RT Journal Article
SR Electronic
T1 Utility of Photon-Counting Detector CT Myelography for the Detection of CSF-Venous Fistulas
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A7887
A1 A.A. Madhavan
A1 L. Yu
A1 W. Brinjikji
A1 J.K. Cutsforth-Gregory
A1 F.R. Schwartz
A1 I.T. Mark
A1 J.C. Benson
A1 T.J. Amrhein
YR 2023
UL http://www.ajnr.org/content/early/2023/05/18/ajnr.A7887.abstract
AB 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.CTMCT myelographyCVFCSF-venous fistulaDSMdigital subtraction myelographyEIDenergy-integrating detectorLDDSMlateral decubitus digital subtraction myelographyPCDphoton-counting detectorSIHspontaneous intracranial hypotensionSRstandard resolutionT3Dlow-energy thresholdUHRultra-high-resolution modeVMIvirtual monoenergetic image