title: Cerebrospinal fluid leakage in intracranial hypotension syndrome: usefulness of indirect findings in radionuclide cisternography for detection and treatment monitoring.
abstract: OBJECTIVE
  To evaluate indirect findings of cerebrospinal fluid (CSF) leakage on radionuclide cisternography and their changes after treatment.
  
  
  METHODS
  This study was approved by the hospital's institutional review board and informed consent was obtained before each examination. A total of 67 patients who were clinically suspected of spontaneous intracranial hypotension (SIH) syndrome underwent radionuclide cisternography, and 27 patients who had direct findings of CSF leakage on radionuclide cisternography were selected for this evaluation. They were 16 males and 11 females, aged between 26 and 58 years. Sequential images of radionuclide cisternography were acquired at 1, 3, 5, and 24 hours after injection. We assessed the presence or absence of 4 indirect findings; early visualization of bladder activity, no visualization of activity over the brain convexities, rapid disappearance of spinal activity, and abnormal visualization of the root sleeves. Changes of the direct and indirect findings after treatment were also evaluated in 14 patients who underwent epidural blood patch treatment.
  
  
  RESULTS
  Early visualization of bladder activity was found in all 27 patients. Seven of 27 (25.9%) patients showed no activity over the brain convexities. Rapid disappearance of spinal activity and abnormal root sleeve visualization were present in 2 (7.4%) and 5 (18.5%) patients, respectively. After epidural blood patch, both direct CSF leakage findings and indirect findings of early visualization of bladder activity had disappeared or improved in 12 of 14 patients (85.7%). The other indirect findings also disappeared after treatment in all cases.
  
  
  CONCLUSIONS
  Indirect findings of radionuclide cisternography, especially early visualization of bladder activity, may be useful in the diagnosis and posttreatment follow-up of CSF leakage.
authors.affiliation: Department of Radiology, University of Occupational and Environmental Health, School of Medicine, Iseigaoka, Yahatanishi-ku, Kitakyushu, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Morioka
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Aoki
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tomoda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Shingo
authors.initials: S
authors.lastname: Kakeda
authors.forename: Iwao
authors.initials: I
authors.lastname: Takeshita
authors.forename: Masato
authors.initials: M
authors.lastname: Ohno
authors.forename: Yukunori
authors.initials: Y
authors.lastname: Korogi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000097:blood / Q000134:cerebrospinal fluid* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D004369:Pentetic Acid / Q000493:pharmacokinetics; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012189:Retrospective Studies; D013577:Syndrome; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D001745:Urinary Bladder Diseases / Q000097:blood / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging
chemical_list: D019275:Radiopharmaceuticals; D004369:Pentetic Acid