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/m 2 . 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.

LEVEL OF EVIDENCE: 4.