[CSF dynamics evaluated by metrizamide CT cisternography (author's transl)].
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Biomedical subjects
Publications and source records attributed to Y Takasato.
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An analysis of metrizamide computed tomography (CT) cisternographic findings in cases of communicating hydrocephalus has been carried out. Serial observations of the density in the periventricular area in 19 cases with metrizamide ventricular reflux have revealed the following different patterns: (a) precontrast periventricular hypodensity diminishing after CT cisternography and possibly indicating transependymal metrizamide migration (two cases); (b) periventricular hypodensity unchanged (two cases); (c) minimal periventricular hypodensity with slight rise in its attenuation values after ventricular metrizamide reflux (four cases); and (d) no periventricular hypodensity and no change after reflux (six cases). Our preliminary experience indicates that the presence of periventricular hypodensity with an increase in its attenuation values following ventricular reflux of metrizamide is possibly a criterion that may be used in favor of a cerebrospinal fluid shunting operation.
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We have studied the diagnostic value of computed tomography with metrizamide CSF enhancement in 37 infants. According to the method of injection, we called CT cisternography, CT ventriculography and CT cystography. These methods were useful for the morphologic and dynamic evaluation of the CSF pathways. We used them especially for the evaluation of hydrocephalus, skull base tumor, infantile subdural hematoma and its allied diseases, or congenital cystic lesion such as Dandy-Walker syndrome. The side effects in children are much less than those in adults.
Metrizamide CT cisternography (CTC) was performed for the evaluation of CSF dynamics and the diagnosis of skull-base tumors. Results of CTC in 52 cases examined for the study of CSF dynamics correlated well with those of isotope cisternography. However, the degree and duration of ventricular stasis of metrizamide and its transition into a periventricular low-density area in hydrocephalus were recognized more accurately in CTC. Twenty out of 23 cases with suspected skull-base tumor were diagnosed as positive and confirmed by operation. CTC was especially useful in parasellar, CP angle, and other posterior fossa tumors.
Delayed enhanced CT was performed in 53 cases and these findings are compared with those of delayed radioisotope scan and with operative and histopathologic findings. We have classified the results of enhancement into four types as follows: (1) immediate enhancement pattern due to rich vascular bed, typical in meningiomas; (2) delayed enhancement pattern due to exudation, often seen in cystic astrocytomas; (3) intermediate sustained pattern due to both mechanisms in glioblastoma multiforme; (4) no enhancement pattern as in diffuse astrocytomas. The results of delayed enhanced CT correlated well with those of radioisotope scan.
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