Photon-Counting Computed Tomography of a Cerebrospinal Fluid (CSF) Venous Fistula

This video shows a CSF venous fistula imaged with a photon-counting computed tomography scanner (Siemens NAEOTOM alpha), newly approved by the US Food and Drug Administration. It shows standard axial computed tomography images of a 56-year-old patient with a clinical diagnosis of spontaneous intracranial hypotension, imaged on the new scanner system, leveraging the system's inherent material decomposition capabilities to show iodine map images. These iodine map images demonstrate where the contrast injected into the spinal canal has a connection (fistula) to the venous system, causing the symptoms of intracranial hypotension through loss of CSF into the venous system. The fistula occurs at the level of T12 (lower thoracic spine), and its course is marked by a white arrow in the video. Localization of the connection between the CSF and the venous system enables more targeted therapy. Click the Related Article link for full details.