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

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

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.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Fides R. Schwartz, MD, Department of Radiology, Duke University, 2301 Erwin Rd, Box 3808-Radiology, Durham, NC 27710 (Fides.schwartz@duke.edu).

Published Online: April 18, 2022. doi:10.1001/jamaneurol.2022.0687

Conflict of Interest Disclosures: Dr Amrhein reported that he is an unpaid member of the medical advisory board of the Spinal Cerebrospinal Fluid Leak Foundation. No other disclosures were reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
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Kranz  PG , Gray  L , Malinzak  MD , Houk  JL , Kim  DK , Amrhein  TJ .  CSF-venous fistulas: anatomy and diagnostic imaging.   AJR Am J Roentgenol. 2021;217(6):1418-1429. doi:10.2214/AJR.21.26182PubMedGoogle ScholarCrossref
2.
Shlobin  NA , Shah  VN , Chin  CT , Dillon  WP , Tan  LA .  Cerebrospinal fluid-venous fistulas: a systematic review and examination of individual patient data.   Neurosurgery. 2021;88(5):931-941. doi:10.1093/neuros/nyaa558PubMedGoogle ScholarCrossref
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Willemink  MJ , Persson  M , Pourmorteza  A , Pelc  NJ , Fleischmann  D .  Photon-counting CT: technical principles and clinical prospects.   Radiology. 2018;289(2):293-312. doi:10.1148/radiol.2018172656PubMedGoogle ScholarCrossref
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