Postpuncture CSF leakage: a potential pitfall of radionuclide cisternography

Area of Science:

• Radiology
• Neurology
• Nuclear Medicine

Background:

• Spontaneous intracranial hypotension (SIH) is often diagnosed using radioisotope cisternography (RICG).
• Post-lumbar puncture cerebrospinal fluid (CSF) leakage is a known complication.
• The relationship between RICG and iatrogenic CSF leakage requires further investigation.

Purpose of the Study:

• To evaluate the incidence of postpuncture CSF leakage related to RICG using MRI.
• To assess the diagnostic utility of MRI and magnetic resonance myelography (MRM) in detecting RICG-induced CSF leakage.

Main Methods:

• Prospective imaging study involving 10 patients with symptoms suggestive of SIH.
• Pre- and post-RICG brain MRI, spinal MRI, and MRM were performed.
• RICG was conducted using a fine-gauge needle, followed by a period of bed rest.

Main Results:

• No pre-RICG CSF leakage was observed on initial MRI/MRM.
• Post-RICG MRI revealed epidural abnormalities suggestive of CSF leakage in 50% of patients.
• RICG and subsequent MRM confirmed definite or minimal CSF leakage in 5 subjects.

Conclusions:

• RICG carries a risk of iatrogenic CSF leakage, even with fine-needle use.
• Detected leakage primarily occurs at the lumbosacral level.
• Abnormal RICG findings localized to the lumbosacral region necessitate careful interpretation for SIH diagnosis.