CSF scintigraphy in the diagnostic chain of cerebrospinal fluid loss syndrome – An interdisciplinary challenge

Introduction CSF scintigraphy is an established nuclear medicine procedure in which a non-absorbable radiopharmaceutical (indium-111-DTPA) is injected intrathecally via a lumbar puncture. Subsequently, the distribution of the radiopharmaceutical over the spinal axis and the neurocranium is visualised planar and by means of SPECT (CT) according to a defined examination protocol.

Problem definition Spontaneous or intermittent CSF fistulas lead to a high level of patient suffering with the leading non-specific symptom of headache. The path to diagnosis often leads to a long diagnostic cascade for the patient, which is not always expedient. Persistent occult or intermittent CSF fistulas, which often cannot be detected with conventional imaging alone, or spontaneous non-traumatic CSF fistulas, which can lead to CSF leak syndrome, represent a challenge.

Outlook The continuous technical development in combination with long-established nuclear medicine procedures offers a wide range of non-invasive or minimally invasive methods and possibilities in diagnostic imaging. Schmieder D et al: CSF-oma identification with nuclear medicine shunt-o-gram. Clin Nucl Med. 44(5):399-400; 2019; Berno MS et al: Two signs identification of successful access in nuclear medicine cerebrospinal fluid diversionary shunt studies. Pediatr. Radiol. 48/8):1130-8; 2018

Publication History

Article published online:
19 April 2024