Faculty Collaboration Database

Intrathecal Gadolinium-Enhanced MR Cisternography Improves the Detection of Skull Base CSF Leaks. Otol Neurotol 2025 Dec 01;46(10):1274-1279

Date

07/29/2025

Pubmed ID

40729572

DOI

10.1097/MAO.0000000000004601

Scopus ID

2-s2.0-105012538669 (requires institutional sign-in at Scopus site)

Abstract

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.

Author List

Totten DJ, Koontz NA, Elms HL, Cumpston EC, Schneider W, Whitted C, Tann M, Booth KT, Mosier KM, Nelson RF

Author

Hunter L. Elms BS, MD Assistant Professor in the Otolaryngology and Communication Sciences department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Cerebrospinal Fluid Leak
Contrast Media
Female
Gadolinium
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Myelography
Retrospective Studies
Skull Base
Tomography, Emission-Computed, Single-Photon