MR cisternography is an MR imaging technique useful in evaluating abnormalities in subarachnoid cisterns 1,2. It is the intracranial equivalent to MR myelography and can similarly be non-contrast-enhanced or, less commonly, contrast-enhanced (off-label).
On this page:
Clinical applications
MR cisternography is infrequently used, but it can be helpful as a problem-solving tool for identifying a CSF leak or assessing a variety of pathologies. Indications include 1,2:
rhinorrhea and otorrhea
arachnoid cyst communication
suprasellar and posterior fossa masses and cysts
location of intracranial tumors (intra-axial vs extra-axial) or vascular abnormalities (aneurysms)
hydrocephalus, including normal pressure hydrocephalus
Contraindications
-
contraindications to lumbar puncture
infection at the puncture site
coagulopathy
raised intracranial pressure
adverse reaction to contrast media (for gadolinium-enhanced cisternography)
Technique
The patient can be in supine or prone position, with prone position being the preferred position in evaluation of CSF leaks 3.
Non-contrast cisternography
Heavily T2 fat-saturated sequences with good spatial resolution are typically employed such as:
3D PSIF - reversed fast imaging with steady state precession (FISP) 1,4
3D constructive interference steady state sequence (CISS) 1,3,4
3D T2 DRIVE sequence- driven equilibrium pulse sequence using TSE (turbo- spin echo) technique 3
Contrast cisternography
In case of contrast enhanced MRC, precontrast T1 (fat suppressed) and 3D T2 weighted images are obtained 1. 0.5 mL of gadopentetate dimeglumine (Gd-DTPA) is injected in the L4-L5 lumbar region using a 24–26-gauge needle 1. Post-contrast images include early-phase imaging within 6 hours and late-phase imaging 1.
Off-label warning: The use of gadolinium-based contrast agents for intrathecal administration is not approved by regulatory agencies such as the FDA. Read more: intrathecal gadolinium
Limitations
Lack of bony detail is a disadvantage of MR in comparison to CT cisternography 3. There may be difficulty in distinguishing pooled CSF from sinus secretions in the paranasal sinuses in some cases of CSF leak 5.
History and etymology
MR cisternography was demonstrated for the first time by Dichiro et al in dogs in 1986 3.
Unable to process the form. Check for errors and try again.