Cerebrospinal fluid rhinorrhea: Diagnostic role of gadolinium enhanced MR cisternography

Accurate localization of the defect is crucial for successful surgical repair of CSF rhinorrhea. This could be achieved by MRI cisternography using T1 weighted sequences followed by intra-thecal injection of low dose of gadolinium for valuable localization and characterization of the defect. The aim of this study was to evaluate the role of intrathecal gadolinium enhanced MR cisternography in localization of the defect in cases of CSF rhinorrhea to demonstrate how to utilize it as a roadmap to select the most appropriate approach for leak repair. This study included 24 patients (16 male and 8 females) with CSF rhinorrhea, referred from Otorhinolaryngology Department. Seventeen leaks were spontaneous, 5 cases were traumatic and two iatrogenic. All cases underwent MR gadolinium enhanced cisternography via lumbar puncture. Gadolinium enhanced MR cisternography accurately diagnosed and confirmed the site of CSF leak in 22/24 (91.7%) cases. The most common site was the ethmoidal roof in 18/24 cases. Our results were correlated with endoscopic surgery and repair with an accuracy rate of 100%. Intra-thecal gadolinium enhanced MR cisternography is essential for accurate pre-operative localization and characterization of the defect in cases of CSF rhinorrhea.