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Photon-Counting Detector vs. Energy-Integrating Detector CT Myelography for Detecting CSF-Venous Fistulas in
Soren Christensen1, Peter G Kranz1, Michael D Malinzak1
1From the Duke University School of Medicine (S.C., D.Z.), Durham, North Carolina and Department of Radiology (P.G.K., M.D.M., A.A.M., E.A., J.W., L.G., T.J.A.), Duke University Medical Center, Durham, North Carolina.
Background And Purpose:
Photon-counting detector CT (PCD-CT) offers improved spatial resolution compared with conventional energy-integrating detector CT (EID-CT), but session-level dose comparisons in multi-acquisition CT myelography (CTM) are limited. We compared radiation dose between PCD-CTM and EID-CTM for detecting CSF-venous fistulas (CVFs) in patients with spontaneous intracranial hypotension (SIH).
Materials And Methods:
This retrospective, single-center cohort study included 603 CTM examinations (EID-CTM, n=470; PCD-CTM, n=133) performed for SIH evaluation between 2020 and 2025. The primary endpoint was session dose-length product (DLP) for the entire CTM examination. Secondary endpoints included diagnostic-series CTDIvol and DLP in CVF-positive examinations (Duke CSF-Venous Fistula Confidence Score ≥2) and a scan length proxy (diagnostic DLP/CTDIvol). Radiation dose metrics were compared using nonparametric tests and reported as median (IQR).
Results:
Session DLP was significantly lower for PCD-CTM than for EID-CTM: 1760 (1277-2206) vs 5030 (3476-6559) mGy·cm (median reduction, 65.0%; P < .001). In CVF-positive examinations, PCD-CTM demonstrated significantly lower diagnostic-series CTDIvol (median reduction, 79.9%; P < .001) and diagnostic-series DLP (median reduction, 74.1%; P < .001). These reductions persisted despite PCD-CTM covering a significantly longer scan length (P < .001) and acquiring more series per examination (P < .001).
Conclusions:
In patients undergoing CT myelography for CVF evaluation, PCD-CTM was associated with an approximately 65% lower session-level radiation dose than EID-CTM, despite covering a longer anatomic range and more acquisitions.
