title: T2-weighted vs. intrathecal contrast-enhanced MR cisternography in the evaluation of CSF rhinorrhea.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The minimally invasive CEMRC is an effective method with higher sensitivity and specificity than T2MRC in the evaluation of CSF fistulas.
authors.affiliation: Department of Radiology.
authors.forename: Gaye
authors.initials: G
authors.lastname: Ecin
authors.forename: A Yusuf
authors.initials: AY
authors.lastname: Oner
authors.forename: Nil
authors.initials: N
authors.lastname: Tokgoz
authors.forename: Murat
authors.initials: M
authors.lastname: Ucar
authors.forename: Sukru
authors.initials: S
authors.lastname: Aykol
authors.forename: Turgut
authors.initials: T
authors.lastname: Tali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis* / Q000601:surgery; D003287:Contrast Media; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014168:Transferrin / Q000032:analysis
chemical_list: D003287:Contrast Media; D014168:Transferrin
keywords: CNS; CSF leakage; MR imaging; contrast medium