Lateral Decubitus Dynamic CT Myelography with Real-Time Bolus Tracking (dCTM-BT) for Evaluation of CSF-Venous Fistulas: Diagnostic Yield Stratified by Brain Imaging Findings

Lateral decubitus dynamic CT myelogram with real-time contrast bolus tracking (dCTM-BT): A, Frontal CT scout image shows patient in the left lateral decubitus position on the CT gantry table, with the hips placed at the apex of a custom firm foam wedge in the Trendelenburg position, at an angle of approximately 10°, to facilitate the caudocranial flow of contrast from the lumbar puncture towards the cervical spine. B–D, Real-time contrast bolus monitoring axial scans at the level of T5 (A, dashed line) with axial slices taken at 5-second intervals until the visualization of dense contrast (D, arrow). Note that dense contrast visualization is typically observed immediately after the initial appearance of contrast (C, arrow). E, Graph of density (Hounsfield units, HU) of monitored contrast bolus over time (region of interest placed at arrow in panels C and D; note that this graph is for illustrative purposes and is not utilized during the procedure). F, Axial CT myelogram showing the contrast enhancement of the paraspinal veins at the left T10, indicating a CSF-venous fistula (F, arrowheads).