Intrathecal Gadolinium-enhanced MR Cisternography Research Articles

Intrathecal use of gadobutrol for gadolinium-enhanced MR cisternography in the evaluation of patients with otorhinorrhea.

Intrathecal gadolinium-enhanced MR cisternography (IGE-MRC) has a high sensitivity to detect accurate localization of cerebrospinal fluid (CSF) leakage in otorhinorrhea patients. Our purpose in this study was to describe our experience in analyzing clinically suspected CSF leakage by IGE-MRC by using gadobutrol with emphasis on its safety and diagnostic performance. We retrospectively reviewed our imaging and clinical database for the evaluation of patients admitted to our clinic with complaints of otorhinorrhea between 2017 and 2019. Two radiologists evaluated the imaging studies independently. Consensus data was used in the analysis. Medical record review and phone call were used for the follow-up. Of the 85 patients included in the retrospective analysis, 82 (96.5%) had rhinorrhea and 3 (3.5%) had otorrhea. Overall, 29 patients (34.1% of all patients) underwent operation for repair of the CSF leakage site. Beta-transferrin test was available and positive in 33 patients (38.8%). Five (5.9%) patients complained headaches after the procedure and complaints were resolved with increased water intake. Postprocedurally, 3 patients (3.5%) had vertigo and 1 patient (1.2%) complained nausea but spontaneous regression were observed in a few hours. None of the patients experienced a significant complication or adverse reaction during follow-up period. Sixty-seven patients (78.8%) had medical record and telephone follow-up. Mean follow-up duration with call was 14.2 months. IGE-MRC is a minimally invasive and highly sensitive imaging technique. The current results during our follow-up demonstrate the relative safety and feasibility of IGE-MRC by using gadobutrol to evaluate CSF leakage.

Intrathecal gadolinium-enhanced MR cisternography in patients with otorhinorrhea: 10-year experience of a tertiary referral center

Despite a considerable amount of literature that has been published about the use of intrathecal gadolinium-enhanced MR cisternography (IGE-MRC), there is still relatively lack of evidence as to its long-term effects. Our purpose in this study was twofold: firstly, to assess the long-term safety of the IGE-MRC; secondly, to evaluate the diagnostic performance of IGE-MRC for detecting cerebrospinal fluid (CSF) leak in otorhinorrhea patients. We retrospectively reviewed our imaging and clinical database for the patients admitted to our department for the evaluation of their otorhinorrhea between 2008 and 2017. Two radiologists evaluated the imaging studies independently. Consensus data was used in the analysis. Medical record review and phone call were used for the long-term follow-up. The retrospective review yielded 166 patients. Rhinorrhea was present in 150 (90.4%) patients and otorrhea in 16 (9.6%) patients. Overall, 67 patients (40.5% of all patients) underwent operation for repair of the CSF leak site. Beta-transferrin test was available and positive in 57 (34.3%) patients. Overall sensitivity of IGE-MRC and paranasal high-resolution CT (HRCT) was 89.3 and 72%, respectively. Within the first 24h after the procedure, none of the patients experienced a significant complication or adverse reaction. Ninety-nine patients (59.6%) had medical record and telephone follow-up. The mean follow-up duration with call was 37.1months. Three (3%) patients complained about severe headache 3-4weeks after the procedure. IGE-MRC is a minimally invasive and highly sensitive imaging technique. No adverse side effect during our long-term follow-up might strengthen and support the safety of IGE-MRC.

Cerebrospinal fluid rhinorrhea: Diagnostic role of gadolinium enhanced MR cisternography

BackgroundAccurate localization of the defect is crucial for successful surgical repair of CSF rhinorrhea. This could be achieved by MRI cisternography using T1 weighted sequences followed by intra-thecal injection of low dose of gadolinium for valuable localization and characterization of the defect. AimThe aim of this study was to evaluate the role of intrathecal gadolinium enhanced MR cisternography in localization of the defect in cases of CSF rhinorrhea to demonstrate how to utilize it as a roadmap to select the most appropriate approach for leak repair. Patients and methodsThis study included 24 patients (16 male and 8 females) with CSF rhinorrhea, referred from Otorhinolaryngology Department. Seventeen leaks were spontaneous, 5 cases were traumatic and two iatrogenic. All cases underwent MR gadolinium enhanced cisternography via lumbar puncture. ResultsGadolinium enhanced MR cisternography accurately diagnosed and confirmed the site of CSF leak in 22/24 (91.7%) cases. The most common site was the ethmoidal roof in 18/24 cases. Our results were correlated with endoscopic surgery and repair with an accuracy rate of 100%. ConclusionsIntra-thecal gadolinium enhanced MR cisternography is essential for accurate pre-operative localization and characterization of the defect in cases of CSF rhinorrhea.

Intrathecal Gadolinium-Enhanced MR Cisternography: A Comprehensive Review

CE-MRC has been in use for the past 15 years and was reported to be a useful method in the evaluation of CSF disorders and hydrocephalus. The use of CE-MRC in conjunction with other MR imaging techniques has been shown to be effective in selected cases for the evaluation of several disorders of cerebrospinal system. CE-MRC has certain advantages over other cisternographic studies with fewer side effects if performed properly. Although intrathecal Gd administration is not widely accepted yet, several recent studies have reported the safety of small-dose intrathecal gadolinium injection. In this review, we describe CE-MRC and review recent applications in several clinical conditions.

