFrom the Division of Neuroradiology (A.A.M., L.Y., W.B., I.T.M., J.C.B.)
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T.J. Amrhein
cDivision of Neuroradiology (F.R.S., T.J.A.), Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Abstract

SUMMARY: CSF-venous fistulas are an increasingly recognized type of CSF leak that can be particularly challenging to detect, even with recently improved imaging techniques. Currently, most institutions use decubitus digital subtraction myelography or dynamic CT myelography to localize CSF-venous fistulas. Photon-counting detector CT is a relatively recent advancement that has many theoretical benefits, including excellent spatial resolution, high temporal resolution, and spectral imaging capabilities. We describe 6 cases of CSF-venous fistulas detected on decubitus photon-counting detector CT myelography. In 5 of these cases, the CSF-venous fistula was previously occult on decubitus digital subtraction myelography or decubitus dynamic CT myelography using an energy-integrating detector system. All 6 cases exemplify the potential benefits of photon-counting detector CT myelography in identifying CSF-venous fistulas. We suggest that further implementation of this imaging technique will likely be valuable to improve the detection of fistulas that might otherwise be missed with currently used techniques.

ABBREVIATIONS:

CTM
CT myelography
CVF
CSF-venous fistula
DSM
digital subtraction myelography
EID
energy-integrating detector
LDDSM
lateral decubitus digital subtraction myelography
PCD
photon-counting detector
SIH
spontaneous intracranial hypotension
SR
standard resolution
T3D
low-energy threshold
UHR
ultra-high-resolution mode
VMI
virtual monoenergetic image

Footnotes

  • Disclosure forms provided by the authors are available with the full text and PDF of this article at www.ajnr.org.

  • © 2023 by American Journal of Neuroradiology
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Utility of Photon-Counting Detector CT Myelography for the Detection of CSF-Venous Fistulas
A.A. Madhavan, L. Yu, W. Brinjikji, J.K. Cutsforth-Gregory, F.R. Schwartz, I.T. Mark, J.C. Benson, T.J. Amrhein
American Journal of Neuroradiology May 2023, DOI: 10.3174/ajnr.A7887

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Utility of Photon-Counting Detector CT Myelography for the Detection of CSF-Venous Fistulas
A.A. Madhavan, L. Yu, W. Brinjikji, J.K. Cutsforth-Gregory, F.R. Schwartz, I.T. Mark, J.C. Benson, T.J. Amrhein
American Journal of Neuroradiology May 2023, DOI: 10.3174/ajnr.A7887
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