Radionuclide cisternography is a nuclear medicine imaging technique that uses intrathecal 111In-DTPA (diethyletriaminepentaacetic acid; pentetate) to visualize the flow of cerebrospinal fluid (CSF).
There are few indications 1:
- localization of CSF leak, such as in spontaneous intracranial hypotension
- evaluation of hydrocephalus, especially communicating hydrocephalus with suspected normal pressure hydrocephalus
Imaging occurs at 2-6 hours after injection into the lumbar subarachnoid space and then delayed imaging is performed at 18-24 hours, sometimes even with additional images at 72 hours.
These days, the test is uncommonly performed. For evaluation of normal pressure hydrocephalus, the cisternographic pattern is not predictive of response to surgical shunting 2. For CSF leak identification, CT is usually adequate for identifying a defect 3.
- 1. Harvey A. Ziessman, Janis P. O'Malley, James H. Thrall, Frederic H. Fahey. Nuclear Medicine,The Requisites (Expert Consult – Online and Print),4. (2019) ISBN: 9780323082990
- 2. Black PM. Idiopathic normal-pressure hydrocephalus. Results of shunting in 62 patients. (1980) Journal of neurosurgery. 52 (3): 371-7. doi:10.3171/jns.1980.52.3.0371 - Pubmed
- 3. Stone JA, Castillo M, Neelon B, Mukherji SK. Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. (1999) AJNR. American journal of neuroradiology. 20 (4): 706-12. Pubmed