Purpose: Despite a considerable amount of literature that has been published about the use of intrathecal gadolinium-enhanced MR cisternography (IGE-MRC), there is still relatively lack of evidence as to its long-term effects. Our purpose in this study was twofold: firstly, to assess the long-term safety of the IGE-MRC; secondly, to evaluate the diagnostic performance of IGE-MRC for detecting cerebrospinal fluid (CSF) leak in otorhinorrhea patients.
Methods: We retrospectively reviewed our imaging and clinical database for the patients admitted to our department for the evaluation of their otorhinorrhea between 2008 and 2017. Two radiologists evaluated the imaging studies independently. Consensus data was used in the analysis. Medical record review and phone call were used for the long-term follow-up.
Results: The retrospective review yielded 166 patients. Rhinorrhea was present in 150 (90.4%) patients and otorrhea in 16 (9.6%) patients. Overall, 67 patients (40.5% of all patients) underwent operation for repair of the CSF leak site. Beta-transferrin test was available and positive in 57 (34.3%) patients. Overall sensitivity of IGE-MRC and paranasal high-resolution CT (HRCT) was 89.3 and 72%, respectively. Within the first 24 h after the procedure, none of the patients experienced a significant complication or adverse reaction. Ninety-nine patients (59.6%) had medical record and telephone follow-up. The mean follow-up duration with call was 37.1 months. Three (3%) patients complained about severe headache 3-4 weeks after the procedure.
Conclusions: IGE-MRC is a minimally invasive and highly sensitive imaging technique. No adverse side effect during our long-term follow-up might strengthen and support the safety of IGE-MRC.
Keywords: Cerebrospinal fluid leak; Cisternography; Gadolinium; Intrathecal; Magnetic resonance imaging.