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MRI cisternography (CSF Rhinorrhea) : Protocol and Planning

CSF Rhinorrhea

Cerebrospinal fluid (CSF) rhinorrhea occurs when there is a fistula between the dura and the skull base, leading to the discharge of CSF from the nose. This condition commonly arises following head trauma, such as fronto-basal skull fractures, as a result of intracranial surgery, or due to destructive lesions. A spinal fluid leak from the intracranial space to the nasal respiratory tract is potentially very serious because of the risk of an ascending infection, which could produce fulminant meningitis.

MRI Cisternography for CSF Rhinorrhea

MRI cisternography is a specialized imaging technique used to visualize cerebrospinal fluid (CSF) pathways and spaces within the brain and spinal cord. It is particularly valuable in diagnosing conditions like CSF rhinorrhea, where there is a leak of CSF from the intracranial space into the nasal cavity.

MRI Cisternography 3D SPACE Images

MRI cisternography (csf rhinorrhea) 3D space coronal image 2
MRI cisternography (csf rhinorrhea) 3D space coronal image 5
MRI cisternography (csf rhinorrhea) 3D space coronal image 6

indications for MRI cisternography

Contraindications

Patient preparation for MRI cisternography

Positioning for CSF Flow MRI

mri brain planning and positioning

Recommended MRI cisternography Protocols and Planning

Localiser

A three-plane localizer must be taken at the beginning to localize and plan the sequences. Localizers are usually less than 25 seconds and are T1-weighted low-resolution scans.

Brain MRI localiser image

T2 tse axial

Plan the axial slices on the sagittal plane and position the block parallel to the genu and splenium of the corpus callosum. Verify the planning block in the other two planes and ensure that an appropriate angle is maintained in the coronal plane, making it perpendicular to the line of the midline of the brain and the 4th ventricle. Ensure that the number of slices is sufficient to cover the entire brain from the vertex to the line of the foramen magnum.

mri brain protocol and planning of axial scans

Protocol Parameters of T2

TR

4000-5500

TE

100-120

SLICE

3MM

FLIP

130-150

PHASE

R>L

MATRIX

320X320

FOV

210-230

GAP

10%

NEX(AVRAGE)

2

T2 SPACE 3D small FOV coronal, 0.5 mm isotropic, with high TE.

Plan the coronal slices on the sagittal plane; angle the planning block perpendicular to the hard palate. Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane (perpendicular to the nasal septum). Slices must be sufficient to cover the sinus area from the nose vestibule to the brain stem.

MRI cisternography (csf rhinorrhea) planning and protocol of coronal SPACE sequence

Protocol Parameters of T2 SPACE 3D

TR

4000-6000

TE

200-300

SLICE

.5mm

FLIP

80

PHASE

R>L

MATRIX

256X256

FOV

160-170

GAP

20%

NEX(AVRAGE)

1

MRI cisternography (csf rhinorrhea) 3D space coronal image 2
MRI cisternography (csf rhinorrhea) 3D space coronal image 5
MRI cisternography (csf rhinorrhea) 3D space coronal image 6

T2 STIR coronal 2mm small FOV

Plan the coronal slices on the sagittal plane; angle the planning block perpendicular to the hard palate. Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane (perpendicular to the nasal septum). Slices must be sufficient to cover the entire sinuses from the tip of the nose to the brain stem.

MRI cisternography (csf rhinorrhea) planning and protocol of coronal STIR sequence

Parameters

TR

5000-6000

TE

110

FLIP

150

NEX

4

SLICE

2 MM

MATRIX

240X240

FOV

160-170

PHASE

R>L

GAP

10%

TI

150

MRI cisternography (csf rhinorrhea) STIR coronal image 1
MRI cisternography (csf rhinorrhea) STIR coronal image 2
MRI cisternography (csf rhinorrhea) STIR coronal image 4

T2 TSE coronal 2mm small FOV

Plan the coronal slices on the sagittal plane; angle the planning block perpendicular to the hard palate. Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane (perpendicular to the nasal septum). Slices must be sufficient to cover the entire sinuses from the tip of the nose to the brain stem.

MRI cisternography (csf rhinorrhea) planning and protocol of coronal STIR sequence

Parameters

TR

4000-5000

TE

100-120

SLICE

2MM

FLIP

130-150

PHASE

R>L

MATRIX

256X256

FOV

150-170

GAP

10%

NEX(AVRAGE)

2

MRI cisternography (csf rhinorrhea) T2 coronal image 3

T1 tse coronal 2 mm small FOV

Plan the coronal slices on the sagittal plane; angle the planning block perpendicular to the hard palate. Check the planning block in the other two planes. An appropriate angle must be given in the axial plane (perpendicular to the nasal septum). Slices must be sufficient to cover the entire sinuses from the tip of the nose to the brain stem.

MRI cisternography (csf rhinorrhea) planning and protocol of coronal STIR sequence

Parameters

TR

450-650

TE

15-25

SLICE

2 MM

FLIP

140

PHASE

R>L

MATRIX

256X256

FOV

160-170

GAP

10%

NEX(AVRAGE)

3

T2 TSE axial 2mm SFOV

Plan the axial slices on the sagittal plane and angle the planning block parallel to the hard palate. Check the planning block in the other two planes. An appropriate angle must be given in the coronal plane (perpendicular to the nasal septum). The slices must be sufficient to cover the entire sinuses, from the superior border of the frontal sinus down to the level of the upper lip.

MRI cisternography (csf rhinorrhea) planning and protocol of axial T2 sequence

Parameters

TR

4000-5000

TE

100-120

SLICE

2MM

FLIP

130-150

PHASE

R>L

MATRIX

256X256

FOV

150-170

GAP

10%

NEX(AVRAGE)

2

T2 tse sagittal 2mm SFOV

Plan the sagittal slices on the axial plane; angle the planning block parallel to the nasal septum. Check the planning block in the other two planes. An appropriate angle must be given in the coronal plane (parallel to the nasal septum). Slices must be sufficient to cover the entire sinuses from right to left.

MRI cisternography (csf rhinorrhea) planning and protocol of Sagittal T2 sequence

Parameters

TR

4000-5000

TE

100-120

SLICE

2MM

FLIP

130-150

PHASE

A>P

MATRIX

256X256

FOV

150-170

GAP

10%

NEX(AVRAGE)

2

For contrast enhancement scans

Use T1-weighted sequences (T1 tse DIXON) in both axial and coronal planes after the administration of IV gadolinium DTPA injection (copy the planning outlined above). The document below provides access to the recommended dosage of gadolinium DTPA injection as advised by the manufacturer.