Diagnostic Performance of Decubitus Photon-Counting Detector CT Myelography for the Detection of CSF-Venous Fistulas

• DOI: 10.3174/ajnr.a8040
• Publication Date: 2023-11-09T23:20:11Z
• Authors: Ajay A. Madhavan; Jeremy K. Cutsfor...; Waleed Brinjikji; Girish Bathla; John C. Benson; Felix E. Diehn; Laurence J. Eckel; Ian T. Mark; Pearse P. Morris; Melissa A. Payne; Jared T. Verdoorn; Nikkole M. Weber; Lifeng Yu; Francis Baffour; Joel G. Fletcher; Cynthia H. McColl...
• Keywords: Cerebrospinal Fluid Leak; Fistula; Intracranial Hypotension; Humans; Tomography, X-Ray Computed; Myelography; 3. Good health; Retrospective Studies

<h3>BACKGROUND AND PURPOSE:</h3> CSF-venous fistulas are a common cause of spontaneous intracranial hypotension. Lateral decubitus digital subtraction myelography and CT the diagnostic imaging standards to identify these fistulas. Photon-counting has technological advantages that might improve fistula detection, though no large studies have yet assessed its performance. We sought determine yield photon-counting detector for detection in patients with <h3>MATERIALS METHODS:</h3> retrospectively searched our database all myelograms performed at institution since introduction technique practice. Per institutional workflow, had prior contrast-enhanced brain MR spine showing extradural CSF. Two neuroradiologists reviewed preprocedural MRIs, assessing previously described findings hypotension (Bern score). Additionally, 2 different each myelogram definitive or equivocal fistula. The was calculated stratified by Bern score using low-, intermediate-, high-probability tiers. <h3>RESULTS:</h3> Fifty-seven consecutive 57 were included. A single definitively present 38/57 patients. After we score, seen 56.0%, 73.3%, 76.5% imaging, respectively. <h3>CONCLUSIONS:</h3> Decubitus an excellent performance intermediate- scores is least as high reported yields energy-integrating scanners. low-probability appears be greater compared other modalities. Due retrospective nature this study, future prospective work will needed compare sensitivity