Various methods are used for diagnosis such as brain MRI, MR or CT myelography, and radionuclide cisternography
. MRI findings are subdural fluid collections, pachymeningeal enhancement, sagging of the brain structures, and engorgement of venous structures (1).
Shinohara et al., "Spinal cerebrospinal fluid leaks detected by radionuclide cisternography
and magnetic resonance imaging in patients suspected of intracranial hypotension," Advances in Medical Sciences, vol.
CT cisternography and radionuclide cisternography
can be used if a defect is not detected on CT.
Mukherji, "Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography
," American Journal of Neuroradiology, vol.
Peng, "Asymmetric radiotracer activity of enlarged cerebral spinal fluid space on radionuclide cisternography
with SPET/CT," Hellenic Journal of Nuclear Medicine, vol.
The invasive procedure of administering contrast-enhanced agent through lumbar puncture carries the risks of brain hernia and allergic reaction.[sup] The ability of radionuclide cisternography
to precisely localize the site of CSF leak is also limited when the site of leak is too small, the leak produces a small volume of fluid, there is temporary adhesion at the site or no active leak.[sup] Similarly, radionuclide cisternography
is an invasive procedure and carries the risk of brain hernia.
In fact, they concluded that other complex procedures like CT cisternography and radionuclide cisternography
(Which is available in selected centers) do not offer any extra advantage over non contrast high-resolution CT scan for detecting the site of leak.
Other tests, such as radionuclide cisternography
or magnetic resonance imaging CSF flow void, have predictive values too low or have too few studies to be recommended.
When combined with CT and MRI, radionuclide cisternography
is useful, but it is not necessary for every patient.