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Comparison of Computed Tomography Myelography and Radioisotope Cisternography to Detect Cerebrospinal Fluid Leakage in Spontaneous Intracranial Hypotension

Hashizume, Keiji, MD*; Watanabe, Keisuke, MD*; Kawaguchi, Masahiko, MD*; Taoka, Toshiaki, MD; Shinkai, Takayuki, MD; Furuya, Hitoshi, MD*

doi: 10.1097/BRS.0b013e31822e606a

Study Design. A retrospective observational study.

Objective. To compare the usefulness of radioisotope cisternography (RIC) and computed tomography myelography (CTM) for the detection of cerebrospinal fluid (CSF) leakage in spontaneous intracranial hypotension (SIH).

Summary of Background Data. CSF leakage sites have been generally identified by RIC in patients with SIH. Although a number of reports have recently indicated the usefulness of CTM, whether RIC or CTM more reliably detects leakage sites has not been decided because the 2 tests have not been directly compared.

Methods. Both RIC and CTM were performed, and the findings were compared in 12 patients with SIH strictly meeting the second edition of the International Classification of Headache Disorders diagnostic criteria.

Results. On RIC, the detection rate of leakage including indirect signs, an early vesicular radioisotope (RI) accumulation and delayed ascent of the RI to the cerebral convexity, was observed in 100%, but that of the direct sign, paraspinal RI accumulation, was in 8 patients (67%). On CTM, the epidural collection of intraspinally administered contrast medium was demonstrated in all patients (100%), and the collection site was located in the cervical and thoracic vertebral regions in most cases. When RIC and CTM findings were collated, paraspinal accumulation in the cervical and thoracic regions on RIC corresponded to the entire or a part of the findings on CTM. In contrast, in 4 of 5 patients with paraspinal accumulation in the lumbosacral region, epidural collection was not noted in this region on CTM.

Conclusion. In patients with SIH, epidural collection on CTM may more accurately demonstrate CSF leakage compared with paraspinal RI accumulation on RIC.

The rate of directly detecting cerebrospinal fluid (CSF) leakage by radioisotope cisternography (RIC) (paraspinal RI accumulation) was 67%, but 100% on computed tomography myelography (CTM) (epidural fluid collection) in 12 typical spontaneous intracranial hypotension (SIH) cases. The differentiation of false-positive paraspinal radioisotope accumulation was difficult employing RIC alone, but possible by collating with the CTM image.

*Department of Anesthesiology and Pain Management, Nara Medical University, Kashihara, Nara, Japan

Department of Radiology, Nara Medical University, Kashihara, Nara, Japan

Department of Radiation Oncology, Nara Medical University, Kashihara, Nara, Japan

Address correspondence and reprint requests to Keiji Hashizume, MD, Department of Anesthesiology and Pain Management, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; E-mail:

Acknowledgment date: December 16, 2010. First revision date: May 26, 2011. Second revision date: July 5, 2011. Acceptance date: July 14, 2011.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.