Scintigraphic Evaluation of Intrathecal Infusion Systems: Selection of Patients for Surgical or Medical Management

The Polyanalgesic Consensus Conference (PACC): Recommendations for Intrathecal Drug Delivery: Guidance for Improving Safety and Mitigating Risks

“…Typically, the radioisotope is injected in the pump chamber and the radioactivity is monitored over 72 hours or more. If the isotope distributes in the spinal canal up to the basal cistern, the system is deemed functional . If the radioactivity is interrupted or accumulates along the catheter path, then catheter kink or leak is inferred.…”

Imaging Evaluation of Intrathecal Baclofen Pump-Catheter Systems

“…111 In DTPA is typically the preferred radiopharmaceutical due to its long half-life, which allows radioactivity to be monitored for Յ7 days as it travels through the catheter and into the subarachnoid space. 38 111 In DTPA is injected at a dose of 0.5-0.6 mCi into the reservoir without interrupting the delivery of baclofen, 38,42,43 or the reservoir can be emptied and refilled with radiopharmaceutical solution. 37 The ideal methodologic approach for scintigraphic evaluation of suspected ITB pump malfunction still remains relatively undefined, as do the normal flow patterns and diagnostic criteria for abnormal study findings.…”

“…37 The ideal methodologic approach for scintigraphic evaluation of suspected ITB pump malfunction still remains relatively undefined, as do the normal flow patterns and diagnostic criteria for abnormal study findings. 38 In a series of 23 studies on 19 patients, Stinchon et al 43 defined a normally functioning pump as one for which radioactivity was observed in the subarachnoid space by 72 hours. Lack of radioactivity distal to the pump reservoir suggested mechanical failure or disruption in the pump-catheter connection and indicated the need for a simple pump rotor test if it had not already been performed.…”

“…34,[42][43][44] As with some of the other techniques of ITB pump evaluation, scintigraphy has limited sensitivity for identifying the exact cause of system failure. Specifically, scintigraphy poorly differentiates intrinsic pump malfunction from high-grade obstruction blocking egress of baclofen from the pump, poorly delineates the specific causes of catheter obstruction, and poorly delineates catheter microfractures.…”

“…Specifically, scintigraphy poorly differentiates intrinsic pump malfunction from high-grade obstruction blocking egress of baclofen from the pump, poorly delineates the specific causes of catheter obstruction, and poorly delineates catheter microfractures. 43 …”