Intrathecal Gd-MRC demonstrated to be the most useful diagnostic method to detect CSF rhinorrhea

by Linda Kossoff •

Intrathecal Gd-MRC was demonstrated to be the most useful diagnostic method to detect CSF rhinorrhea.

BACKGROUND: Traumatic CSF leakage is the most common cause of CSF rhinorrhea. Meningitis develops in 10% to 25% of patients with unresolved leakage, resulting in death in 10% of these cases. Nasal endoscopy has limitations for confirming CSF rhinorrhea and localizing leak points. Radiological imaging methods play important roles for this purpose.

STUDY DESIGN: Retrospective analysis.

SETTING: Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, N.Y.

SYNOPSIS: Researchers conducted a multi-database search up to December 2021 to compare the diagnostic accuracy among seven radiological methods in analyzing CSF rhinorrhea: computed tomography (CT), CT cisternography (CTC), magnetic resonance imaging (MRI), magnetic resonance cisternography (MRC), CT + MRI, radionuclide cisternography, and intrathecal gadolinium (Gd)-MRC. A total of 23 trials, comprising 900 subjects, were included in the final analysis. Outcomes were sensitivity, specificity, and accuracy. Both a traditional pairwise meta-analysis and a network meta-analysis were performed. Results showed that all imaging modalities had greater diagnostic accuracy than CT, apart from CTC, which had lower sensitivity. There were no significant differences in specificity among the different methods. Only Gd-MRC was shown to be significantly superior to other imaging methods regarding sensitivity and accuracy. However, authors note that each diagnostic method has its own characteristics, and thus advantages and disadvantages, which should be considered in clinical application. Researchers stress that the diagnostic modality should be selected with clinical condition and resource availability in mind. Study limitations included differences among trials in equipment quality and techniques, which may have affected diagnostic accuracy.

CITATION: Hwang SH, Kim SW, Kim DH. Efficacy of imaging methods in the detection and diagnosis of cerebrospinal fluid rhinorrhea. Laryngoscope. 2023;133:1281-1287.