Douglas J Totten, Nicholas A Koontz, Hunter L Elms, Evan C Cumpston, William Schneider, Cody Whitted, Mark Tann, Kevin T Booth, Kristine M Mosier, Rick F Nelson
{"title":"鞘内钆增强磁共振脑池造影提高颅底脑脊液渗漏的检出率。","authors":"Douglas J Totten, Nicholas A Koontz, Hunter L Elms, Evan C Cumpston, William Schneider, Cody Whitted, Mark Tann, Kevin T Booth, Kristine M Mosier, Rick F Nelson","doi":"10.1097/MAO.0000000000004601","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy of contrast enhanced magnetic resonance cisternography (CE-MRC), computed tomography cisternography (CTC), and single-photon emission computed tomography (SPECT-CT) radionuclide cisternography (RNC) in detection of skull base cerebrospinal fluid (CSF) leaks.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>Adult patients with suspected anterior skull base (ASB) or lateral skull base (LSB) CSF leak who underwent CE-MRC, CTC, and/or SPECT-CT RNC to assess for CSF leak from 2018 to 2024.</p><p><strong>Main outcome measures: </strong>Evidence of CSF leak on single or multiple cisternogram types.</p><p><strong>Results: </strong>Fifty patients (74% female) had a mean (standard deviation) age of 50 (17) years and a median BMI of 34 (IQR, 28-42) kg/m2. Nineteen patients had a surgically or laboratory-confirmed CSF leak. Of these, 78% were spontaneous CSF leaks. There were no false-positive tests for any mode of cisternograms. CT cisternograms had a sensitivity of 53% (ASB: 86%, LSB: 33%) compared with a sensitivity of 90% (ASB: 100%, LSB: 86%) for CE-MR cisternograms and 67% (ASB: 100%, LSB: 33%) for SPECT-CT RN cisternograms.</p><p><strong>Conclusions: </strong>CE-MRC appears to be more sensitive than CTC and SPECT-CT RNC in detecting skull base CSF leaks, particularly in the lateral skull base. CE-MRC should be used when appropriate in combination with high-resolution CT to assess for CSF leaks when there is a high index of suspicion with inconclusive beta-2 transferrin testing.</p><p><strong>Level of evidence: </strong>4.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intrathecal Gadolinium-Enhanced MR Cisternography Improves the Detection of Skull Base CSF Leaks.\",\"authors\":\"Douglas J Totten, Nicholas A Koontz, Hunter L Elms, Evan C Cumpston, William Schneider, Cody Whitted, Mark Tann, Kevin T Booth, Kristine M Mosier, Rick F Nelson\",\"doi\":\"10.1097/MAO.0000000000004601\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To compare the efficacy of contrast enhanced magnetic resonance cisternography (CE-MRC), computed tomography cisternography (CTC), and single-photon emission computed tomography (SPECT-CT) radionuclide cisternography (RNC) in detection of skull base cerebrospinal fluid (CSF) leaks.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>Adult patients with suspected anterior skull base (ASB) or lateral skull base (LSB) CSF leak who underwent CE-MRC, CTC, and/or SPECT-CT RNC to assess for CSF leak from 2018 to 2024.</p><p><strong>Main outcome measures: </strong>Evidence of CSF leak on single or multiple cisternogram types.</p><p><strong>Results: </strong>Fifty patients (74% female) had a mean (standard deviation) age of 50 (17) years and a median BMI of 34 (IQR, 28-42) kg/m2. Nineteen patients had a surgically or laboratory-confirmed CSF leak. Of these, 78% were spontaneous CSF leaks. There were no false-positive tests for any mode of cisternograms. CT cisternograms had a sensitivity of 53% (ASB: 86%, LSB: 33%) compared with a sensitivity of 90% (ASB: 100%, LSB: 86%) for CE-MR cisternograms and 67% (ASB: 100%, LSB: 33%) for SPECT-CT RN cisternograms.</p><p><strong>Conclusions: </strong>CE-MRC appears to be more sensitive than CTC and SPECT-CT RNC in detecting skull base CSF leaks, particularly in the lateral skull base. CE-MRC should be used when appropriate in combination with high-resolution CT to assess for CSF leaks when there is a high index of suspicion with inconclusive beta-2 transferrin testing.</p><p><strong>Level of evidence: </strong>4.</p>\",\"PeriodicalId\":19732,\"journal\":{\"name\":\"Otology & Neurotology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-07-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Otology & Neurotology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/MAO.0000000000004601\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Otology & Neurotology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MAO.0000000000004601","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Intrathecal Gadolinium-Enhanced MR Cisternography Improves the Detection of Skull Base CSF Leaks.
Objective: To compare the efficacy of contrast enhanced magnetic resonance cisternography (CE-MRC), computed tomography cisternography (CTC), and single-photon emission computed tomography (SPECT-CT) radionuclide cisternography (RNC) in detection of skull base cerebrospinal fluid (CSF) leaks.
Study design: Retrospective cohort study.
Setting: Tertiary referral center.
Patients: Adult patients with suspected anterior skull base (ASB) or lateral skull base (LSB) CSF leak who underwent CE-MRC, CTC, and/or SPECT-CT RNC to assess for CSF leak from 2018 to 2024.
Main outcome measures: Evidence of CSF leak on single or multiple cisternogram types.
Results: Fifty patients (74% female) had a mean (standard deviation) age of 50 (17) years and a median BMI of 34 (IQR, 28-42) kg/m2. Nineteen patients had a surgically or laboratory-confirmed CSF leak. Of these, 78% were spontaneous CSF leaks. There were no false-positive tests for any mode of cisternograms. CT cisternograms had a sensitivity of 53% (ASB: 86%, LSB: 33%) compared with a sensitivity of 90% (ASB: 100%, LSB: 86%) for CE-MR cisternograms and 67% (ASB: 100%, LSB: 33%) for SPECT-CT RN cisternograms.
Conclusions: CE-MRC appears to be more sensitive than CTC and SPECT-CT RNC in detecting skull base CSF leaks, particularly in the lateral skull base. CE-MRC should be used when appropriate in combination with high-resolution CT to assess for CSF leaks when there is a high index of suspicion with inconclusive beta-2 transferrin testing.
期刊介绍：
Otology & Neurotology publishes original articles relating to both clinical and basic science aspects of otology, neurotology, and cranial base surgery. As the foremost journal in its field, it has become the favored place for publishing the best of new science relating to the human ear and its diseases. The broadly international character of its contributing authors, editorial board, and readership provides the Journal its decidedly global perspective.
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