Detecting the Undetectable: Dr. Andrew Callen on Spinal CSF Leaks

Episode notes

Spinal CSF leaks are among medicine’s most elusive disorders—often missed, misdiagnosed, or misunderstood. But emerging imaging techniques are changing that narrative. In this episode of Frame by Frame: Rethink Imaging, host Chris St. John welcomes Dr. Andrew Callen, the pioneering radiologist behind the University of Colorado’s multidisciplinary CSF Leak Program, to discuss how specialized MRI and CT protocols are enabling clinicians to “detect the undetectable.” Dr. Callen explains how subtle imaging details, like distinguishing fat from fluid through fat-suppressed T2-weighted MRI, can mean the difference between a missed diagnosis and life-changing treatment. He also describes how dynamic CT myelography and innovative patient-positioning techniques are revealing leaks and fistulas invisible to conventional imaging. Beyond technology, Dr. Callen offers a candid look at the systemic and economic challenges of building a CSF leak program, the importance of multidisciplinary collaboration, and the need to keep an open mind for the patients whose symptoms defy explanation.