Localization of Cerebrospinal Fluid Leaks by Gadolinium-Enhanced Magnetic Resonance Cisternography

Abstract

Gd-enhanced MR cisternography is a sensitive and safe imaging method for detection of CSF leaks in patients with rhinorrhea.

Intrathecal Gadolinium-Enhanced MR Cisternography: A Comprehensive Review

“…21 In these studies, no significant change was observed on physical and neurologic examinations, electroencephalography, and CSF findings of patients following CE-MRC with Ͻ1 mL of intrathecal Gd injection. 2,6,9,10,[12][13][14][15][16][17][22][23][24][25][26] Gd-DTPA has been reported as the safest and most recommended intrathecal contrast agent in human studies. 2,4,6,9,10 In our cohort of approximately 100 patients who had CE-MRC for at past 7 years in 2 different centers, we have not encountered a major complication.…”

“…Intrathecal Gd injection is not approved by the FDA, though its safety has been reported in several pilot studies in Europe. [2][3][4]6,[9][10][11][12][13][14] Tolerance and dose limits of intrathecal Gd injection were established in animal model studies, and different Gd compounds (eg, gadodiamide, gadobenate dimeglumine, and Gd-DTPA) were compared in different experimental animal protocols. 5,[14][15][16][17] High-dose intraventricular Gd injection was reported to result in behavioral and neurologic disturbances (focal seizures, ataxia, latent tremor) with histopathologic changes (loss of oligodendroglia, astrocytic hypertrophy, and eosinophilia); on the other hand, it was concluded that these changes and distur-bance did not occur if the total injected dose wasϽ15 mL (3.3 mmol/g).…”

Diagnosis and treatment of cerebrospinal fluid rhinorrhea following accidental traumatic anterior skull base fractures

“…96,97 In human studies, no gross behavioral changes, neurological alterations, or seizure activity at any time after the procedure has been reported. 5,6,109,120 Symptoms, such as postural post-lumbar puncture headache, nausea, and episodes of vomiting, were documented, but all resolved within the first 24 hours of the lumbar puncture with conservative bed rest. 109 In a prospective pilot trial in 20 patients, Aydin and colleagues 5 used a total volume of 0.5-1.0 ml of intrathecal contrast medium without any significant gross neurological, CSF, electroencephalography, or MRI changes related to the medium on the initial follow-up examination.…”

MR cisternography: is it useful in the diagnosis of normal pressure hydrocephalus and the selection of “good shunt responders”?

“…Intrathecal gadolinium application has not been recognized worldwide. In the literature, it is reported that intrathecal administration of 1 ml (0.5 mmol) Gd-DTPA does not cause neurological or behavioral abnormalities or early or late complications (14,15,26). It is also used for evaluation of CSF dynamics, CSF leaks and communication of ACs; the safety of this dose has been verified in other studies (14,15,(26)(27)(28).…”