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Isotopic Scintigraphy Coupled With Computed Tomography for the Investigation of Intrathecal Baclofen Device Malfunction

Published:November 12, 2015DOI:https://doi.org/10.1016/j.apmr.2015.10.101

      Abstract

      Objective

      To assess the potential use of indium-111 diethylenetriamine pentaacetic acid (111In-DTPA) scintigraphy coupled with computed tomography (CT) for the investigation of intrathecal baclofen (ITB) device malfunction.

      Design

      Retrospective study of a case series of patients.

      Setting

      Neurosurgical and physical and rehabilitation medicine departments.

      Participants

      Patients (N=7) with reduced ITB effectiveness in whom prior conventional radiographs were inconclusive.

      Intervention

      Nine 111In-DTPA scintigraphic studies and 8 CT scans. Planar acquisitions were followed by tomoscintigraphy combined with CT.

      Main Outcome Measure

      Progression of the radiotracer in the pump, catheters, and in the subarachnoid space.

      Results

      In 7 cases, scintigraphy coupled with CT showed leakage behind the pump, lack of activity outside the pump reservoir, abrupt interruption of activity in the catheter, or abnormal distribution of the radiotracer, thus demonstrating that the drug did not reach its target. Surgical revision confirmed these findings in 5 cases. In 1 case, combined imagery ruled out device dysfunction. In the remaining case, only planar acquisitions were performed, showing correct diffusion of the radiotracer.

      Conclusions

      The combination of scintigraphy and CT provides simultaneous functional and anatomic imagery of the device. The slow infusion of the radioisotope mimics the diffusion of baclofen, and this could be a useful method to explore intrathecal device malfunction. Further studies are required to compare scintigraphy coupled with CT, to radiopaque injection followed by fluoroscopy or CT.

      Keywords

      List of abbreviations:

      CT (computed tomography), 111In-DTPA (indium-111 diethylenetriamine pentaacetic acid), ITB (intrathecal baclofen), SPECT (single-photon emission computed tomography)
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      Linked Article

      • Isotopic Scintigraphy Coupled With Computed Tomography for the Investigation of Intrathecal Baclofen Device Malfunction
        Archives of Physical Medicine and RehabilitationVol. 97Issue 9
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          With great interest we read the article of Frémondière et al1 and were pleased that your journal offered the opportunity to publish this article. Rehabilitation physicians are often involved in the aftercare of intrathecal baclofen (ITB) devices, and for this, their knowledge on troubleshooting is a prerequisite. In our experience, because sophisticated imaging examinations are not often performed, patients are often unjustifiably regarded as tolerant to ITB treatment. As a referral center for ITB troubleshooting, we have used indium-111 diethylenetriamine pentaacetic acid scintigraphy in treatment failures for many years.
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