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CSF cisternography is an imaging technique used to study the flow and dynamics of cerebrospinal fluid (CSF) in the subarachnoid space, particularly the basal cisterns and arachnoid villi. It is mainly performed by radionuclide scintigraphy, though CT and MR cisternography are also used in specific contexts.

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Types

| Radionuclide cisternography | • Standard technique using intrathecal injection of a radiotracer (commonly In-111 DTPA or Tc-99m DTPA). • Sequential imaging with gamma camera demonstrates CSF flow dynamics. | | --- | --- | | CT Cisternography | • Uses intrathecal non-ionic iodinated contrast. • High-resolution CT performed to detect CSF leaks (esp. skull base). | | MR Cisternography | • Non-invasive, heavily T2-weighted MRI sequences that highlight CSF spaces. • Useful for detecting CSF leaks and cystic lesions without intrathecal contrast. |

Cerebrospinal Fluid (CSF) // rev.med

Indications

Radionuclide Cisternography:

• Evaluation of normal pressure hydrocephalus (NPH).
• Assessment of CSF flow obstruction or circulation disorders.
• Differentiating communicating vs. non-communicating hydrocephalus.
• Suspected CSF rhinorrhea/otorrhea (if CT/MR inconclusive).

CT/MR Cisternography:

• Localization of CSF leaks (skull base, spine).
• Detection of arachnoid cyst communication with CSF.

Technique – Radionuclide Cisternography

• Tracer: In-111 DTPA (half-life 67 hrs) or Tc-99m DTPA.
• Procedure:
  • Intrathecal lumbar puncture injection of tracer.
  • Serial images obtained at 1, 3, 6, 24, and 48 hrs.
• Normal flow:
  • Rapid ascent over basal cisterns (few hours).
  • Over cerebral convexities by 24 hrs.
  • Clearance via arachnoid villi into systemic circulation.