Kim Do Hyun, Kim Sung Won, Kim So-Hyun, Jung Jae Hoon, Hwang Se Hwan
Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Int Forum Allergy Rhinol. 2022 Jun;12(6):828-837. doi: 10.1002/alr.22932. Epub 2022 Jan 5.
Our aim in this study was to determine the usefulness of diagnosis by imaging studies for the localization of cerebrospinal fluid (CSF) rhinorrhea.
PubMed, SCOPUS, Embase, Web of Science, and Cochrane Library databases were searched up to July 2021. True and false positive and negative data were collected along with the characteristics of each study. Methodologic quality was assessed using the QADAS-2 tool.
Sixteen studies involving 472 patients were included. The diagnostic odds ratio (DOR) of imaging studies was 13.6195 (95% confidence interval [CI], 7.4756-24.8129; I = 28.1%). The area under the summary receiver-operating characteristic curve was 0.712. Sensitivity, specificity, negative predictive value, and positive predictive value were 0.8507 (0.7773-0.9029), 72.1%; 0.7827 (0.6865-0.8556), 26.8%; 0.5828 (0.4398-0.7132), 67.4%; and 0.9407 (0.8935-0.9678), 59.1%, respectively. In the subgroup analysis, there were significant differences for sensitivity (computed tomography [CT], 0.7421; computed tomography cisternography [CTC], 0.8872; magnetic resonance imaging [MRI], 0.8365; magnetic resonance cisternography [MRC], 0.8565; intrathecal gadolinium magnetic resonance cisternography [GaMRC], and 0.9307; radionuclide cisteronography [RNC], 0.7097; p = 0.0481) and for negative predictive value among imaging modalities (CT, 0.3028; CTC, 0.4848; MRI, 0.4658; MRC, 0.7465; GaMRC, 0.8611; and RNC, 0.5263; p = 0.0046). There were no significant differences among imaging modalities for specificity, positive predictive value, or DOR (p > 0.05).
Imaging studies can be used in the diagnosis of CSF rhinorrhea. Gadolinium magnetic resonance cisternography showed the highest diagnostic accuracy. MRC showed fair diagnostic accuracy without intrathecal injection.
本研究的目的是确定影像学检查对脑脊液鼻漏定位诊断的实用性。
检索截至2021年7月的PubMed、SCOPUS、Embase、Web of Science和Cochrane图书馆数据库。收集真阳性、假阳性、真阴性和假阴性数据以及每项研究的特征。使用QADAS-2工具评估方法学质量。
纳入16项研究，共472例患者。影像学检查的诊断比值比（DOR）为13.6195（95%置信区间[CI]，7.4756 - 24.8129；I² = 28.1%）。汇总受试者工作特征曲线下面积为0.712。敏感性、特异性、阴性预测值和阳性预测值分别为0.8507（0.7773 - 0.9029），72.1%；0.7827（0.6865 - 0.8556），26.8%；0.5828（0.4398 - 0.7132），67.4%；和0.9407（0.8935 - 0.9678），59.1%。在亚组分析中，不同影像学检查方法在敏感性（计算机断层扫描[CT]，0.7421；计算机断层扫描脑池造影[CTC]，0.8872；磁共振成像[MRI]，0.8365；磁共振脑池造影[MRC]，0.8565；鞘内钆增强磁共振脑池造影[GaMRC]，0.9307；放射性核素脑池造影[RNC]，0.7097；p = 0.0481）以及阴性预测值方面存在显著差异（CT，0.3028；CTC，0.4848；MRI，0.4658；MRC，0.7465；GaMRC，0.8611；RNC，0.5263；p = 0.0046）。不同影像学检查方法在特异性、阳性预测值或DOR方面无显著差异（p > 0.05）。
影像学检查可用于脑脊液鼻漏的诊断。钆增强磁共振脑池造影显示出最高的诊断准确性。MRC在无需鞘内注射的情况下显示出较好的诊断准确性。
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