Ecin Gaye, Oner A Yusuf, Tokgoz Nil, Ucar Murat, Aykol Sukru, Tali Turgut
Department of Radiology.
Acta Radiol. 2013 Jul;54(6):698-701. doi: 10.1177/0284185113478008. Epub 2013 Apr 30.
Endoscopic surgical approach is being more widely used in the treatment of cerebrospinal fluid (CSF) rhinorrhea. Accurate localization of CSF fistulas prior to surgery is essential in increasing the success of dural repair and in decreasing negative or recurrent explorations.
To evaluate and compare intrathecal contrast medium-enhanced magnetic resonance cisternography (CEMRC) with T2-weighted MR cisternography (T2MRC) in identifying the presence and site of CSF rhinorrhea.
Sixty patients with suspected CSF rhinorrhea underwent MR cisternography including intrathecally enhanced fat-suppressed T1WI in three orthogonal planes and T2WI in the coronal plane. Both set of images were reviewed by two blinded radiologists for the presence and location of CSF leakage. Imaging data were compared with surgical findings and/or beta-2 transferrin testing.
With surgery proven CSF leakage in 20 instances as reference, CEMRC detected 18 (90%), whereas T2MRC reported only 13 (65%) correctly. Overall, sensitivity, specificity, positive predictive value, and negative predictive value in detecting CSF fistulas were 92%, 80%, 76%, and 93% for CEMRC, and 56%, 77%, 64%, and 71% for T2MRC, respectively.
The minimally invasive CEMRC is an effective method with higher sensitivity and specificity than T2MRC in the evaluation of CSF fistulas.
内镜手术方法在脑脊液鼻漏的治疗中应用越来越广泛。术前准确确定脑脊液瘘的位置对于提高硬脑膜修复的成功率以及减少阴性或复发性探查至关重要。
评估并比较鞘内注射造影剂增强磁共振脑池造影（CEMRC）与T2加权磁共振脑池造影（T2MRC）在识别脑脊液鼻漏的存在及部位方面的效果。
60例疑似脑脊液鼻漏患者接受了磁共振脑池造影检查，包括在三个正交平面进行鞘内增强脂肪抑制T1加权成像以及在冠状面进行T2加权成像。两位不知情的放射科医生对两组图像进行了审查，以确定脑脊液漏的存在及位置。将影像数据与手术结果和/或β-2转铁蛋白检测结果进行比较。
以手术证实20例存在脑脊液漏为参照，CEMRC检测出18例（90%），而T2MRC仅正确报告了13例（65%）。总体而言，CEMRC检测脑脊液瘘的灵敏度、特异度、阳性预测值和阴性预测值分别为92%、80%、76%和93%，T2MRC分别为56%、77%、64%和71%。
微创的CEMRC是一种有效的方法，在评估脑脊液瘘方面比T2MRC具有更高的灵敏度和特异度。
