- Radionuclide cisternogram
A radionuclide cisternogram is a
medical imagingstudy which involves injecting a radionuclideby lumbar puncture(spinal tap) into a patient's cerebral spinal fluid(CSF) to determine if there is abnormal CSF flow with the brain and spinal canal termed hydrocephalus. It may also evaluate a suspected leak (also known as a CSF fistula) from the CSF cavity into the nasal cavity. A leak can also be confirmed by the presence of beta-2 transferrinin fluid collected from the nose before this more invasive procedure is performed.
The patient may be instructed to not eat or drink, or take medications such as
aspirinor other blood thinners before the procedure. Pledgets can be inserted into the nasal cavity before the procedure when a CSF leak is suspected.
The patient's spinal fluid is injected with a radiopharmaceutical tracer, such as
DTPAtagged with indium 111, through a lumbar puncture(spinal tap). The tracer will diffuse up the spinal column and into the brain. The progress of the tracer's diffusionthrough the CSF will be recorded by a nuclear medicine gamma camera. Images are usually taken immediately, at 6 hours, and at 24 hours. The patient may be asked to return for 48 and 72 hour follow-up scans.
The pledgets will be removed and either imaged with a gamma camera or counted using a
gamma counter. If the tracer has leaked onto the pledget through the skull, it will appear on the gamma camera image or register abnormal counts allowing the diagnostician to determine the location of the leak within the sinus cavity. The site of the CSF leak can be plugged with fat or muscle by endoscopicsurgery.
Headaches following the procedure are uncommon, but should fade in 3-5 days. Drinking caffeinated liquids, as well as
bed rest, is often recommended, though at least one scientific paper disputes the practice.
* [http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijnuc/vol2n1/csf.xml Radiology examples of a CSF leak]
* [http://www.emedicine.com/radio/topic139.htm eMedicine entry on CSF leaks]
* [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1071660 2002 paper disputing caffeine as a cure for CSF headaches]
* [http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=1232 Information for DTPA In-111]
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