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Abnormal [18F]FDG PET/MRI findings in paraspinal structures of patients with suspected cerebrospinal fluid leak
Daehyun Yoon1, Peter William Cipriano1, Ryan Penticuff2
1Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA.
Abstract:
A combination of magnetic resonance imaging (MRI), computed tomography (CT), and radionuclide cisternography are typically used to locate a cerebrospinal fluid (CSF) leak. However, the site of leakage cannot be determined, making treatment more difficult. Therefore, more sensitive imaging tools are needed. A whole-body [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/MRI was conducted on six patients with suspected CSF leak and the resulting images were reviewed in comparison with those from six healthy controls. Paraspinal regions of focally increased uptake of [18F]FDG were quantified using maximum standardized uptake values (SUVmax) and compared to the SUVmax of corresponding regions in the healthy controls. All six patients with suspected CSF leak showed paraspinal regions of significantly greater [18F]FDG uptake compared to the corresponding areas in controls (P < 0.05). Two patients treated with local injections (epidural blood patches and/or epidural fibrin patches) on the site of abnormal PET/MRI findings reported temporary but significant improvement in symptoms. Our results suggest [18F]FDG PET/MRI is sensitive to abnormalities potentially due to suspected CSF leak, which are not necessarily visible on conventional MRI alone or by the standard-of-care imaging methods.
Insights
Whole-body [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/MRI shows promise for detecting cerebrospinal fluid (CSF) leaks. This advanced imaging technique identified abnormal uptake in patients, aiding in diagnosis where conventional methods failed.
Area of Science:
- Nuclear Medicine
- Radiology
- Medical Imaging
Background:
- Conventional imaging like MRI, CT, and radionuclide cisternography often fail to pinpoint the exact site of cerebrospinal fluid (CSF) leaks.
- Difficulty in locating CSF leaks complicates treatment and impacts patient outcomes.
Purpose of the Study:
- To evaluate the sensitivity of whole-body [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/MRI in detecting suspected CSF leaks.
- To compare [18F]FDG PET/MRI findings with conventional imaging methods and healthy controls.
Main Methods:
- Six patients with suspected CSF leaks underwent whole-body [18F]FDG PET/MRI.
- Paraspinal regions of [18F]FDG uptake were quantified using maximum standardized uptake values (SUVmax).
- Findings were compared to six healthy controls and conventional imaging results.
Main Results:
- All six patients demonstrated significantly higher [18F]FDG uptake in paraspinal regions compared to controls (P < 0.05).
- Two patients treated based on PET/MRI findings experienced temporary symptom improvement.
- [18F]FDG PET/MRI identified abnormalities not visible on conventional MRI alone.
Conclusions:
- [18F]FDG PET/MRI is a sensitive tool for detecting abnormalities associated with suspected CSF leaks.
- This technique offers potential advantages over standard-of-care imaging for diagnosing CSF leaks.
- Further research may validate [18F]FDG PET/MRI for improved localization and management of CSF leaks.
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