Lu Xing, Zhai Xiang, Li Haiyan, Yang Xiao, Hang Wei, Liu Gang
Department of Otolaryngology Head and Neck Surgery，Tianjin Huanhu Hospital，Tianjin，300350，China.
Department of Radiology，Tianjin Huanhu Hospital.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Nov;36(11):859-864. doi: 10.13201/j.issn.2096-7993.2022.11.010.
To evaluate the accuracy of preoperative computed tomographic cisternography（CTC） and magnetic resonance hydrography（MRH）in the diagnosis of cerebrospinal fluid（CSF） rhinorrhea. Retrospective analysis was made on the data of 38 patients diagnosed as cerebrospinal rhinorrhea who completed preoperative HRCT, CTC and MRH examinations in the Department of Otolaryngology Head and Neck Surgery of Tianjin Huanhu Hospital from October 2016 to January 2022. The diagnostic accuracy of preoperative imaging examinations was compared according to the leak location found during operation. Among all the 38 cases with CSF rhinorrhea, the detection rates of HRCT, CTC, and cranial MRH were 31.58%, 89.47%, and 60.53%, respectively. The accuracy of CTC was significantlyhigher than that of MRH （ =8.49, =0.007）, and the accuracy of MRH was significantly higher than that of HRCT （=6.41, =0.01）. Subgroup analyses were performed according to the precise positioning of cerebrospinal fluid rhinorrhea leakage. In patients with cerebrospinal fluid rhinorrhea located in ethmoid sinus, the accuracy of CTC（80.95% vs. 14.29%，<0.01）and MRH（52.38% vs. 14.29%，=0.02）were significantly higher than that of HRCT, but the accuracy but the difference between CTC and MRH between CTC and MRH was not statistically significant （=0.10）. The accuracy of CTC was significantly higher than that of MRH （100.00% vs. 61.54%, =0.04） and HRCT （100.00% vs. 53.85%, <0.01） in patients with CSF rhinorrhea located in sphenoid sinus. However, there was no significant difference in the accuracy between MRH and HRCT （ =1.00）. However, There was no significant difference in the accuracy of CTC, MRH and HRCT in patients with cerebrospinal fluid rhinorrhea located in frontal sinus. The accuracy of CTC and MRH was 84.62% and 57.69% respectively in 26 patients who failed to detect a CSF rhinorrhea by HRCT, and the difference was not statistically significant（=4.59, =0.06）. The comprehensive application of the multiple imaging methods has important guiding significance for the accurate treatment and prognosis evaluation. CTC and MRH could improve the accuracy of the localization diagnosis of cerebrospinal fluid rhinorrhea.
评估术前计算机断层扫描脑池造影（CTC）和磁共振水成像（MRH）在诊断脑脊液鼻漏中的准确性。回顾性分析2016年10月至2022年1月在天津环湖医院耳鼻咽喉头颈外科完成术前高分辨率计算机断层扫描（HRCT）、CTC和MRH检查的38例诊断为脑脊液鼻漏患者的数据。根据手术中发现的漏口位置比较术前影像检查的诊断准确性。在所有38例脑脊液鼻漏病例中，HRCT、CTC和头颅MRH的检出率分别为31.58%、89.47%和60.53%。CTC的准确性显著高于MRH（χ² = 8.49，P = 0.007），MRH的准确性显著高于HRCT（χ² = 6.41，P = 0.01）。根据脑脊液鼻漏漏口的精确定位进行亚组分析。在筛窦脑脊液鼻漏患者中，CTC（80.95%对14.29%，P < 0.01）和MRH（52.38%对14.29%，P = 0.02）的准确性显著高于HRCT，但CTC与MRH之间的差异无统计学意义（χ² = 0.10）。在蝶窦脑脊液鼻漏患者中，CTC的准确性显著高于MRH（100.00%对61.54%，P = 0.04）和HRCT（100.00%对53.85%，P < 0.01）。然而，MRH与HRCT之间的准确性无显著差异（χ² = 1.00）。然而，在前额窦脑脊液鼻漏患者中，CTC、MRH和HRCT的准确性无显著差异。在26例HRCT未检测到脑脊液鼻漏的患者中，CTC和MRH的准确性分别为84.62%和57.69%，差异无统计学意义（χ² = 4.59，P = 0.06）。多种影像方法的综合应用对准确治疗和预后评估具有重要指导意义。CTC和MRH可提高脑脊液鼻漏定位诊断的准确性。
