Localization of Postoperative Cerebrospinal Fluid Rhinorrhea by Fusion of Radionuclide SPECT Cisternography and MR Images

以單光子電腦斷層腦池造影與磁振造影影像融合診斷術後之腦脊髓液滲漏

陳愫美(Su-Mei Chen) ； 秦公焯(Kun-Chou Chin) ； 劉家龍(Chia-Lung Liu)

《核子醫學雜誌》 19卷4期 (2006/12) Pp. 279-283

https://doi.org/10.6332/ANMS.1904.010

摘要

腦脊髓液滲漏的診斷與滲漏點的定位在手術修補前是必須的，但是影像學檢查卻不易發現滲漏點，因此常常成為臨床醫師與影像醫學專家的一個挑戰。藉由單光子電腦斷層腦池造影與磁振造影影像融合我們成功診斷一位接受過顱底手術患者腦脊髓液滲漏並定位滲漏點。一位三年前接受過顱底手術之55歲婦女，臨床上懷疑有腦脊髓液滲漏。病患接受腰椎穿刺術，穿刺腰椎的蜘蛛膜下腔，注射鎝－99m-DTPA進行同位素腦池造影，並於24小時後施行單光子電腦斷層掃描。我們將單光子電腦斷層腦池造影影像與患者以前磁振造影的影像融合。單光子電腦斷層腦池造影影像顯示顱底附近有同位素聚集證實有腦脊髓液滲漏。而單光子電腦斷層腦池造影與磁振造影的融合影像則提供更精確的解剖定位。單光子電腦斷層腦池造影與磁振造影的融合影像對於某些病患，確實可以提供診斷與定位實質上的優勢。

關鍵字

腦脊髓液滲漏 ； 同位素腦池造影 ； 單光子電腦斷層掃描 ； 影像融合

並列摘要

The purpose of this case report is to demonstrate the utility of SPECT cisternography-MRI fused imaging in the diagnosis of postoperative cerebrospinal fluid (CSF) leakage. A 55-year-old woman had history of surgical interventions for a pituitary tumor. Three years after, she was suspected clinically with CSF leakage. Radionuclide cisternography was performed with intrathecal lumbar injection of (superscript 99m)Tc-DTPA and SPECT images were acquired at 24h. The SPECT cisternography was registered with previous performed MRI to obtain fused images. Planar and SPECT cisternography revealed accumulation of the tracer near the skull base. The SPECT cisternography-MRI fused imaging provided precise anatomic localization of CSF leak. Fusion of SPECT and MRI images as exemplified in the present report could provide substantial informational and diagnostic benefit in selected cases.

並列關鍵字

cerebrospinal fluid leak ； radionuclide cisternography ； single photon emission tomography ； image fusion