DETEKSI KEBOCORAN CAIRAN LIQUOR DENGAN PEMERIKSAAN SPECT/CT SISTERNOGRAFI RADIONUKLIDA
Radionuclide cisternography is often used to prove the presence of cerebrospinal fluid leakage from the nose or ears and to localize the location of the leak. Whether the leak is active or not at the time of examination greatly affects the results of the radionuclide examination. We report a rare study case in a female patient 56 years old, who had the main complaints of nasal discharge, apathy, and weakness. The discharge is mainly felt when the patient is sitting. The patient had a history of transsphenoidal surgery for removal tumor at the epiphyses. Cisternography examination was carried out at the Department of Nuclear Medicine and Molecular Theranostic to confirm a liquor leak in the patient. Imaging was performed at 1.3.6 hours after intrathecal 99mTc-DTPA injection. There is an increase in radioactivity in the nasal area, especially on the 3 hour image. SPECT / CT fusion imaging provides the exact location of the liquor leak at the sphenoid area. The nasal tampon to blood serum ratio is 4: 1. Therapy for the patient is surgery to re-seal the leak.
2. Nuclear Medicine and Molecular Imaging : The Requisites 5th edition , Harvey A. Ziessman MD, Janis P. O'Malley MD, James H. Thrall MD, Elsevier 2021
3. Tatalaksana Pemeriksaan dan Diagnostik Kedokteran Nuklir dan Teranostik Molekuler, Johan S Masjhur, A Hussein S Kartamihardja, Unpad Press 2020
4. Essential of Nuclear Medicine and Molekular Imaging 7th edition, Fred A Mettler, Jr and Milton J.Guiberteau, Elsevier 2019
5. CSF Rhinorrhea: Detection and Localization Cisternography DTPA Using Overpressure with Tc-99m-DTPA, Richard William Edward Curnes, M.D.2 M. Vincent, M.D. J. Kowalsky, H. McCartney, M.D. V. Staab, M.D. Radiology 1985; 154: 795-799
6. Non-traumatic cerebrospinal fluid rhinorrhea: Diagnosis and management. Khalid Al-Sebeih, MD, FRCSC, Kostadin Karagiozo MD, Ahmed Elbeltagi, MD, FFR RCSI and Fuad Al-Qattan, FRCS(ORL). Ann Saudi Med 2004 Nov-Dec; 24(6): 453–458.
7. Ommaya AK. Spinal fluid fistulae. Clin Neurosurg. 1976;23:363–392.
8. Anderson WM, Schwartz GA, Gommon GD. Chronic spontaneous cerebrospinal rhinorrhea. Arch Intern Med. 1961;107:723–731.
9. Casiano RR, Jassir D. Endoscopic cerebrospinal fluid rhinorrhea repair: Is lumbar drain necessary? Otolaryngol Head Neck Surg. 1999;121:745–750.
10. Wax MK, Ramadan HH, Ortiz O, et al. Contemporary management of cerebrospinal fluid rhinorrhea. Otolaryngol Head Neck Surg. 1997;116:442–449.
11. Calvert CA, Cairns H. Discussion on injuries of the frontal and ethmoid sinuses. Proc R Soc Med. 1942;35:805–810.
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