High-Resolution PET Cisternography With 64Cu-DOTA for CSF Leak Detection

Freesmeyer, Martin; Schwab, Matthias; Besteher, Bianca; Gröber, Sebastian; Waschke, Albrecht; Drescher, Robert

doi:10.1097/rlu.0000000000002695

Cited by 8 publications

(5 citation statements)

References 8 publications

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“…When there is a clinical suspect or clear diagnosis of CSF leak the neuroradiological evaluation is essential, detecting leaks using computed tomography, magnetic resonance imaging, or nuclear imaging 10,11 . The use of High Resolution Computed Tomography (HRTC) scan to assess any bony defect in the skull base, including also the petrous bone, followed by MRI that can show the presence of meningocele, meningoencephaloceles, inflammatory reaction of the nasal or middle ear mucosa, and obviously any meningeal or intracranial involvement (i.e.…”

Section: Diagnosismentioning

confidence: 99%

“…Prophylactic antibiotics are often administered to decrease the risk of meningitis or local infection during conservative management of CSF leaks. However, this strategy carries the risk to create resistant bacteria; as a result, routine use of prophylactic antibiotics has been questioned [10][11][12] . Nevertheless, prophylactic antibiotics are indispensable for high-risk patients like those with medical history of upper airways infection or meningitis 15 .…”

Section: Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Trattamento delle fistole rinoliquorali: quando è richiesto un approccio chirurgico multidisciplinare al basicranio?

Galli

Morelli

Rigante

et al. 2021

Acta Otorhinolaryngol Ital

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Cerebrospinal fluid (CSF) leak remains a rare condition, characterized by serious complications and potentially fatal. According to different etiologies, CSF leaks may be classified into two main categories: traumatic and spontaneous. Spontaneous fistulas seem to be mainly related to obesity and idiopathic intracranial hypertension. Diagnosis is both clinical and radiological. During the last three decades, surgical treatment has mostly shifted to endonasal endoscopic approach, which widely demonstrated to be more effective than invasive intracranial ones. Post-operative complications, long-term sequelae and hospital stay are strongly reduced thanks to endoscopic approach. The diagnosis and treatment of CSF leaks represent a difficult and challenge task. The main effort seems to be related to the precise localization of the leak. An accurate assessment of both predisposing factors and comorbidities is mandatory in case of spontaneous leaks. However, a clinical multidisciplinary evaluation as well as treatment, is essential to decrease the rate of failure of surgery. The presence of a dedicated instruments, the Skull Base Team, the knowledge of reconstructive materials and techniques represents a decisive result in therapeutical management even if for each patient an effective therapeutic algorithm can be obtained considering the correct leak detection and characteristics. In conclusion the strict teamwork with neurosurgeons, neuroradiologists, ophtalmologists will enable the development also of innovative biomaterials, which could spread and standardize multi-layer techniques, nowadays still related to surgeon preferences.

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Section: Diagnosismentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Trattamento delle fistole rinoliquorali: quando è richiesto un approccio chirurgico multidisciplinare al basicranio?

Galli

Morelli

Rigante

et al. 2021

Acta Otorhinolaryngol Ital

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“…As it is commercially available and due to FDA administration approval [ 28 ], we chose the DOTA ligand as the chelator for the copper-64 radionuclide in the formulation. In 2019, the first successful CSF leak detection with PET radionuclide cisternography using [ 64 Cu]Cu-DOTA was reported [ 31 ]. Herein, we describe in detail the radiopharmaceutical production of [ 64 Cu]Cu-DOTA in compliance with standards of good manufacturing practice (GMP) and its use in a clinical case, where PET RNC with [ 64 Cu]Cu-DOTA proved superior to conventional RNC with [ 111 In]In-DTPA.…”

