Fig 2.

A 65-year-old woman with several years of orthostatic headaches and brain MR imaging demonstrating diffuse pachymeningeal enhancement and brain sag (not shown). Representative image from a right lateral decubitus DSM (A) shows multiple meningeal diverticula that remained stable during dynamic imaging (A, dashed arrows), with no evidence of a CVF. Axial images from a right lateral decubitus PCD CTM at the same time point (B–D) reconstructed at a T3D (B), 55 keV (C), and 40 keV (D) demonstrate a right T3 CVF (B–D, arrows), which is most apparent at 40 keV. The CVF is not apparent during imaging 30 seconds later, even at 40 keV (E, arrow). Additional images at adjacent slices, both from the earlier time point at 40 keV (F and G), show that this venous enhancement, though discontinuous, does, in fact, arise from a prominent meningeal diverticulum (F and G, arrows). In this case, the high degree of temporal resolution and spectral imaging conferred by PCD CT were necessary to confidently make the diagnosis. The patient underwent successful transvenous Onyx embolization of the right T3 CVF.