Postpuncture CSF leakage: a potential pitfall of radionuclide cisternography.
OBJECTIVE
We sought to evaluate radioisotope cisternography (RICG)-related postpuncture CSF leakage by MRI.


METHODS
We conducted a prospective 3-day imaging study. Ten patients with orthostatic headache and other symptoms underwent pre-RICG brain and spinal MRI, magnetic resonance myelography (MRM), RICG, and post-RICG spinal MRI and MRM. For RICG, we used a 25-gauge pencil point spinal needle at the L3/4 or L4/5 level after which subjects took bed rest for 2.5 hours.


RESULTS
On pre-RICG MRI and MRM, none of the 10 patients showed CSF leakage. However, 5 subjects (50%) showed epidural abnormalities suggesting CSF leakage on MRI after lumbar puncture for RICG. On RICG and subsequent MRM, 4 of the subjects showed definite findings of CSF leakage and 1 showed minimal leakage.


CONCLUSIONS
RICG carries a risk of iatrogenic CSF leakage even with careful puncturing using a fine needle. This leakage produces abnormal RICG and MRM findings at the lumbosacral level. Therefore, abnormal RICG findings restricted to the lumbosacral level should be carefully interpreted when diagnosing SIH.
Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. ksak666@yahoo.co.jp
K
K
Sakurai
M
M
Nishio
S
S
Sasaki
H
H
Ogino
J
J
Tohyama
K
K
Yamada
Y
Y
Shibamoto
D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006261:Headache / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D019585:Intracranial Hypotension / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009192:Myelography / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013129:Spinal Puncture / Q000009:adverse effects*