Photon-Counting CT Myelography for the Detection of Spinal CSF Leaks

Photon-counting CT myelography is a relatively recently described technique for the detection of spinal CSF leaks in patients with spontaneous intracranial hypotension.^1-3 In this Video, we outline the fundamental procedural techniques used in CT myelography for CSF leak detection, as well as specific advantages and reconstruction options available when using photon-counting CT.^4-7 Additionally, we show examples demonstrating the typical appearance of common spinal CSF leaks detected on photon-counting CT myelography, which mainly include dural tears and CSF-venous fistulas.⁸ This Video draws on technical insights gleaned from a multi-institutional perspective, while specific techniques continue to vary at different centers. Future refinement of photon-counting CT myelographic techniques at multiple centers will be helpful to maximally leverage this nascent technology.