To evaluate the role of Intrathecal Iohexol-enhanced Mr Cisternography in detecting CSF Rhinorrhea with correlation to Ct Cisternography

Abstract

Background: Cerebrospinal fluid (CSF) leak occurs when there is a bony and dural defect at the skull base, with direct communication of the subarachnoid space to the extra cranial space, usually a paranasal sinus. Recognition of the leak site and source and appropriate treatment are necessary to avoid rhinorrhea or otorrhea, low-pressure headaches, and meningitis, known complications of CSF leak.Aims & Objectives: To Evaluate the role of MR Cisternography in detecting CSF Rhinorrhea with correlation to CT Cisternography. To aid in identifying defects for timely management of a treatable disorder.Materials & Methodology: The study was conducted for eight months in patients referred to the Department of Radiology at Bapuji Hospital, Davangere. MR and CT Cisternography were performed on patients presenting with persistent clear nasal discharge, and head trauma with symptoms of postural headache.MRI brain protocol was performed T23D, – Axial & Coronal, FLAIR axial, DWI, contrast-enhanced sequence with CISS and T2 fat suppression using fast spin-echo sequences. 64 Slice GE CT Scanner was used allowing Trendelenburg position.Results: We observed objective CSF leakage in 20 patients (80%). 11 cases revealed a defect in the cribriform plate with an active leak along the lamina papyracea (44%). 6 cases revealed a defect in the sphenoid bone; 2 in the greater wing of the sphenoid bone with downward herniation of meninges and adjacent brain parenchyma (24%). 2 cases revealed a defect in the temporal region (8%). 1 case revealed a defect in the bilateral cribriform plate and the sphenoid bone (4%). 5 patients did not reveal any defect.Conclusion: Intrathecal Iohexol-enhanced MR Cisternography is a promising technique that may permit direct, sensitive visualization of the site of spontaneous, posttraumatic, or postsurgical CSF leakage. It is also apparent that thin-section CT is complementary to gadolinium-enhanced MR Cisternography and therefore should be performed in all cases.