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Cephalalgia. 2016 Nov;36(13):1291-1295. doi: 10.1177/0333102416628467. Epub 2016 Sep 30.

The utility of radioisotope cisternography in low CSF/volume syndromes compared to myelography.

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1 Headache Division, Department of Neurology, University of Miami, Miller School of Medicine, USA.
2 Department of Radiology and Imaging Sciences, Indiana University School of Medicine, USA.
3 Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA.
4 Headache Group, Department of Neurology, University of California, San Francisco, USA.
5 NIHR-Wellcome Trust Clinical Research Facility, King's College London, UK.


Objective The objective of this report is to compare computed tomography (CT) and magnetic resonance (MR) myelography with radioisotope cisternography (RC) for detection of spinal cerebrospinal (CSF) leaks. Methods We retrospectively reviewed 12 spontaneous intracranial hypotension (SIH) patients; CT and RC were performed simultaneously. Three patients had MR myelography. Results CT and/or MR myelography identified CSF leaks in four of 12 patients. RC detected spinal leaks in all three patients confirmed by CT myelography; RC identified the CSF leak location in two of three cases, and these were due to osteophytic spicules and/or discs. RC showed only enlarged perineural activity. Only intrathecal gadolinium MR myelography clearly identified a slow leak from a perineural cyst. In eight remaining cases, the leak site was unknown; however, two of these showed indirect signs of CSF leak on RC. CSF slow leaks from perineural cysts were the most common presumed etiology; and the cysts were best visualized on myelography. Conclusion RC is comparable to CT myelography but has spatial limitations and should be limited to atypical cases.


CSF leaks; Spontaneous intracranial hypotension; diagnostic; low pressure headache syndrome; myelography; radioisotope cisternography

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