ARRS 2022 Abstracts


E1820. Nuclear Cisternography: A Primer for the Radiology Resident for Clinical Applications, Imaging Protocoling, and Interpretation
  1. Megan Mercer; Medical University of South Carolina
  2. Lisa Blacklock; University of New Mexico
  3. Jonathan Revels; University of New Mexico
  4. William Rieter; Medical University of South Carolina
  5. Manuela Matesan; University of Washington
  6. David Lewis; University of Washington
  7. Saeed Elojeimy ; Medical University of South Carolina
Although nuclear medicine cisternography is a relatively uncommon procedure, it can provide valuable diagnostic information for patients undergoing evaluation for cerebrospinal fluid (CSF) leaks and normal pressure hydrocephalus (NPH).

Educational Goals / Teaching Points
The goal of this presentation is to provide an overview of key principles of In-111 DTPA cisternography including common indications, radiopharmaceutical considerations, imaging techniques, and interpretation. Common indications for cisternography are reviewed, including normal pressure hydrocephalus, evaluation of orthostatic intracranial hypotension, and CSF leak, and cases, including those with SPECT/CT and multimodality correlation, are used to demonstrate expected imaging patterns in normal and abnormal cisternograms. Pitfalls and variants that may mimic pathology are shown, and the clinical implications of a positive examination are discussed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In this case-based review, radiologists can familiarize themselves with normal and abnormal cisternogram findings, study techniques, indications, and limitations. The use of In-111 DTPA and specific patient preparation techniques, including the use of pledgets in the evaluation of cerebral CSF leak, are addressed.

Cisternography can be very helpful in the evaluation of CSF leak and normal pressure hydrocephalus. It is important for radiologists to appreciate key technical factors and be familiar with common abnormal and normal CSF patterns on cisternograms.