Section: Introductionmentioning

confidence: 99%

Radionuclide Cisternography with [64Cu]Cu-DOTA

Greiser,

Groeber,

Weisheit

et al. 2023

Pharmaceuticals

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Radionuclide cisternography (RNC) is a method for conducting imaging of the cerebrospinal system and can be used to identify cerebrospinal fluid leaks. So far, RNC has commonly employed radiopharmaceutical agents suitable only for single-photon emission tomography techniques, which are thus lacking in terms of image resolution and can potentially lead to false-negative results. Therefore, [64Cu]Cu-DOTA was investigated as an alternative radiopharmaceutical for RNC, employing positron emission tomography (PET) instead of single-photon emission tomography. A formulation of [64Cu]Cu-DOTA was produced according to the guidelines for good manufacturing practice. The product met the requirements of agents suitable for intrathecal application. [64Cu]Cu-DOTA was administered to a patient and compared to the approved scintigraphic RNC agent, [111In]In-DTPA. While no cerebrospinal fluid leak was detected with [111In]In-DTPA, [64Cu]Cu-DOTA RNC exhibited a posterolateral leak between the vertebral bodies C1 and C2. Thus, in this patient, PET RNC with [64Cu]Cu-DOTA was superior to RNC with [111In]In-DTPA. Since radiopharmaceuticals have a very good safety profile regarding the occurrence of adverse events, PET RNC with [64Cu]Cu-DOTA may become an attractive alternative to scintigraphic methods, and also to computed tomography or magnetic resonance imaging, which often require contrast agents, causing adverse events to occur much more frequently.

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“…To date, RC is still commonly performed as planar scintigraphic imaging without taking advantage of state-of-the-art imaging like positron emission tomography (PET)/CT which offers improved sensitivity, spatial resolution, and quantification. In fact, CSF-PET was proposed 40 years ago using 68 Ga-EDTA (14), but has only rarely been applied in single cases (e.g., 64 Cu-DOTA) (18).…”

Section: Introductionmentioning

confidence: 99%

⁶⁸Ga-DOTA PET for Diagnosis of Spinal Cerebrospinal Fluid Leaks

Evangelou

Omrane²,

Thurow³

et al. 2022

J Nucl Med

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Spontaneous intracranial hypotension (SIH) due to spinal cerebrospinal fluid (CSF) leakage causes substantial disease burden. In many patients, the course is protracted and refractory to conservative treatment, requiring targeted therapy. We propose positron emission tomography (PET) of the CSF space with 68 Ga-DOTA as a state-of-the-art approach of radionuclide cisternography (RC) and validate its diagnostic value.Methods: Retrospective analysis of patients with suspected intracranial hypotension due to spinal CSF leaks who underwent whole-body PET/CT at 1, 3 and 5 hours after intrathecal lumbar injection of 68 Ga-DOTA.Two independent raters blinded to clinical data analyzed all scans by for direct and indirect RC signs of CSF leakage. Volume of interest analysis was performed to assess the biological half-life of the tracer in CSF space (T 1/2,biol ) and the ratio of decay-corrected activity in CSF space at 5 and 3 hours (R5/3; simplified marker of tracer clearance). Comprehensive stepwise neuroradiological work-up served as reference, which was additionally validated by surgical findings and follow-up.Results: Of 40 consecutive patients, 39 patients with a working diagnosis of intracranial hypotension due to a spinal CSF leak (n=31 spontaneous and n=8 post-interventional) could be analyzed. A spinal CSF leak was verified by the neuroradiological reference method in 18 of 39 patients. As the only direct and indirect diagnostic signs, extrathecal tracer accumulation at the cervicothoracic junction and lack of activity over the cerebral convexities (5h) showed a high diagnostic value for spinal CSF leaks (sensitivity/specificity: 67%/90% and 94%/67%, respectively). Their combination provided little improvement (71%/95%).

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High-Resolution PET Cisternography With 64Cu-DOTA for CSF Leak Detection

Cited by 8 publications

References 8 publications

Trattamento delle fistole rinoliquorali: quando è richiesto un approccio chirurgico multidisciplinare al basicranio?

Trattamento delle fistole rinoliquorali: quando è richiesto un approccio chirurgico multidisciplinare al basicranio?

Radionuclide Cisternography with [64Cu]Cu-DOTA

⁶⁸Ga-DOTA PET for Diagnosis of Spinal Cerebrospinal Fluid Leaks

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High-Resolution PET Cisternography With 64Cu-DOTA for CSF Leak Detection

Cited by 8 publications

References 8 publications

Trattamento delle fistole rinoliquorali: quando è richiesto un approccio chirurgico multidisciplinare al basicranio?

Trattamento delle fistole rinoliquorali: quando è richiesto un approccio chirurgico multidisciplinare al basicranio?

Radionuclide Cisternography with [64Cu]Cu-DOTA

68Ga-DOTA PET for Diagnosis of Spinal Cerebrospinal Fluid Leaks

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⁶⁸Ga-DOTA PET for Diagnosis of Spinal Cerebrospinal Fluid Leaks