Neuroimaging Procedures in Daily Clinical Routine

Cerebrospinal Fluid Studies

Synopsis

Study protocols

Cisternography

Patient preparation: Verification of adequate platelet counts and clotting parameters for intrathecal access

Radiopharmaceutial: Indium-111 DTPA, 250 μCi (9.3 Mbq)

Instrumentation:

Camera: large-field-of-view gamma

Collimator: medium energy

Imaging procedure:

Inject slowly into lumbar subarachnoid space using a 22-gauge needle. Patient should remain recumbent for at least 1 hour after injection. All 2D planar images should be obtained for 50k counts. SPECT imaging may also be performed.

Imaging times:

Immediate post injection: thoracic-lumbar spine for evaluation of injection adequacy and any unusual appearance suggestive of leak, i.e. early appearance of kidney

1–3 hour: base of the skull to visualize basilar cisterns.

24 and 48 hour: evaluation of ventricular reflux and arachnoid villi reabsorption

Obtain anterior, posterior and both lateral views of