Localization of Postoperative Cerebrospinal Fluid Rhinorrhea by Fusion of Radionuclide SPECT Cisternography and MR Images

Received 7/21/2006; revised 8/11/2006; accepted 8/15/2006. For correspondence or reprints contact: Su-Mei Chen, M.D., Division of Nuclear Medicine, Taipei City Hospital, Renai Branch, 10 Section 4, Renai Road, Daan District, Taipei 106, Taiwan. Tel: (886)2-27093600 ext. 5117, Fax: (886)227037710, E-mail: [email protected] The purpose of this case report is to demonstrate the utility of SPECT cisternography-MRI fused imaging in the diagnosis of postoperative cerebrospinal fluid (CSF) leakage. A 55-year-old woman had history of surgical interventions for a pituitary tumor. Three years after, she was suspected clinically with CSF leakage. Radionuclide cisternography was performed with intrathecal lumbar injection of Tc-DTPA and SPECT images were acquired at 24 h. The SPECT cisternography was registered with previous performed MRI to obtain fused images. Planar and SPECT cisternography revealed accumulation of the tracer near the skull base. The SPECT cisternography-MRI fused imaging provided precise anatomic localization of CSF leak. Fusion of SPECT and MRI images as exemplified in the present report could provide substantial informational and diagnostic benefit in selected cases.