CT cisternography

Last revised by Bahman Rasuli on 28 Oct 2023

Computed tomography (CT) cisternography is a minimally-invasive imaging technique used to visualize the intracranial CSF cisterns using iodinated contrast medium injected into the subarachnoid space.

  • obtain medical history relating to medications, allergies, seizures, and bleeding
  • review any available spinal imaging
  • consider holding medications that decrease seizure threshold
  • consider holding anticoagulant and antiplatelet therapy
  • obtain informed consent relating to the risk, benefits, and alternatives of the procedures
  • evaluate need for moderate sedation or general anesthesia
  • consider obtaining a non-contrast head CT
  • standard equipment for fluoroscopy-guided lumbar puncture
  • tilt table with device to secure the patient
  • contrast media approved for intrathecal use
  • 10 mL syringe and needle
  • CT scanner
  • fluoroscopy guided lumbar puncture is performed
  • optionally, opening pressure can be measured or CSF samples collected
  • 3-10 mL of an iodinated non-ionic low-osmolar contrast agent is slowly instilled into the thecal sac under intermittent fluoroscopy
  • the spinal needle is withdrawn
  • the patient is tilted with foot-end elevation (Trendelenburg position) and intermittently imaged until the contrast column flows into the cervical spinal canal
  • the table is returned to horizontal position and the head is flexed into neutral position under imaging to document flow of contrast into the basal cisterns
  • CT is performed immediately in prone and/or supine positions; concurrent maneuvers that provoke an active CSF leak, such as head hanging or sneezing, can also be performed
  • headache (common)
  • radicular pain or paresthesia (transient)
  • bleeding
  • infection
  • seizure

ADVERTISEMENT: Supporters see fewer/no ads

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.