Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
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Effectiveness of Radionuclide Cisternography to Detect the Leakage Site of CSF in Spontaneous Intracranial Hypotension; Preliminary Report

자발성 두개강내 저뇌압증 환자의 뇌척수액 누출부위 진단에 방사성동위원소 뇌조조영술의 유효성: 예비결과 보고

  • Kim, Seong-Min (Departments of Nuclear Medicine, Chungnam National University College of Medicine) ;
  • Kim, Jae-Moon (Departments of Neurology, Chungnam National University College of Medicine)
  • 김성민 (충남대학교 의과대학 핵의학교실) ;
  • 김재문 (충남대학교 의과대학 신경과학교실)
  • Published : 2006.06.30
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Abstract

Purpose: Although radionuclide cisternography (RNC) is an useful study to detect cerebrospinal fluid (CSF) leakage in the patient with spontaneous intracranial hypotension (SIH), it sometimes fails to demonstrate the site of CSF leakage. The aim of the study is to improve the detection of leakage site of CSF and to reduce time for the study in RNC using modified protocol (m-RNC). Materials & methods : The study consists of 8 studies of 7 patients ($38{\pm}8$ years, M:F=2:5) with SIH, who underwent m-RNC following administration of 185-222 MBq of $^{99m}Tc$-DTPA into the lumbar subarachnoid space. Sequential images were obtained the whole spine with the head including urinary bladder at 10 minute, 30 minute, 1 hour, 2 hour, 4 hour and 6 hour. Radioactivity of extradural space and urinary bladder was evaluated. Results: Leakage site of CSF was identified in all 8 cases by m-RNC. Leakage site was cervicothoracic junction (CTJ, n=3), CTJ with C1-2 (n=2), CTJ with thoracic spine, thoracolumbar spine and lumbar spine (each n=1). All cases presented leakage sites within 1 hour and multiple sites, where CTJ was included in 6 cases. Only one case presented additional site in 6 hour image. Early radioactivity within the urinary bladder was noted in 6 cases, but that was fellowing after identification of the leakage site. Conclusion: Radionuclide cisternography is sensitive to detect the leakage site of CSF and is expected to improve the detection of CSF leakage site and reduce time for the study using modified protocol.

목적 : 방사성동위원소 뇌조조영술은 자발성 두개강내 저뇌압증이 의심되는 환자에서 뇌척수액의 누출을 진단하는데 유용한 검사이지만, 뇌척수액의 누출 부위를 증명하지 못하는 경우가 있다. 본 연구의 목적은 방사성동위원소 뇌조조영술의 검사 방법을 변화함으로써 뇌척수액 누출 부위의 진단율을 향상시키고, 검사 소요시간을 단축할 수 있는지 알아 보고자 한다. 대상 및 방법 : 자발성 두개강내 저뇌압증으로 진단되어 방사성동위원소 뇌조조영술을 시행한 7명의 환자(평균 나이=$38{\pm}8$세, 남자 2명, 여자 5명), 8회 검사를 대상으로 하였다. 모든 환자들은 자주막하강에 $^{99m}Tc$-DTPA 185-222 MBq을 투여한 후 10분, 30분, 1시간, 2시간, 4시간 그리고 6시간에 방광을 포함하는 요추부부터 두부까지의 영상을 얻었다. 그리고 영상시간에 따라 뇌척수액의 누출과 방광의 방사능 조기 출현을 평가하였다. 결과: 방사성동위원소 뇌조조영술을 통해 8예 모두에서 뇌척수액의 누출 부위를 확인할 수 있었다. 뇌척수액의 누출 부위는 경흉추 경계부(cervico-thoracic junction)에서 3예, 경흉추 경계부와 C1-2에서 2예, 경흉추 경계부와 흉추부, 흉요추부 여러 곳 그리고 요추부가 각각 1예씩 이었다. 모든 예에서 1시간까지의 영상을 통해 모든 예에서 뇌척수액의 누출 부위를 발견할 수 있었으며, 모두 두 곳 이상에서 누출이 있었다. 이 중 경흉추 경계부를 포함하는 경우가 5예였다. 지연 영상에서 뇌척수액의 누출 부위가 추가로 발견된 경우는 단 1예 뿐 이었다. 조기 방광방사능 출현은 6예에서 관찰되었으며, 모두 뇌척수액 유출부위가 더 먼저 관찰되었다. 결론: 방사성동위원소 뇌조조영술은 자발성 두개강내 저뇌압증 환자에서 뇌척수액의 누출 부위를 확인하는데 매우 예민한 검사이며, 검사법을 변형함으로써 뇌척수액의 누출 부위를 발견하는 빈도를 향상시키고, 검사시간을 단축할 수 있을 것으로 기대된다.

