Reliability of multidetector CT in the diagnosis of cerebrospinal fluid rhinorrhea with operative correlation

Abstract

PurposeTo evaluate the role of non-contrast multidetector CT (MDCT) reliability in localizing CSF leaks and skull base defects in correlation to operative findings. Materials and methodsTwenty patients clinically diagnosed to have CSF rhinorrhea; 8 spontaneous and 12 post-traumatic patients were evaluated using 64-rows MDCT with slice section 0.6mm. CT is considered accurate if correctly determine the site and size of bony defect as matched with operative findings. ResultsMDCT accurately detected the site of presumed CSF leak in 19 out of 20 cases with sensitivity 95%. Cribriform plate defect is the most common site of defect in 40% of cases with 75% of cases categorized as Keros type II. The consensus image with fair agreement (K=0.38) shows that coronal reformat has the highest diagnostic performance in 75% of cases while the least diagnostic value is encountered with the axial plane in 15% of cases (p=0.095). There is almost a perfect agreement (K=0.810) between the MDCT measurements and operative size of bony defect with minimal difference in 10% of patients (P<0.001). ConclusionNon-contrast MDCT is an accurate reliable non-invasive imaging modality for preoperative evaluation of CSF rhinorrhea.