CT Cisternographie
CSF
rhinorrhea: non-contrast CT, contrast-enhanced CT cisternography or combined?. Non-contrast CT with bone window in coronal and sagittal planes (A and B) show bony defect (3 mm) at roof of right compartment of sphenoid sinus (white arrow), CT cisternography in coronal plane (C) show CSF active contrast leak through that bony defect (black arrow) into the right sphenoid sinus (D), right frontal sinus (E) and right nasal cavity (F)
CSF
rhinorrhea: non-contrast CT, contrast-enhanced CT cisternography or combined?. Non-contrast CT in coronal plane (A) shows defect in left cribriform plate of ethmoid (white arrow), CT cisternography in coronal and axial planes (B&C) show: contrast leak through left cribriform plate of ethmoid (black arrow) (B) to the left nasal cavity and left sphenoid sinus (arrowhead and star) (C). Note previous left middle turbinectomy, partial excision of nasal septum, minimal mucosal thickening of both maxillary sinuses and mildly deviated nasal septum to the right side (A and B)
CSF
rhinorrhea: non-contrast CT, contrast-enhanced CT cisternography or combined?. Non-contrast CT with bone window in coronal plane (A) shows no bone defect, CT cisternography in coronal and sagittal planes (B and C, respectively) show: CSF contrast leak into the right ethmoidal sinus (white arrow). Note mild bilateral mucosal thickening of both maxillary sinuses, left nasal septum spur and mildly deviated nasal septum to the left side
CSF
rhinorrhea: non-contrast CT, contrast-enhanced CT cisternography or combined?. Non-contrast CT in coronal (A), CT cisternography in coronal (B), sagittal (C) and axial (D) planes show defect measuring 6 mm in the roof of the right ethmoid sinus (white arrow) (A and B) with evidence of contrast leak through this defect in addition to herniated brain tissue from the right frontal lobe (black arrow) (C and D)
Computed tomography (CT) cisternography is an imaging technique used to diagnose CSF rhinorrhea or CSF otorrhea (CSF leaks), as CT allows the assessment of the bones of the base of the skull.
Procedure
- pre-contrast CT is performed with thin slices
- 3-10 mL of an iodinated non-ionic low-osmolar contrast agent is installed into the thecal sac after lumbar puncture
- the patient is then tilted with foot-end elevation and a CT scan is performed with thin slices; maneuvers that provoke an active leak, such as head hanging or sneezing, are performed to visualize intermittent or occult leaks
- post-contrast images are then compared with the pre-contrast image to see where the CSF and the contrast are leaking out
- radionuclide cisternography is more sensitive but has poor anatomic resolution compared to CT cisternography
Siehe auch:
Assoziationen und Differentialdiagnosen zu CT Cisternographie:
Defekt in der
Lamina cribrosa des Os ethmoidale