Keywords

References

  1. Schaltenband G. Neuere Anschauungen zur Pathophysiologie der Liquorzirkulation. Zentralbl Neurochir 1938;23;290-300
  2. Schaltenband G. Die acute Aliquorrhoe. Qerh Dtsch Ges Inn Med 1940;52;473-81
  3. Weber WE, Heidendal GA, de Krom MC. Primary intracranial hypotension and abnormal radionuclide cisternography. Report of a case and review of the literature. Clin Neurol Neurosurg 1991; 93:55-60 https://doi.org/10.1016/0303-8467(91)90010-M
  4. Spielman FJ. Post-lumbar puncture headache. Headache 1982;22: 280-3 https://doi.org/10.1111/j.1526-4610.1982.hed2206280.x
  5. Mamelak AN, Fishman RA, Dillon WP, Wilson CB. Spontaneous intracranial hypotension. J Neurosurg 1996;85:192-3
  6. Khurana RK. Intracranial hypotension. Semin Neurol 1996;16:5-10 https://doi.org/10.1055/s-2008-1040953
  7. Spelle L, Boulin A, Pierot L, Graveleau P, Tainturier C. Spontaneous intracranial hypotension: MRI and radionuclide cisternography findings. J Neurol Neurosurg Psychiatry 1997;62: 291-2 https://doi.org/10.1136/jnnp.62.3.291
  8. Rando TA, Fishman RA. Spontaneous intracranial hypotension: report of two cases and review of the literature. Neurology 1992;42:481-7 https://doi.org/10.1212/WNL.42.3.481
  9. Moriyama E, Ogawa T, Nishida A, Ishikawa S, Beck H. Quantitative analysis of radioisotope cisternography in the diagnosis of intracranial hypotension. J Neurosurg 2004;101:421-6 https://doi.org/10.3171/jns.2004.101.3.0421
  10. Schievink WI, Meyer FB, Atkinson JL, Mokri B. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. J Neurosurg 1996;84:598-605 https://doi.org/10.3171/jns.1996.84.4.0598
  11. Jung DJ, Kim JS, Ryu JS, Shin JW, Im JH, Lee MC, et al. Radionuclide cisternographic findings in patients with spontaneous intracranial hypotension. Kor J Nucl Med 1998;32:482-8
  12. Diaz JH. Epidemiology and outcome of postural headache management in spontaneous intracranial hypotension. Reg Anesth Pain Med 2001;26:582-7 https://doi.org/10.1097/00115550-200111000-00017
  13. Chiapparini L, Farina L, D'Incerti L, Erbetta A, Pareyson D, CarrieroM R, et al. Spinal radiological findings in nine patients with spontaneous intracranial hypotension. Neuroradiology 2002;44:143-50 https://doi.org/10.1007/s002340100685
  14. Kong DS, Park K, Nam do H, Lee JI, Kim JS, Eoh W, et al. Clinical features and long-term results of spontaneous intracranial hypotension. Neurosurgery 2005;57:91-6
  15. Kim JS, Yang DW, Park SK. A case of spontaneous intracranial hypotension: detection of cerebrospinal fluid leakage by early dynamic radionuclide cisternography. Kor J Nucl Med 1999; 33:184-5
  16. Takahashi M, Momose T, Kameyama M, Mizuno S, Kumakura Y, Ohtomo K. Detection of cerebrospinal fluid leakage in intracranial hypotension with radionuclide cisternography and blood activity monitoring. Ann Nucl Med 2005;19:339-43 https://doi.org/10.1007/BF02984630
  17. Benamor M, Tainturier C, Graveleau P, Pierot L. Radionuclide cisternography in spontaneous intracranial hypotension. Clin Nucl Med 1998;23:150-1 https://doi.org/10.1097/00003072-199803000-00003
  18. Spelle L, Boulin A, Tainturier C, Visot A, Graveleau P, Pierot L. Neuroimaging features of spontaneous intracranial hypotension. Neuroradiology 2001;43:622-7 https://doi.org/10.1007/s002340000529
  19. Jeon TJ, Lee JD, Lee BI, Kim DI, Yoo HS. Radionuclide cisternography in spontaneous intracranial hypotension with simultaneous leaks at the cervicothoracic and lumbar levels. Clin Nucl Med 2001;26:114-6 https://doi.org/10.1097/00003072-200102000-00004
  20. Stern WE. Dural ectasia and the Marfan syndrome. J Neurosurg 1988;69:221-7 https://doi.org/10.3171/jns.1988.69.2.0221
  21. Fattori R, Nienaber CA, Descovich B, Ambrosetto P, Reggiani LB, Pepe G, et al. Importance of dural ectasia in phenotypic assessment of Marfan's syndrome. Lancet 1999 11;354:910-3
  22. Eross EJ, Dodick DW, Nelson KD, Bosch P, Lyons M. Orthostatic headache syndrome with CSF leak secondary to bony pathology of the cervical spine. Cephalalgia 2002;22:439-43. Erratum in: Cephalalgia 2002;22:769 https://doi.org/10.1046/j.1468-2982.2002.00385.x
  23. Mokri B. Headaches caused by decreased intracranial pressure: diagnosis and management. Curr Opin Neurol 2003;16:319-26 https://doi.org/10.1097/00019052-200306000-00011
  24. Milledge JT, Ades LC, Cooper MG, Jaumees A, Onikul E. Severe spontaneous intracranial hypotension and Marfan syndrome in an adolescent. J Paediatr Child Health 2005;41:68-71 https://doi.org/10.1111/j.1440-1754.2005.00541.x