Cisternography is a medical imaging technique to examine the flow of

cerebrospinal fluid Cerebrospinal fluid (CSF) is a clear, colorless Extracellular fluid#Transcellular fluid, transcellular body fluid found within the meninges, meningeal tissue that surrounds the vertebrate brain and spinal cord, and in the ventricular system, ven ...

(CSF) in the

brain The brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It consists of nervous tissue and is typically located in the head (cephalization), usually near organs for ...

, and

spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue that extends from the medulla oblongata in the lower brainstem to the lumbar region of the vertebral column (backbone) of vertebrate animals. The center of the spinal c ...

. The gold standard for diagnosis of a cranial

cerebrospinal fluid leak A cerebrospinal fluid leak (CSF leak or CSFL) is a medical condition where the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord leaks out of one or more holes or tears in the dura mater. A CSF leak is classed as either spontane ...

is CT cisternography. For the diagnosis of a spinal CSF leak radionuclide cisternography also known as radioisotope cisternography is used. The false negative rate of cisternography is high (30%), so the radiographic study of choice is CT myelography. The third type of cisternography is MR cisternography.

Types

Radionuclide

Radionuclide cisternography may be used to diagnose a spinal cerebrospinal fluid leak. CSF pressure is measured and imaged over 24 hours. A

radionuclide A radionuclide (radioactive nuclide, radioisotope or radioactive isotope) is a nuclide that has excess numbers of either neutrons or protons, giving it excess nuclear energy, and making it unstable. This excess energy can be used in one of three ...

(radioisotope) is injected by lumbar puncture (spinal tap) into the cerebral spinal fluid to determine if there is abnormal CSF flow within the brain and spinal canal which can be altered by

hydrocephalus Hydrocephalus is a condition in which cerebrospinal fluid (CSF) builds up within the brain, which can cause pressure to increase in the skull. Symptoms may vary according to age. Headaches and double vision are common. Elderly adults with n ...

, Arnold–Chiari malformation,

syringomyelia Syringomyelia is a generic term referring to a disorder in which a cyst or cavity forms within the spinal cord. Often, syringomyelia is used as a generic term before an etiology is determined. This cyst, called a syrinx, can expand and elongate ...

, or an

arachnoid cyst Arachnoid cysts are cerebrospinal fluid covered by arachnoidal cells and collagen that may develop between the surface of the brain and the cranial base or on the arachnoid membrane, one of the three meningeal layers that cover the brain and th ...

. It may also evaluate a suspected

CSF leak A cerebrospinal fluid leak (CSF leak or CSFL) is a medical condition where the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord leaks out of one or more holes or tears in the dura mater. A CSF leak is classed as either spontaneo ...

(also known as a CSF

fistula In anatomy, a fistula (: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") is an abnormal connection (i.e. tube) joining two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other h ...

) from the CSF cavity into the nasal cavity. A leak can also be confirmed by the presence of

beta-2 transferrin Beta-2 transferrin is a carbohydrate-free ( desialated) isoform of transferrin, which is almost exclusively found in the cerebrospinal fluid. It is not found in blood, mucus or tears, thus making it a specific marker of cerebrospinal fluid, applied ...

in fluid collected from the nose before this more invasive procedure is performed. The spinal fluid is injected with a radiopharmaceutical tracer, such as

DTPA Pentetic acid or diethylenetriaminepentaacetic acid (DTPA) is an aminopolycarboxylic acid consisting of a diethylenetriamine backbone with five carboxymethyl groups. The molecule can be viewed as an expanded version of EDTA and is used similarl ...

tagged with indium 111, through a lumbar puncture. The tracer will diffuse up the spinal column and into the intracranial ventricles and the subarachnoid spaces around the brain. The progress of the tracer's

diffusion Diffusion is the net movement of anything (for example, atoms, ions, molecules, energy) generally from a region of higher concentration to a region of lower concentration. Diffusion is driven by a gradient in Gibbs free energy or chemical p ...

through the CSF will be recorded by a nuclear medicine

gamma camera A gamma camera (γ-camera), also called a scintillation camera or Anger camera, is a device used to image gamma radiation emitting radioisotopes, a technique known as scintigraphy. The applications of scintigraphy include early drug development ...

. Images are usually taken immediately, at 6 hours, and at 24 hours, and may also be taken at follow-up scans at 48 hours and 72 hours. Headaches following the procedure are common, but should fade in 3–5 days. Drinking caffeinated liquids, as well as

bed rest Bed rest, also referred to as the rest-cure, is a medical treatment in which a person lies in bed for most of the time to try to cure an illness. Bed rest refers to voluntarily lying in bed as a treatment and not being confined to bed because of ...

, is often recommended, though at least one scientific paper disputes the practice.

Computed tomography

Computed tomography (CT) cisternography is a

CT scan A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

with the use of a

contrast agent A contrast agent (or contrast medium) is a substance used to increase the contrast of structures or fluids within the body in medical imaging. Contrast agents absorb or alter external electromagnetism or ultrasound, which is different from radiop ...

to show up CSF leakages that may occur anywhere in the skull base.

References

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External links

eMedicine entry on CSF leaks2002 paper disputing caffeine as a cure for CSF headachesInformation for DTPA In-111
Neuroimaging CSF tests