Localization of cerebrospinal fluid leaks by gadolinium-enhanced magnetic resonance cisternography: a 5-year single-center experience.
OBJECTIVE
Intrathecal gadolinium (Gd)-enhanced magnetic resonance (MR) cisternography is a newly introduced imaging method. Two main objectives of this study were to investigate the sensitivity of Gd-enhanced MR cisternography for presurgical localization of cerebrospinal fluid (CSF) leaks in patients with CSF rhinorrhea and to study the potential long-term adverse effects of intrathecal Gd application.


METHODS
Fifty-one patients (19 women; mean age, 36.2 yr) with CSF rhinorrhea were included in the study. A total of 0.5 ml of Gd was injected into the lumbar subarachnoid space. T1-weighted MR cisternographic images were obtained to detect CSF leakage. The patient's neurological states and vital signs were recorded for the first 24 hours after the procedure. Neurological evaluations were repeated 1, 3, and 12 months after the procedure. The patients were followed for at least 3 years with annual neurological examinations.


RESULTS
Gd-enhanced MR cisternography demonstrated CSF leaks in 43 of the 51 patients. The sensitivity of Gd-enhanced MR cisternography for localization of CSF leaks was 84%. Forty-four patients underwent surgery to repair dural tears. Surgical findings confirmed the results of Gd-enhanced cisternography in 43 of the 44 patients who underwent surgery (98%). Eight patients with negative Gd-enhanced MR cisternography had no active rhinorrhea at the time of procedure, and seven of them did not need surgery. None of the patients developed an acute adverse reaction that could be attributed to the procedure. None of the patients developed any neurological symptoms or signs caused by intrathecal Gd injection during a mean follow-up period of 4.12 years.


CONCLUSIONS
Gd-enhanced MR cisternography is a sensitive and safe imaging method for detection of CSF leaks in patients with rhinorrhea.
Aydin
Kubilay
K
Department of Neuroradiology, Istanbul Medical School, Istanbul University, Istanbul, Turkey. dr.aydink@superonline.com
Terzibasioglu
Ege
E
Sencer
Serra
S
Sencer
Altay
A
Suoglu
Yusufhan
Y
Karasu
Aykut
A
Kiris
Talat
T
Turantan
M Inan
MI
D000328:Adult; D003287:Contrast Media; D005260:Female; D005682:Gadolinium / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007278:Injections, Spinal; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009192:Myelography / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013353:Subdural Effusion / Q000175:diagnosis*
D003287:Contrast Media; D005682:Gadolinium