CSF-Venous Fistula Detection in Spontaneous Intracranial Hypotension: Comparative Diagnostic Yields of Energy Integrating Detector Versus Photon Counting Detector CT Myelography
Duke University
Summary
The purpose of this research study is to compare two types of Computed Tomography Myelography (CTM) scans, one on the photon counting detector scanner (called PCD-CTM) and the other on the energy integrating detector scanner (called EID-CTM); both of which doctors usually use to diagnose abnormal connections between the cerebrospinal fluid and the venous system, or CSF-venous fistulas. This study will help to see if the newer PCD-CTM scan can find more spinal fluid leaks \[CSF-venous fistulas (CVF)\] than the scan that is normally used (EID-CTM).
Description
Spontaneous intracranial hypotension (SIH) is a debilitating condition caused by a spinal CSF leak. One subtype of spinal CSF leak, the CSF-venous fistula (CVF), is a pathologic connection between the CSF-containing nerve root sleeve and an adjacent paraspinal vein. Identifying and localizing the CVF that causes SIH is a critical prerequisite to curative treatment. Visualizing CVFs requires high-quality myelography. Despite improvements in myelographic techniques, CVF identification remains challenging because they are diminutive structures and depend on identifying small volumes of contrast i…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. Adult patient, 2. Confirmed diagnosis of SIH using International Classification of Headache Disorders criteria (third edition), and 3. Brain MRI demonstrating at least one positive imaging finding for SIH (e.g., dural enhancement, venous sinus distention, brain sagging, pituitary engorgement, spontaneous subdural fluid collections). Exclusion Criteria: 1. Prior treatment of a CVF, 2. Inability to undergo both exams (EID-CTM and PCD-CTM) if needed for diagnosis, 3. Spine MRI demonstrating extradural CSF (confirming CSF leak type other than CVF), and 4. inability to pro…
Interventions
- Diagnostic Testphoton counting detector CT myelography (PCD- CTM)
Randomization (1:1) to either photon counting detector CT myelography (PCD- CTM) or energy integrating detector CT myelography (EID-CTM)
- Diagnostic Testenergy integrating detector CT myelography (EID-CTM)
Randomization (1:1) to either photon counting detector CT myelography (PCD- CTM) or energy integrating detector CT myelography (EID-CTM)
Location
- Duke University Medical CenterDurham, North Carolina