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Updated: Jun 23, 2026

Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique

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The Duke CSF-Venous Fistula Confidence Score: Real World Application on CTM.

Timothy J Amrhein¹, Daphne Zhu², Ajay A Madhavan²

¹From the Department of Radiology (T.J.A., A.A.M., L.G., J.W., M.D.M., P.G.K.), Duke University Medical Center, Duke University School of Medicine (D.Z., S.D.C.), Durham, North Carolina, USA. timothy.amrhein@duke.edu.

AJNR. American Journal of Neuroradiology

|June 20, 2026

Summary

Identifying cerebrospinal fluid-venous fistulas (CVFs) causing spontaneous intracranial hypotension (SIH) can be challenging. The Duke CSF-Venous Fistula Confidence Score (DCCS) offers a structured approach to improve diagnostic certainty during CT myelography.

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Area of Science:

Neurology
Radiology
Medical Imaging

Background:

Cerebrospinal fluid-venous fistulas (CVFs) are a frequent cause of spontaneous intracranial hypotension (SIH).
Identifying CVFs via myelography is challenging due to subtle imaging findings and reliance on small contrast volumes.
Diagnostic uncertainty regarding CVF presence is common during CT myelogram interpretation.

Purpose of the Study:

To demonstrate the practical, real-world application of the Duke CSF-Venous Fistula Confidence Score (DCCS).
To illustrate how the DCCS can enhance diagnostic certainty in identifying CVFs.

Main Methods:

The study utilizes a case-based approach to showcase the DCCS.
The Duke CSF-Venous Fistula Confidence Score (DCCS) is a structured reporting system based on imaging findings.
Video demonstration of DCCS application in clinical scenarios.

Main Results:

The DCCS provides a standardized method for assessing confidence in CVF diagnosis.
Practical application highlights the DCCS's utility in real-world CT myelogram interpretation.
The DCCS aims to reduce ambiguity in identifying CVFs at specific spinal levels.

Conclusions:

The Duke CSF-Venous Fistula Confidence Score (DCCS) is a valuable tool for improving diagnostic accuracy in spontaneous intracranial hypotension (SIH) cases.
Structured reporting using the DCCS enhances confidence in identifying cerebrospinal fluid-venous fistulas (CVFs).
This video article provides practical guidance for applying the DCCS in clinical practice.