31 year old male patient with recent head trauma and and fracture of the skull base. Sent to rule out a leak.
Suboccipital  puncture was done  injecting 9 mCi of Tc99m DTPA.
Note symmetric activity in basal cisterns  at 2h and proper circulation to reabsorption sites in the Pacchioni bodies at 24 h.
No nasal uptake was seen.
Nasal cotton pledgets were also used in both nasal cavities and counted at 2, 4 and 6 h. At the same time, blood samples were also counted to get the ratio to nasal  pledgets. They were negative.
Prepared by Dr Guillermo Contreras
Radiocisternography is an excelent procedure to study CSF circulation. Images  may be completed with simultaneous quantitative assessment in case of leak suspicion. Spatial resolution though is limited.
 

Mitjavila M, Balsa MA, Penín J, Pey C. Radionuclide cisternography in spontaneous intracranial hypotension syndrome. Rev Esp Med Nucl. 2004 Sep-Oct;23(5):338-42.
 

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