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PT  - JOURNAL ARTICLE
AU  - Huls, S.J.
AU  - Shlapak, D.P.
AU  - Kim, D.K.
AU  - Leng, S.
AU  - Carr, C.M.
TI  - Utility of Dual-Energy CT to Improve Diagnosis of CSF Leaks on CT Myelography following Lateral Decubitus Digital Subtraction Myelography with Negative Findings
AID  - 10.3174/ajnr.A7628
DP  - 2022 Oct 01
TA  - American Journal of Neuroradiology
PG  - 1539--1543
VI  - 43
IP  - 10
4099  - http://www.ajnr.org/content/43/10/1539.short
4100  - http://www.ajnr.org/content/43/10/1539.full
SO  - Am. J. Neuroradiol.2022 Oct 01; 43
AB  - SUMMARY: CSF leaks, including CSF-venous fistulas, which cause spontaneous intracranial hypotension, remain difficult to diagnose, even on digital subtraction myelography and CT myelography. Dual-energy CT technology has been used to improve diagnostic utility within multiple organ systems. The capability of dual-energy CT to create virtual monoenergetic images can be leveraged to increase conspicuity of contrast in CSF-venous fistulas and direct epidural CSF leakage to improve the diagnostic utility of CT myelography. Six cases (in 5 patients) are shown in which virtual monoenergetic images demonstrate a leak location that was either occult or poorly visible on high- or low-kilovolt series. This clinical report describes the novel application of dual-energy CT for the detection of subtle CSF leaks including CSF-venous fistulas.CTDIvolvolume CT dose indexCTMCT myelographyCVFCSF-venous fistulaDECTdual-energy CTDSMdigital subtraction myelographyLDDSMlateral decubitus digital subtraction myelographySIHspontaneous intracranial hypotensionVMIvirtual monoenergetic images