Myelography Using Energy-Integrating Detector CT Versus Photon-Counting Detector CT for Detection of CSF-Venous Fistulas in Patients With Spontaneous Intracranial Hypotension.
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2024-01
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Background: CSF-venous fistulas (CVFs) are an increasingly recognized cause of spontaneous intracranial hypotension (SIH) that are often diminutive in size and exceedingly difficult to detect by conventional imaging. Objective: This study's objective was to compare EID-CT myelography and PCD-CT myelography in terms of image quality and diagnostic performance for detecting CVFs in patients with SIH. Methods: This retrospective study included 38 patients (15 men, 23 women; mean age, 55±10 years) with SIH who underwent both clinically indicated EID-CT myelography (slice thickness, 0.625 mm) and PCD-CT myelography (slice thickness, 0.2 mm; performed in ultrahigh-resolution mode) to assess for CSF leak. Three blinded radiologists reviewed examinations in random order, assessing image noise, discernibility of spinal nerve root sleeves, and overall image quality using 0-100 scales (100=highest quality), and recording locations of CVFs. Definite CVFs were defined as CVFs described in CT myelography reports using unequivocal language and showing attenuation >70 HU. Results: For all readers, PCD-CT myelography, in comparison with EID-CT myelography, showed higher image noise (reader 1: 69±19 vs 38±15; reader 2: 59±9 vs 49±13; reader 3: 57±13 vs 43±15), higher nerve root sleeve discernibility (reader 1: 84±19 vs 30±14; reader 2: 84±19 vs 70±19; reader 3: 60±13 vs 52±12), and higher overall image quality (reader 1: 84±21 vs 40±15; reader 2: 81±10 vs 72±20; reader 3: 58±11 vs 53±11) (all p<.05). Eleven patients had a definite CVF. Sensitivity and specificity for detection of definite CVF for EID-CT myelography and PCD-CT myelography for reader 1 were 45% and 96% versus 64% and 85; for reader 2 were 36% and 100% versus 55% and 96%; and for reader 3 were 45% and 100% versus 55% and 93%. For all readers, PCD-CT myelography, in comparison with EID-CT myelography, showed significantly higher sensitivity (all p<.05), without significant difference in specificity (all p>.05). Conclusion: In comparison with EID-CT myelography, PCD-CT myelography yielded significantly improved image quality with significantly higher sensitivity for CVFs without significant loss of specificity. Clinical Impact: The findings support a potential role of PCD-CT myelography in facilitating earlier diagnosis and targeted treatment of SIH, avoiding high morbidity during potentially prolonged diagnostic workups.
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Schwartz, Fides R, Peter G Kranz, Michael D Malinzak, David N Cox, Francesco Ria, Cindy McCabe, Brian Harrawood, Linda G Leithe, et al. (2024). Myelography Using Energy-Integrating Detector CT Versus Photon-Counting Detector CT for Detection of CSF-Venous Fistulas in Patients With Spontaneous Intracranial Hypotension. AJR. American journal of roentgenology. 10.2214/ajr.23.30673 Retrieved from https://hdl.handle.net/10161/30129.
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Peter George Kranz
Francesco Ria
Dr. Francesco Ria is a medical physicist and he serves as an Assistant Professor in the Department of Radiology. Francesco has an extensive expertise in the assessment of procedure performances in radiology. In particular, his research activities focus on the simultaneous evaluation of radiation dose and image quality in vivo in computed tomography providing a comprehensive evaluation of radiological exams. Moreover, Francesco is developing and investigating novel mathematical models that, uniquely in the radiology field, can incorporate a comprehensive and quantitative risk-to-benefit assessment of the procedures; he is continuing to apply his expertise towards the definition of new patient specific risk metrics, and in the assessment of image quality in vivo also using state-of-the-art imaging technology, such as photon counting computed tomography scanners, and machine learning reconstruction algorithms.
Dr. Ria is a member of the American Association of Physicists in Medicine (AAPM) task group 392 (Investigation and Quality Control of Automatic Exposure Control System in CT), of the AAPM task group 430 (Comprehensive quantification and dissemination of patient-model-based organ and effective dose estimations and their associated uncertainties for CT examinations), of the AAPM Medicine Public Education working group (WGATE), and of the Italian Association of Medical Physics task group Dose Monitoring in Diagnostic Imaging.
Timothy James Amrhein
Dr. Amrhein is an Associate Professor in the Department of Radiology at Duke University Medical Center where he also serves as the Director of Spine Intervention. He completed residency training in Diagnostic Radiology at Duke, where he served as chief resident, and stayed to complete a Neuroradiology fellowship.
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