Analysis the imaging characteristics of radionuclide cisternography in spontaneous intracranial hypotension

Abstract

Objective To investigate the imaging features and clinical significance of radionuclide cisternography(RNC) in patients with spontaneous intracranial hypotension(SIH). Methods Lumbar puncture was made on 19 patients with SIH(4 males and 15 females), and 99Tcm-DTPA was injected into their spinal subarachnoid space. Multitemporal RNC was also performed. SPECT/CT tomography and MRI were added to examine abnormal distribution, and RNC image features were comprehensively analyzed. χ2-test was conducted to compare the enumeration data between groups. Results RNC could be applied to diagnose SIH by showing direct signs such as spinal cord or nasal cerebrospinal fluid leak points or by revealing the abnormal circulation of the cerebrospinal fluid (CSF), such as a slow increase in imaging agents; difficulty in reaching the cistern, the cerebral convex surface, and the superior sagittal sinus; and early imaging of the bladder and the kidney. RNC could also be used to detect the CSF leaks in 17 cases and reveal a direct sign of CSF leaks in 12 cases. Its detection rate was 63.2%. Of these cases, 9 were located in the cervicothoracic junction or the thoracic region, 1 was found in the lumbar, and 2 were observed to have CSF rhinorrhea. A case of high-flow CSF leakage (lumbar segment) occurred in 1 patient. When conservative treatment was ineffective, the patients were treated with targeted epidural blood patch. Two more cases had a normal RNC. A comparison of the MRI findings of 17 patients showed no significant differences between MRI (positive rate of 58.8% [10/17]) and RNC (positive rate of 88.2% [15/17]) in the diagnosis of low intracranial pressure (P > 0.05). However, RNC was superior to MRI in detecting CSF leakage. Of the 12 cases subjected to RNC, only 1 case was found to have CSF leaks through MRI. Conclusions RNC can help diagnose SIH by determining direct or indirect signs and is superior to MRI in terms of detecting CSF leakage. RNC can also be used to show the amount of CSF leakage and facilitate individualized treatment, which is important for the diagnosis and treatment of SIH. Key words: Cerebrospinal fluid leak; Radionuclide cisternography; Spontaneous intracranial hypotension