Abstract
Since cerebrospinal fluid (CSF) leakage is highlighted as a cause of persistent headache, radionuclide cisternography has been increasingly performed in Japan to confirm the disorder, although the limited ability of the examination should be recognized. We present 3 cases in which failure of a tracer injection was strongly suspected. In 2 cases with chronic symptoms, the tracer appeared to be injected into the epidural space, because of irregular initial accumulation of the tracer and lack of diffusion along the CSF cavity. Another is a case with spontaneous CSF leakage confirmed by MRI, and the tracer was thought to be injected into the leaked fluid accumulated in the spinal epidural space. Tracer in the CSF space rapidly disappeared within several hours in all cases. As such cisternographic images may be misdiagnosed as severe CSF leakage, careful interpretation of images in patients especially with no typical MR findings of CSF leakage is necessary. Excessive tracer clearance from the body suggests such technical failure.
References
Schievink WI, Maya MM, Moser FG, Tourje J. Spectrum of subdural fluid collection in spontaneous intracranial hypotension.J Neurosurg 2005; 103: 608–613.
Fitzek S, Smesny S, Fitzek C, Axer H, Wohlfarth M, Vieweg U, et al. Organic bipolar disorder occurring together with spontaneous intracranial hypotension.Psychiatry Res 2004; 131: 177–183.
Schievink WI. Misdiagnosis of spontaneous intracranial hypotension.Arch Neurol 2003; 60: 1713–1718.
Ferrante E, Savino A. Nonpostural headache by spontaneous intracranial hypotension.Headache 2003; 43: 127–129.
Horikoshi T, Watanabe A, Hashizume K, Hashimoto K, Nukui H, Umeda T. Two cases of whiplash associated syndrome successfully treated with lumbar epidural blood patch.Yamanashi Med J 2003; 18: 61–65. (Japanese)
Shinonaga M, Suzuki S. Diagnosis and treatment of traumatic intracranial hypotension (cerebrospinal fluid hypovo-lemia).Neurotraumatology 2003; 26: 98–102. (Japanese)
Moriyama E, Ogawa T, Nishida A, Ishikawa S, Beck H. Quantitative analysis of radioisotope cisternography in the diagnosis of intracranial hypotension.J Neurosurg 2004; 101:421–426.
Horikoshi T, Uchida M, Watanabe A, Ikegawa H, Umeda T. Jugular compression and radionuclide cisternographic patterns in patients with chronic headache.Headache 2006; 46: 150–157.
Horikoshi T, Ikegawa H, Uchida M, Takahashi T, Watanabe A, Umeda T. Tracer clearance in radionuclide cisternography in patients with spontaneous intracranial hypotension.Cepahlalgia 2006; 26: (in press)
Larson S, Schall GL, Di Chiro G. The unsuccessful injection in cisternography: incidence, cause and appearance. In Harbert JC, ed.Cisternography and hydrocephalus. Springfield, Illinois; Charles C Thomas, 1972: 153–160.
Kawaguchi S, Iio M, Chiba K, Murata H, Matui K, Yamada H, et al. Study of unsuccessful cases of cisternography.KAKU IGAKU (Jpn J Nucl Med) 1977; 14: 243–253. (Japanese)
Bai J, Yokoyama K, Kinuya S, Konishi S, Michigishi T, Tonami N. Radionuclide cisternography in intracranial hypotension.Ann Nucl Med 2002; 16: 75–78.
Schievink WI, Meyer FB, Atkinson JLD, Mokri B. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension.J Neurosurg 1996; 84: 598–605.
Sugino T, Matsusaka Y, Mitsuhashi Y, Murata K, Sakaguchi M. Intracranial hypotension due to cerebrospinal fluid leakage detected by radioisotope cisternography.Neurol Med Chir 2000; 40: 404–407.
Nowak D, Rodiek SO, Zinner J, Guhlmann A, Topka H. Broadening the clinical spectrum: unusual presentation of spontaneous cerebrospinal fluid hypovolemia.J Neurosurg 2003; 98: 903–907.
Takahashi M, Momose T, Kameyama M, Mizuno S, Kumakura Y, Ohtomo K. Detection of cerebrospinal fluid leakage in intracranial hypotension with radionuclide cisternography and blood activity monitoring.Ann Nucl Med 2005; 19: 339–343.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Horikoshi, T., Asari, Y., Watanabe, A. et al. Unsuccessful tracer injection in radionuclide cisternography revisited. Ann Nucl Med 20, 333–336 (2006). https://doi.org/10.1007/BF02984653
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02984653