Detection of rhinorrhoea by cisternography in combination with single photon emission tomography, following lumbar injection of iodine-123-labelled albumin.

Eight patients were examined. Seven had verified rhinorrhoea and six had had one or more episodes of pneumococcal meningitis. In four of the patients a fistula could not be visualized by computed tomography. All eight patients had injections of iodine-123-labelled albumin by lumbar puncture. Tomoscintigraphy (SPET) was performed 3, 6 and 8-9 h after injection. After 6-8 h we were able to demonstrate a fistula in seven of the patients with verified rhinorrhoea and the findings were confirmed by a subsequent operation. In one of the patients we were not able to visualize any leak of cerebrospinal fluid into the nasal cavity. This patient was not operated upon and we were not able to verify the findings in this patient. The operated patients all did well after the operation with no relapse of meningitis. In conclusion, SPECT-cisternography after intralumbar injection of iodine-123-labelled albumin is a valuable diagnostic tool for the detection of small fistulae in patients with rhinorrhea.