Cisternogram

Indications:

-For the detection and localization of cerebrospinal fluid leaks
-Normal pressure hydrocephalus
-Shunt patency



Contraindications:
  • If patient is pregnant
  • If patient is severely allergic to the radionuclide

Questions asked in Patient History:
List the common questions asked when taking a patient history for this specific procedure.
  1. Are you pregnant?
  2. Are you breast feeding?


Radiopharmaceutical information:
  • Radionuclide: In-111, Tc-99m
  • Radiopharmaceutical: In-111 DTPA, Tc-99 m DTPA (In-111 has a longer half life which can be beneficial when imaging at extended times)
  • Adult dosing: 250 microCi In-111 DTPA
  • Pediatric dosing:
  • Method of administration: intrathecal (lumbar puncture), use at least a 22 gauge needle, patient remains recumbent for at least 1 hour post injection
  • Method of Localization: compartmental
  • Physical Half-life: 67 hrs

Patient Preparation:

What does the patient need to do prior to coming for the procedure?
None

Side Effects:

Will the patient feel any different during or after the procedure?
  • pain at the site of injection
  • bleeding
  • infection
  • nerve damage (rare)

Equipment Used:
Type of Camera or Probe
Gamma camera, large FOV
Collimator used: Medium energy general purpose

Acquisition Setup:

Photopeak(s)/Window(s):

20% windows centered at 172 KeV and 245 KeV




Statics: View(s)
image 1-2 hours, 4 hours, 24 hours, 48 hours, 72 hours post injection
Ant/post head, Rt/lt laterals head
Matrix:
Total Counts or Duration: 50k counts per image

Processing:


Filter:
Cut-off:
Frequency:


Procedure:
Describe the procedure from verifying the requisition to completing the scan. Include any patient instructions pre- or post- injection/scan, delays between injection and imaging, and any side effects.
  1. inject slowly into lumbar subarachnoid space using a 22-gauge needle with the bevel positioned vertically.
  2. patient should remain recumbent for at least 1 hr after injection.
  3. all images should be obtained for 50k counts.
  4. 1 hour: image thoracic-lumbar spine for evaluation of injection adequacy.
  5. 3 hour: image base of skull to visualize basilar cisterns.
  6. 24 and 48 hour: image to evaluate for ventricular reflux and arachnoid villi absorption.
  7. Obtain anterior, posterior, and both lateral views of the head at 3, 24, and 48 hours.

Normal Uptake and common varients:
Insert an image of a normal scan. Describe the normal uptake, and any normal varients visualized.

nph15.jpg
this image shows that the patient have normal pressure hydrocephalus

http://www.lowback-pain.com/nphnormalpressurehydrocephalus.htm

Abnormal Uptake and causes:
Insert an image of an abnormal scan. Describe the abnormal uptake, and the cause of the abnormal uptake.

This is an image of an obstructed shunt.
abnormal_CSF_study.gif
A- The anterior image of the head and chest demonstrates reflux into ventricles and transit down the shunt. B- The anterior image of the lower chest and abdomen shows the absence of activity in the shunt at the level of lower chest.

Artifacts:
Insert an image with an artifact, and explain what the artifact is.


References:

http://www.nlm.nih.gov/medlineplus/ency/article/003823.htm