Cerebrospinal Fluid (CSF) Scintigraphy

Abstract

Cerebrospinal fluid (CSF) scintigraphy (also referred to as “cisternogram”) is a traditional clinical nuclear medicine neuroimaging modality, mainly used to help diagnose normal pressure hydrocephalus (NPH), to detect CSF leaks, and to evaluate CSF shunt patency (Ali et al., Clin Nucl Med 23(3):52–155, 1998; Chiewvit et al., World J Nucl Med 13(2):75–84, 2014; Eljazzar et al., World Neurosurg 127:307–315, 2019; Kitami et al., No To Shinkei 38(8):781–788, 1986; Klassen and Ahlskog, Neurology 77:1119–1125, 2011). Corresponding to these applications are cases grouped in three sections. Section “CSF Imaging in Normal Pressure Hydrocephalus (NPH)” shows classic imaging features consistent with NPH including persistent ventricular reflux and significantly delayed CSF flow. Cases in section “CSF Leak Imaging” demonstrate that CSF scintigraphy is a highly specific imaging technique for detecting CSF leaks, which can be effectively treated with epidural blood patch (Eljazzar et al., World Neurosurg 127:307–315, 2019). Finally, section “CSF Imaging in the Evaluation of Shunt Patency” shows the value of CSF imaging in the evaluation of ventriculoperitoneal (VP) and lumboperitoneal (LP) shunt patency, especially in patients with recurrent symptoms and/or equivocal anatomic imaging findings. CSF scintigraphy is an imaging choice in the evaluation of Ommaya shunt patency, which is a prerequisite for intrathecal chemotherapy. In addition to Ommaya shunt occlusion, uneven CSF distribution in the subarachnoid spaces and/or significant slow CSF flow is often associated with intrathecal treatment failure and  a poor prognosis.