Reliability of multidetector CT in the diagnosis of cerebrospinal fluid rhinorrhea with operative correlation

Atta, Haisam; Seifeldein, Gehan S.; Almamoun, Momen; Imam, Hisham

doi:10.1016/j.ejrnm.2016.12.005

Cited by 3 publications

(5 citation statements)

References 21 publications

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“…Our results showed that the most common site of the bony defect is the cribriform plate (50%) which is in line with Atta et al [3], where 40% of their cases showed bone defects at cribriform plate, whereas Scholsem et al [10] found a high percentage of leaks through cribriform plate (87%).…”

Section: Discussionsupporting

confidence: 91%

“…It is related to disruption of the dura and arachnoid mater, leading to communication between the intracranial and nasal cavities [6] Imaging plays a remarkable role in preoperative workup through localizing the site of the leak and determining the accurate dimensions of the osteodural defect [7]. However, there is no imaging "gold standard" for diagnosis of such important entity reflecting the difficulty of this diagnosis [3].…”

Section: Discussionmentioning

confidence: 99%

“…The patients may be presented by a wide variety of symptoms including clear nasal discharge and headache or develop complications like meningitis, pneumocephalus or even brain abscess [3] that is why closing the defect, either endoscopic or surgical, is of paramount importance which in turn requires accurate localization of its site and measurement of its dimensions [2].…”

Section: Introductionmentioning

confidence: 99%

“…CSF rhinorrhea can be divided into active when continuous dripping is encountered or inactive when the dripping is intermittent [3].…”

Section: Introductionmentioning

confidence: 99%

“…Different imaging modalities including isotope scans, computed tomography (CT) and magnetic resonance (MR) imaging techniques have been employed to localize and characterize skull base defects that are believed to be responsible for CSF leakage. Yet, there is no gold standard imaging modality [3].…”

Section: Introductionmentioning

confidence: 99%

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CSF rhinorrhea: non-contrast CT, contrast-enhanced CT cisternography or combined?

Hablas

Ammar

Elnagar

2022

Egypt J Radiol Nucl Med

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Background Radiologic diagnosis of CSF leaks is challenging. We evaluated the diagnostic value of non-contrast CT and contrast-enhanced CT cisternography in identifying the presence of CSF rhinorrhea and site of leak as well as comparing them to surgical data and/or clinical follow-up. Results Fifty patients (20 males and 30 females) were included in our study with age ranging from 19 to 67 years. 76% of cases had spontaneous CSF rhinorrhea. Cribriform plate defect was the most common site of CSF leak, accounting for about 50% of cases. The highest sensitivity, specificity, PPV and NPV for diagnosis of CSF rhinorrhea were observed with the combined NCCT and CECTC with values 87%, 100%, 100% and 67%, respectively. Conclusion Accurate surgical planning and successful dural repair requires accurate localization of the dural and osseous defects. CT cisternography which already involves pre-cisternography non-contrast images holds great sensitivity in detection of the exact defect site together with confirmation of the CSF leak.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…CSF rhinorrhea can be divided into active when continuous dripping is encountered or inactive when the dripping is intermittent [3].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

CSF rhinorrhea: non-contrast CT, contrast-enhanced CT cisternography or combined?

Hablas

Ammar

Elnagar

2022

Egypt J Radiol Nucl Med

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Endoscopic Integrated Multipoint Laser System to Perform Quantitative Measurements for Anterior Skull Base Defects

Nuredini,

Parmar,

Hall

et al. 2024

Clinical Otolaryngology

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Diagnosis and Localization of Cerebrospinal Fluid Rhinorrhea: A Systematic Review

Xie

Zhou

Kachra

et al. 2021

Am J Rhinol�Allergy

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Background Cerebrospinal fluid (CSF) rhinorrhea results from abnormal communications between the subarachnoid and sinonasal spaces. Accurate preoperative diagnosis and localization are vital for positive clinical outcomes. However, the diagnosis and localization of CSF rhinorrhea remain suboptimal due to a lack of accurate understanding of test characteristics. Objective This systematic review aims to assess the diagnostic accuracy of various tests and imaging modalities for diagnosing and localizing CSF rhinorrhea. Methods A systematic review of the MEDLINE and EMBASE databases was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Our search identified 4039 articles—53 cohort studies and 24 case series describing 1622 patients were included. The studies were heterogeneous and had a wide range of sensitivities and specificities. Many specificities were incalculable due to a lack of true negative and false positive results, thus precluding a meta-analysis. Median sensitivities and specificities were calculated for cohort studies of the following investigations: high-resolution computed tomography (HRCT) 0.93/0.50 (sensitivity/specificity), magnetic resonance cisternography (MRC) 0.94/0.77, computed tomography cisternography (CTC) 0.95/1.00, radionuclide cisternography (RNC) 0.90/0.50, and contrast-enhanced magnetic resonance cisternography (CEMRC) 0.99/1.00, endoscopy 0.58/1.00, topical intranasal fluorescein (TIF) 1.00/incalculable, intrathecal fluorescein (ITF) 0.96/1.00. Case series were reviewed separately. Etiology and site-specific data were also analyzed. Conclusion MR cisternography is more accurate than high-resolution CT at diagnosing and localizing CSF rhinorrhea. CT cisternography, contrast-enhanced MR cisternography, and radionuclide cisternography have good diagnostic characteristics but are invasive. Intrathecal fluorescein shows promising data but has not been widely adopted for purely diagnostic use. Office endoscopy has limited data but does not sufficiently diagnose CSF rhinorrhea independently. These findings confirm with current guidelines and evidence.

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Reliability of multidetector CT in the diagnosis of cerebrospinal fluid rhinorrhea with operative correlation

Cited by 3 publications

References 21 publications

CSF rhinorrhea: non-contrast CT, contrast-enhanced CT cisternography or combined?

CSF rhinorrhea: non-contrast CT, contrast-enhanced CT cisternography or combined?

Endoscopic Integrated Multipoint Laser System to Perform Quantitative Measurements for Anterior Skull Base Defects

Diagnosis and Localization of Cerebrospinal Fluid Rhinorrhea: A Systematic Review

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