A Muñoz1, J Hinojosa, J Esparza. 1. Section of Pediatric Neuroradiology, Hospital Materno-Infantil 12 de Octubre, Madrid, Spain. almugo@teleline.es
Abstract
BACKGROUND AND PURPOSE: Complex CSF diseases may be underdiagnosed or poorly understood on conventional CT or MR imaging. Although intrathecal CT cisternography with water-soluble iodinated contrast medium has been used, very few studies have dealt with the intrathecal use of gadopentate dimeglumine (Gd-DTPA), though it appears superior to CT. We report our experience with the intrathecal use of Gd-DTPA for MR cisternography and ventriculography in pediatric patients referred for study and treatment of complex CSF-related diseases. MATERIALS AND METHODS: Ten patients (range, 1 month-16 years of age) were selected after we obtained specific informed consent. Intrathecal gadolinium injection was performed via transfontanelle ventriculostomy, ventriculoperitoneal shunt reservoir, or lumbar puncture. Cases included spontaneous CSF leaks (n=1), complex traumatic frontoethmoidal fractures with suspected CSF leak (n=2), multiloculated congenital or acquired hydrocephalus (n=3), intraventricular tumor (n=1), suspected postoperative arachnoiditis (n=1), complex midline defect (n=1), and acquired orbital meningoencephalocele (n=1). RESULTS: No patient showed biologic, behavioral, or neurologic alterations. In complex hydrocephalus or intraventricular cysts, ventriculography Gd-DTPA MR imaging helped to differentiate isolation of a ventricle or noncommunicating cyst in all 4 patients. In suspected posttraumatic CSF leaks, the procedure established with precision the place of the leak in 1 patient and excluded it in the other. In 1 patient who underwent surgery for spinal cord neoplasm, the procedure excluded arachnoiditis. In the other 3 patients with complex CSF-related diseases, the procedure showed distinctive radiologic findings for the understanding and treatment of the disease. Altogether, in 8 patients, imaging findings influenced or changed clinical decisions and surgical planning. CONCLUSIONS: Our preliminary results showed no side effects and potential useful clinical applications in the evaluation of CNS diseases involving the ventricular system or the subarachnoid space in selected pediatric patients.
BACKGROUND AND PURPOSE: Complex CSF diseases may be underdiagnosed or poorly understood on conventional CT or MR imaging. Although intrathecal CT cisternography with water-soluble iodinated contrast medium has been used, very few studies have dealt with the intrathecal use of gadopentate dimeglumine (Gd-DTPA), though it appears superior to CT. We report our experience with the intrathecal use of Gd-DTPA for MR cisternography and ventriculography in pediatric patients referred for study and treatment of complex CSF-related diseases. MATERIALS AND METHODS: Ten patients (range, 1 month-16 years of age) were selected after we obtained specific informed consent. Intrathecal gadolinium injection was performed via transfontanelle ventriculostomy, ventriculoperitoneal shunt reservoir, or lumbar puncture. Cases included spontaneous CSF leaks (n=1), complex traumatic frontoethmoidal fractures with suspected CSF leak (n=2), multiloculated congenital or acquired hydrocephalus (n=3), intraventricular tumor (n=1), suspected postoperative arachnoiditis (n=1), complex midline defect (n=1), and acquired orbital meningoencephalocele (n=1). RESULTS: No patient showed biologic, behavioral, or neurologic alterations. In complex hydrocephalus or intraventricular cysts, ventriculography Gd-DTPA MR imaging helped to differentiate isolation of a ventricle or noncommunicating cyst in all 4 patients. In suspected posttraumatic CSF leaks, the procedure established with precision the place of the leak in 1 patient and excluded it in the other. In 1 patient who underwent surgery for spinal cord neoplasm, the procedure excluded arachnoiditis. In the other 3 patients with complex CSF-related diseases, the procedure showed distinctive radiologic findings for the understanding and treatment of the disease. Altogether, in 8 patients, imaging findings influenced or changed clinical decisions and surgical planning. CONCLUSIONS: Our preliminary results showed no side effects and potential useful clinical applications in the evaluation of CNS diseases involving the ventricular system or the subarachnoid space in selected pediatric patients.
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