PT - JOURNAL ARTICLE AU - Madhavan, Ajay A. AU - Cutsforth-Gregory, Jeremy K. AU - Brinjikji, Waleed AU - Bathla, Girish AU - Benson, John C. AU - Diehn, Felix E. AU - Eckel, Laurence J. AU - Mark, Ian T. AU - Morris, Pearse P. AU - Payne, Melissa A. AU - Verdoorn, Jared T. AU - Weber, Nikkole M. AU - Yu, Lifeng AU - Baffour, Francis AU - Fletcher, Joel G. AU - McCollough, Cynthia H. TI - Diagnostic Performance of Decubitus Photon-Counting Detector CT Myelography for the Detection of CSF-Venous Fistulas AID - 10.3174/ajnr.A8040 DP - 2023 Dec 01 TA - American Journal of Neuroradiology PG - 1445--1450 VI - 44 IP - 12 4099 - http://www.ajnr.org/content/44/12/1445.short 4100 - http://www.ajnr.org/content/44/12/1445.full SO - Am. J. Neuroradiol.2023 Dec 01; 44 AB - BACKGROUND AND PURPOSE: CSF-venous fistulas are a common cause of spontaneous intracranial hypotension. Lateral decubitus digital subtraction myelography and CT myelography are the diagnostic imaging standards to identify these fistulas. Photon-counting CT myelography has technological advantages that might improve CSF-venous fistula detection, though no large studies have yet assessed its diagnostic performance. We sought to determine the diagnostic yield of photon-counting detector CT myelography for detection of CSF-venous fistulas in patients with spontaneous intracranial hypotension.MATERIALS AND METHODS: We retrospectively searched our database for all decubitus photon-counting detector CT myelograms performed at our institution since the introduction of the technique in our practice. Per our institutional workflow, all patients had prior contrast-enhanced brain MR imaging and spine MR imaging showing no extradural CSF. Two neuroradiologists reviewed preprocedural brain MRIs, assessing previously described findings of intracranial hypotension (Bern score). Additionally, 2 different neuroradiologists assessed each myelogram for a definitive or equivocal CSF-venous fistula. The yield of photon-counting detector CT myelography was calculated and stratified by the Bern score using low-, intermediate-, and high-probability tiers.RESULTS: Fifty-seven consecutive photon-counting detector CT myelograms in 57 patients were included. A single CSF-venous fistula was definitively present in 38/57 patients. After we stratified by the Bern score, a definitive fistula was seen in 56.0%, 73.3%, and 76.5% of patients with low-, intermediate-, and high-probability brain MR imaging, respectively.CONCLUSIONS: Decubitus photon-counting detector CT myelography has an excellent diagnostic performance for the detection of CSF-venous fistulas. The yield for patients with intermediate- and high-probability Bern scores is at least as high as previously reported yields of decubitus digital subtraction myelography and CT myelography using energy-integrating detector scanners. The yield for patients with low-probability Bern scores appears to be greater compared with other modalities. Due to the retrospective nature of this study, future prospective work will be needed to compare the sensitivity of photon-counting detector CT myelography with other modalities.CTMCT myelographyCVFCSF-venous fistulaDSMdigital subtraction myelographyEIDenergy-integrating detectorEVVPexternal vertebral venous plexusIVVPinternal vertebral venous plexusPCphoton-counting detectorSIHspontaneous intracranial hypotensionSRstandard resolutionT3Dlow-energy thresholdUHRultra-high resolutionVMIvirtual monoenergetic image