Benefit of tomography in the scintigraphic localization of cerebrospinal fluid leak

A CSF leak was demonstrated by tomography after planar acquisition failed to localize it. The rotatogram was more definitive than the reconstructed images in showing the leak. Tomography should be considered when the leak may be in an unusual location and the patient does not have rhinorrhea or otorrhea. Tomography allows a complete 360 degrees survey to examine for the best angle for inspection of the leak, whereas the empirically oriented planar study can sample only limited projections, particularly if given time limitations for acquisition.