Photon-Counting Computed Tomography Scan of a Cerebrospinal Fluid Venous Fistula

A 56-year-old female patient was experiencing spontaneous intracranial hypotension (SIH). We report what are, to our knowledge, the first images of cerebrospinal fluid (CSF) venous fistula (CVF) acquired on a photon-counting computed tomography (PCCT) scanner, newly approved by the US Food and Drug Administration. Images were acquired in high-resolution mode and with an iodine map using the scanner’s material decomposition capabilities. The standard clinical images do not include iodine quantification or high-resolution images. The magnetic resonance imaging results were diagnostic of SIH but prior imaging at an outside institution had been unable to identify the site of the CVF. Nontargeted blood patches had not resulted in symptom relief for the patient.