Stone J A, Castillo M, Neelon B, Mukherji S K
Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, USA.
AJNR Am J Neuroradiol. 1999 Apr;20(4):706-12.
Radiologic evaluation of CSF leaks is a diagnostic challenge that often involves multiple imaging studies with the associated expense and patient discomfort. We evaluated the use of screening noncontrast high-resolution CT in identifying the presence and site of CSF rhinorrhea and otorrhea and compared it with contrast-enhanced CT cisternography and radionuclide cisternography.
We retrospectively reviewed the imaging studies and medical records of all patients who were evaluated for CSF leak during a 7-year period. Forty-two patients with rhinorrhea and/or otorrhea underwent high-resolution CT of the face or temporal bone and then had CT cisternography and radionuclide cisternography via lumbar puncture. The results of the three studies were compared and correlated with the surgical findings in 21 patients.
High-resolution CT showed bone defects in 30 of 42 patients (71%) with CSF leak. High-resolution, radionuclide cisternography and CT cisternography did not show bone defects or CSF leak for 12 patients (29%) who had clinical evidence of CSF leak. Among the 30 patients with bone defects, 20 (66%) had positive results of their radionuclide cisternography and/or CT cisternography. For the 21 patients who underwent surgical exploration and repair, intraoperative findings correlated with the defects revealed by high-resolution CT in all cases. High-resolution CT identified significantly more patients with CSF leak than did radionuclide cisternography and CT cisternography, with a moderate degree of agreement.
Noncontrast high-resolution CT showed a defect in 70% of the patients with CSF leak. No radionuclide cisternography or CT cisternography study produced positive results without previous visualization of a defect on high-resolution CT. CT cisternography and radionuclide cisternography may be reserved for patients in whom initial high-resolution CT does not identify a bone defect or for patients with multiple fractures or postoperative defects.
脑脊液漏的放射学评估是一项诊断挑战，通常需要进行多项影像学检查，这会带来相关费用以及患者不适。我们评估了采用非增强高分辨率CT筛查来确定脑脊液鼻漏和耳漏的存在及部位，并将其与增强CT脑池造影和放射性核素脑池造影进行比较。
我们回顾性分析了7年间所有接受脑脊液漏评估患者的影像学检查和病历资料。42例有鼻漏和/或耳漏的患者接受了面部或颞骨的高分辨率CT检查，随后通过腰椎穿刺进行CT脑池造影和放射性核素脑池造影。将这三项检查的结果进行比较，并与21例患者的手术结果相关联。
42例脑脊液漏患者中，30例（71%）在高分辨率CT上显示有骨缺损。12例（29%）有脑脊液漏临床证据的患者，高分辨率CT、放射性核素脑池造影和CT脑池造影均未显示骨缺损或脑脊液漏。在30例有骨缺损的患者中，20例（66%）放射性核素脑池造影和/或CT脑池造影结果为阳性。对于21例接受手术探查和修复的患者，术中所见在所有病例中均与高分辨率CT显示的缺损相符。高分辨率CT发现脑脊液漏患者的数量明显多于放射性核素脑池造影和CT脑池造影，一致性程度为中等。
非增强高分辨率CT显示70%的脑脊液漏患者存在缺损。如果高分辨率CT之前未显示缺损，放射性核素脑池造影或CT脑池造影检查均不会得出阳性结果。CT脑池造影和放射性核素脑池造影可保留用于初始高分辨率CT未发现骨缺损的患者或有多处骨折或术后缺损的患者。
