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Dual energy CT for the identification of CSF-Venous Fistulas and CSF leaks in spontaneous intracranial hypotension: Report of four cases.

Publication ,  Journal Article
Houk, JL; Marin, DM; Malinzak, MD; Kranz, PG; Amrhein, TJ
Published in: Radiol Case Rep
May 2022

Spontaneous intracranial hypotension (SIH) is a debilitating condition caused by spinal CSF leaks or CSF-venous fistulas (CVFs). Localizing the causative CSF leak or CVF is critical for definitive treatment but can be difficult using conventional myelographic techniques because these lesions are often low contrast compared to background, diminutive, and in some cases may be mistaken for calcified structures. Dual energy CT (DECT) can increase the conspicuity of iodinated contrast compared to background and can provide the ability to distinguish materials based on differing anatomic properties, making it well suited to address the shortcomings of conventional myelography in SIH. The purpose of this report is to illustrate the potential benefits of using DECT as an adjunct to traditional myelographic techniques in order to increase the conspicuity of these often-subtle CVFs and CSF leaks. This retrospective case series included 4 adult patients with SIH who demonstrated findings equivocal for either CVF or CSF leak using our institution's standard initial CT myelogram and in whom subsequent evaluation with DECT ultimately helped to identify the CVF or CSF leak. DECT demonstrated utility by increasing the conspicuity of two subtle CVFs compared to background and also helped to differentiate between calcified osteophytes and extradural contrast in 2 CSF leaks, confirming their presence and identifying the causative pathology. Our observations demonstrate the benefit of DECT as a problem-solving tool in the accurate diagnosis and localization of CVFs and CSF leaks.

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Published In

Radiol Case Rep

DOI

ISSN

1930-0433

Publication Date

May 2022

Volume

17

Issue

5

Start / End Page

1824 / 1829

Location

Netherlands
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Houk, J. L., Marin, D. M., Malinzak, M. D., Kranz, P. G., & Amrhein, T. J. (2022). Dual energy CT for the identification of CSF-Venous Fistulas and CSF leaks in spontaneous intracranial hypotension: Report of four cases. Radiol Case Rep, 17(5), 1824–1829. https://doi.org/10.1016/j.radcr.2022.02.053
Houk, Jessica L., Daniele M. Marin, Michael D. Malinzak, Peter G. Kranz, and Timothy J. Amrhein. “Dual energy CT for the identification of CSF-Venous Fistulas and CSF leaks in spontaneous intracranial hypotension: Report of four cases.Radiol Case Rep 17, no. 5 (May 2022): 1824–29. https://doi.org/10.1016/j.radcr.2022.02.053.
Houk JL, Marin DM, Malinzak MD, Kranz PG, Amrhein TJ. Dual energy CT for the identification of CSF-Venous Fistulas and CSF leaks in spontaneous intracranial hypotension: Report of four cases. Radiol Case Rep. 2022 May;17(5):1824–9.
Houk, Jessica L., et al. “Dual energy CT for the identification of CSF-Venous Fistulas and CSF leaks in spontaneous intracranial hypotension: Report of four cases.Radiol Case Rep, vol. 17, no. 5, May 2022, pp. 1824–29. Pubmed, doi:10.1016/j.radcr.2022.02.053.
Houk JL, Marin DM, Malinzak MD, Kranz PG, Amrhein TJ. Dual energy CT for the identification of CSF-Venous Fistulas and CSF leaks in spontaneous intracranial hypotension: Report of four cases. Radiol Case Rep. 2022 May;17(5):1824–1829.
Journal cover image

Published In

Radiol Case Rep

DOI

ISSN

1930-0433

Publication Date

May 2022

Volume

17

Issue

5

Start / End Page

1824 / 1829

Location

Netherlands