Postural tremor as a manifestation of spontaneous intracranial hypotension

Spontaneous intracranial hypotension (SIH) is a syndrome caused by low cerebrospinal fluid (CSF) pressure due to leakage of CSF. Clinically, orthostatic headache, neck pain, nausea, emesis, interscapular pain, diplopia, dizziness, changes in hearing, visual blurring and radicular upper extremity symptoms are most frequently observed. We describe a 57-year-old man with SIH who presented with postural tremor. CSF leakage was revealed by cranial MRI. Lumbar puncture identified low CSF pressure and intrathecal gadolinium enhanced MR cisternography showed diffuse CSF leakage in the thoracolumbar region. The patient underwent epidural blood patching, which resulted in complete resolution of postural tremor within 2 months.

Intrathecal Gadolinium-Enhanced MR Cisternography in the Evaluation of CSF Leakage

Radiologic identification of the location of the CSF leakage is important for proper surgical planning and increases the chance of dural repair. This article describes our experience in analyzing clinically suspected cranial CSF fistulas by using MR imaging combined with the intrathecal administration of a gadolinium-based contrast agent. A total of 85 consecutive patients with suspected CSF fistulas who presented with persistent or intermittent rhinorrhea or otorrhea lasting for more than 1 month between 2003 and 2007 were included in this study. We observed objective CSF leakage in 64 of 85 patients (75%). The CSF leak was located in the ethmoidal region in 37 patients (58%), in the superior wall of the sphenoid sinus in 8 patients (13%), in the posterior wall of the frontal sinus in 10 patients (15%), in the superior wall of the mastoid air cells in 6 patients (9%), and from the skull base into the infratemporal fossa in 1 patient (2%). Two patients (3%) showed leakage into >1 paranasal sinus. MR cisternography after the intrathecal administration of gadopentate dimeglumine represents an effective and minimally invasive method for evaluating suspected CSF fistulas along the skull base. It provides multiplanar capabilities without risk of radiation exposure and is an excellent approach to depict the anatomy of CSF spaces and CSF fistulas.

Gadolinium-Enhanced MR Cisternography to Evaluate Dural Leaks in Intracranial Hypotension Syndrome

We evaluated the use of MR cisternography after intrathecal administration of gadopentetate dimeglumine to detect the presence and localization of CSF leaks in 19 patients diagnosed with spontaneous intracranial hypotension syndrome according to the criteria of International Headache Society. Lumbar puncture with an injection of 0.5 mL of gadopentetate dimeglumine into the subarachnoid space in the lumbar area was performed. MR images of the cervical, thoracic, and lumbar regions in axial, coronal, and sagittal planes with fat-saturated T1-weighted images were acquired. We observed objective CSF leakage in 17 (89%) of 19 patients. In 14 of these 17 patients, the site of dural tear was demonstrated accurately. In 3 of these 17 patients, the contrast leakage was diffuse, and site of the leak could not be located accurately. No leakage was observed in 2 patients. No complications were detected in any of the patients during the first 24 hours after the procedure or during the 6- to 12-month follow-up. The current results demonstrate the relative safety, accuracy, and feasibility of intrathecal gadolinium-enhanced MR cisternography to evaluate dural leaks.

Contrast Agent for Intrathecal Gadolinium Administration

Contrast Agent for Intrathecal Gadolinium AdministrationSait Albayram, Aysegul Gunduz and Harun ÖzerAudio Available | Share

Intrathecal Gadolinium-Enhanced MR-Cisternography: Depiction of the Subarachnoidal Space and Evaluation of Gadobenat-Dimeglumin-(Gd-BOPTA, “Multihance®”) Toxicity in an Animal Model and a Clinical Case

As other gadolinium-based contrast medias (CM) intravenously administered, gadobenate dimeglumine has proved to be well tolerated and safe (1). The application of gadolinium within the subarachnoidal space has been tested in several studies with promising results (2,3). This technique has not entered routine clinical use. Because of its particular molecular structure, GdBOPTA showes T1 relaxivity values almost twice those seen with conventional CM due to its weak interactions with macromolecules (4). This characteristic leads to improved results in diagnostics and a lower required concentration. Encouraged by these results, Gd-BOPTA was used for this study to determine the best concentration of gadobenate dimeglumine in the cerebrospinal fluid and to evaluate the diagnostic value of MR-Myelography with intrathecal gadobenate dimeglumine. Additionally, the presence of toxic side effects to the CNS were investigated. Due to certain clinical circumstances, one patient received gadobenate dimeglumine by lumbar puncture to evaluate a spinal cyst. MATERIALS AND METHODS

Intrathecal gadolinium-enhanced MR myelography and cisternography: a pilot study in human patients.

This study was designed to evaluate the safety, MR imaging characteristics, and clinical response to intrathecal gadopentetate dimeglumine (gadolinium) administration in human patients. Eleven adult patients were included in this prospective study. Via lumbar puncture, a single dose of either 0.2 ml, 0.5 ml, or 1.0 ml of gadolinium (500 mmol/l) mixed with 5 ml of previously removed CSF was slowly injected into the lumbar subarachnoid space. Immediate and delayed MR imaging were subsequently carried out using a 1.0-T magnet. No patient manifested gross behavioral changes, neurologic alterations, or seizure activity. The intrathecal gadolinium-enhanced MR myelography revealed disk herniation (n = 4), posttraumatic spinal stenosis (n = 3), postsurgical noncommunicating cyst (n = 1), myelitis (n = 1), intradural extramedullary mass formation (n = 1), and intradural vascular malformation (n = 1). This pilot study shows the relative safety and feasibility of low-dose intrathecal gadolinium administration. The potential clinical applications include the evaluation of obstructions and communications of the subarachnoid space, spontaneous or traumatic CSF leaks, and CSF dynamics. Additional animal and human studies must be performed to further evaluate the long-term safety and to prove the clinical applications of this procedure in a larger number of subjects.