title: Comparison of computed tomography myelography and radioisotope cisternography to detect cerebrospinal fluid leakage in spontaneous intracranial hypotension.
abstract: METHODS
  A retrospective observational study.
  
  
  OBJECTIVE
  To compare the usefulness of radioisotope cisternography (RIC) and computed tomography myelography (CTM) for the detection of cerebrospinal fluid (CSF) leakage in spontaneous intracranial hypotension (SIH).
  
  
  BACKGROUND
  CSF leakage sites have been generally identified by RIC in patients with SIH. Although a number of reports have recently indicated the usefulness of CTM, whether RIC or CTM more reliably detects leakage sites has not been decided because the 2 tests have not been directly compared.
  
  
  METHODS
  Both RIC and CTM were performed, and the findings were compared in 12 patients with SIH strictly meeting the second edition of the International Classification of Headache Disorders diagnostic criteria. : On RIC, the detection rate of leakage including indirect signs, an early vesicular radioisotope (RI) accumulation and delayed ascent of the RI to the cerebral convexity, was observed in 100%, but that of the direct sign, paraspinal RI accumulation, was in 8 patients (67%). On CTM, the epidural collection of intraspinally administered contrast medium was demonstrated in all patients (100%), and the collection site was located in the cervical and thoracic vertebral regions in most cases. When RIC and CTM findings were collated, paraspinal accumulation in the cervical and thoracic regions on RIC corresponded to the entire or a part of the findings on CTM. In contrast, in 4 of 5 patients with paraspinal accumulation in the lumbosacral region, epidural collection was not noted in this region on CTM.
  
  
  CONCLUSIONS
  In patients with SIH, epidural collection on CTM may more accurately demonstrate CSF leakage compared with paraspinal RI accumulation on RIC.
authors.affiliation: Department of Anesthesiology and Pain Management, Nara Medical University, Kashihara, Nara, Japan. kzume@naramed-u.ac.jp
authors.forename: Keiji
authors.initials: K
authors.lastname: Hashizume
authors.forename: Keisuke
authors.initials: K
authors.lastname: Watanabe
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kawaguchi
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Taoka
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shinkai
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Furuya
mesh_terms: D000328:Adult; D002555:Cerebrospinal Fluid; D015170:Cerebrospinal Fluid Pressure; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications / Q000175:diagnosis*; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D009192:Myelography / Q000379:methods*; D011877:Radionuclide Imaging; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology*; D013353:Subdural Effusion / Q000175:diagnosis* / Q000209:etiology; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA