Reiche Werner, Komenda Yvonne, Schick Bernhard, Grunwald Iris, Steudel Wolf-Ingo, Reith Wolfgang
Department for Neuradiology, Radiologic Clinic, Centre for Skull Base Surgery, Saarland University Clinic, Homburg/Saar, Germany.
Eur Radiol. 2002 Dec;12(12):2943-9. doi: 10.1007/s00330-002-1606-9. Epub 2002 Aug 9.
The purpose of this study was to establish and to evaluate MR cisternography after intrathecal Gd-DTPA administration to detect rhinobasal cerebrospinal fluid (CSF) fistulae in patients with suspected CSF rhinorrhoea. Ten patients with suspected CSF rhinorrhoea were examined. The MR cisternography included the following investigation steps: acquisition of nonenhanced fat-suppressed T1-weighted spin-echo (SE) scans of the skull base and the paranasal sinuses, lumbar puncture with administration of 1 ml Gd-DTPA solute with 4 ml NaCl and performance of MR cisternography with the same fat-suppressed T1-weighted sequences as used initially. In 10 patients with suspected CSF rhinorrhoea Gd-DTPA enhanced MR cisternography detected 5 CSF fistulae. In 3 of 5 CSF leaks were located in the cribriform plate and in 2 of 5 sphenoidal. Whereas 4 of these depicted leaks were confirmed surgically, in 1 case the CSF fistula closed spontaneously. In another case, CSF leakage after severe head injury was clinically highly suspected but ceased prior to MR cisternography with inability to detect the temporary fistula. In the remaining 4 patients with serous rhinorrhoea MR cisternography did not provide any evidences for CSF fistulae. Intrathecal Gd-DTPA injection was tolerated excellently. Clinical and EEG examinations showed no gross behavioural or neurological disturbances and no seizure activity, respectively. The MR cisternography after intrathecal administration of Gd-DTPA represents a safe, promising and minimally invasive method for detection of CSF fistulae. This MR investigation provides excellent depiction of CSF spaces and pinpoints CSF fistulae.
本研究的目的是建立并评估鞘内注射钆喷酸葡胺（Gd-DTPA）后的磁共振脑池造影，以检测疑似脑脊液鼻漏患者的鼻基底脑脊液（CSF）瘘。对10例疑似脑脊液鼻漏的患者进行了检查。磁共振脑池造影包括以下检查步骤：获取颅底和鼻窦的非增强脂肪抑制T1加权自旋回波（SE）扫描图像，腰椎穿刺并注射1 ml Gd-DTPA溶质与4 ml氯化钠，然后用与最初相同的脂肪抑制T1加权序列进行磁共振脑池造影。在10例疑似脑脊液鼻漏的患者中，Gd-DTPA增强磁共振脑池造影检测到5例脑脊液瘘。5例脑脊液漏中，3例位于筛板，2例位于蝶窦。其中4例显示的漏口经手术证实，1例脑脊液瘘自发闭合。在另一例中，严重颅脑损伤后的脑脊液漏在临床上高度怀疑，但在磁共振脑池造影前漏液停止，未能检测到临时瘘口。其余4例浆液性鼻漏患者的磁共振脑池造影未发现脑脊液瘘的任何证据。鞘内注射Gd-DTPA耐受性良好。临床和脑电图检查分别未显示明显的行为或神经功能障碍，也未发现癫痫活动。鞘内注射Gd-DTPA后的磁共振脑池造影是一种安全、有前景且微创的检测脑脊液瘘的方法。这种磁共振检查能很好地显示脑脊液间隙并精确指出脑脊液瘘。
