Detection and quantitation of intermittent CSF rhinorrhea during prolonged cisternography with 111In-DTPA

In an attempt to improve the diagnosis and to assess the intensity of intermittent cerebrospinal fluid rhinorrhea, indium-111 uptake by nasal pledgets during prolonged cisternography using 111In-DTPA was determined. In 12 patients having suspected cerebrospinal fluid rhinorrhea, cisternograms with calculation of counts/pixel in regions of interest were obtained, blood samples drawn, and nasal pledgets placed several times during 48 or 72 hr after lumbar intrathecal administration of 111In-DTPA. In three patients intermittent cerebrospinal fluid rhinorrhea was thus revealed; study by computed tomography was negative in each case. This procedure of extended radionuclide cisternography helped to detect, localize, and quantify intermittent cerebrospinal fluid rhinorrhea so that therapeutic decisions were facilitated and surgical intervention was minimized.