Dural Injury Revealed by 64Cu-DOTA PET/CT Cisternography and Intraoperative Detection of a Cholesteatoma After a Temporal Bone Gunshot Injury

A 50-year-old man with a history of a gunshot wound to the skull base in 1997 presented with new secretion from a retroauricular skin defect and clinical signs of a cerebrospinal fluid (CSF) leak. MRI was contraindicated due to retained metallic foreign bodies. [64Cu]Cu-DOTA PET/CT cisternography revealed progressive extravasation of CSF tracer from the posterior fossa toward a mastoid defect, consistent with a CSF leak, but no fistula to the skin. Intraoperative findings confirmed the leak and identified a cholesteatoma within the bullet tract. This case illustrates the complexity of temporal bone gunshot injuries and highlights the diagnostic utility of PET/CT cisternography in detecting CSF leaks.