Photon-Counting CT Myelography Increases Diagnostic Certainty for CSF-Venous Fistulas

Photon-counting detector CT myelography led to 66% greater odds of a higher diagnostic confidence score for cerebrospinal fluid-venous fistulas compared with energy-integrating detector CT (OR 1.66; 95% CI 1.17-2.36), in a retrospective study of 628 exams.

• Retrospective review of 628 CT myelography examinations (456 patients, 63% women) comparing photon-counting detector (PCD) and energy-integrating detector (EID) CT for suspected spontaneous intracranial hypotension.
• Overall CSF-venous fistula (CVF) detection rate was 63.1%, numerically higher for PCD-CT (69.6% vs 61.0%, P=0.07), but the primary outcome was a shift toward higher confidence scores on the Duke CSF-Venous Fistula Confidence Score.
• Single-center retrospective design, temporal confound (PCD exams performed more recently), and smaller PCD sample (n=148 vs 480 EID) limit generalizability.

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