Myelogram and Cisternogram

Myelogram & Cisternogram Overview

For patients with suspected cerebrospinal fluid (CSF) flow abnormalities, specialized imaging tests such as a myelogram or cisternogram may be recommended. These procedures provide critical insight into conditions where CSF becomes trapped, forms cysts, or leaks from the brain and spinal cord.

By injecting a contrast dye or radioactive tracer directly into the CSF space—usually through a lumbar puncture—physicians can closely evaluate how fluid circulates through the central nervous system. This detailed imaging helps diagnose complex disorders such as arachnoid cysts, Chiari malformations, intracranial hypotension, and CSF leaks, allowing for accurate treatment planning and improved patient outcomes.

What is a Myelogram and Cisternogram?

A myelogram or cisternogram is an invasive imaging test designed to track CSF circulation and identify abnormalities. These procedures can reveal:

• Trapped fluid in pockets, such as arachnoid cysts
• Leakage of CSF outside the central nervous system (CNS)
• Blockages or disruptions in fluid flow around the brain and spinal cord

Knowing the Symptoms

When symptoms are thought to be related to the spine, a myelogram is prescribed. This images the CSF fluid along the entire spinal cord and nerve roots into the sacrum (pelvis). Conditions where this may be helpful include intracranial hypotension (low brain pressure) due to spontaneous CSF leakage, spinal arachnoid cysts or Chiari malformations.

When symptoms are likely cranial in origin, a cisternogram is prescribed. In addition to imaging the spinal cord, this shows CSF fluid flow in the brain as well. Indications for this test may include nasal CSF leakage (CSF rhinorrhea) or intracranial arachnoid cysts.

Dyes and Tracers

CT myelograms/cisternograms require injection of contrast dye and is helpful to show high-resolution anatomy of the fluid with relation to the bony and nervous structures.

Nuclear myelograms/cisternograms require injection of a radioactive tracer and is helpful to demonstrate subtle leaks. It is more sensitive than CT myelography. In addition, gauze (pledgets) can be placed at potential sites of leakage (e.g. in the nose) and the radiation can be measured to identify occult (hidden) leaks.

There is a small risk of allergic reaction to the dyes and tracers used.