Sunday, April 20, 2025

CT Cisternography

 CT Cisternography is a specialized imaging procedure used primarily to evaluate cerebrospinal fluid (CSF) leaks, CSF dynamics, and arachnoid cysts. It combines a lumbar puncture (for contrast injection into the subarachnoid space) with CT imaging of the brain or spine.


๐Ÿ” Indications

  • Suspected CSF rhinorrhea or otorrhea

  • Evaluation of skull base fractures

  • Assessment of arachnoid cysts

  • Pre-surgical mapping of CSF pathways

  • Detection of normal pressure hydrocephalus (NPH)


๐Ÿงช Procedure Overview

  1. Preparation:

    • Patient consent

    • Check for contraindications (e.g., elevated ICP, bleeding disorders)

    • Local anesthesia and lumbar puncture

  2. Contrast Injection:

    • Intrathecal injection of iodinated, non-ionic contrast via lumbar puncture (typically at L3-L4)

    • Patient is then positioned head-down (Trendelenburg) to allow contrast to move cranially

  3. CT Imaging:

    • Images taken at intervals (commonly 1–6 hours after injection)

    • Target area: skull base, brain, or spine

    • Thin slices and multiplanar reconstructions for accurate leak localization


⚠️ Risks and Complications

  • Headache (especially post-lumbar puncture headache)

  • Infection

  • Bleeding

  • Allergic reaction to contrast

  • Seizure (very rare)


๐Ÿง  Key Points

  • Highly sensitive in detecting active CSF leaks

  • Often used when MR cisternography is inconclusive

  • Dynamic CT cisternography can detect intermittent leaks

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