Evaluation of MR cisternography in diagnosis of cerebrospinal fluid fistula

J Med Assoc Thai. 2004 Dec;87(12):1471-6.


Purpose: To study the clinical usefulness and sensitivity of MR cisternography as noninvasive study in the diagnosis of CSF fistula in patients with clinical diagnosis CSF rhinorrhea or otorrhea.

Method: Thirty-five patients with clinically diagnosed CSF leakage were examined for site of dural tear with MR cisternography with additional plain high-resolution CT in some cases from Jan. 1999 to Dec.2002. The MR imaging technique was performed as a heavily T2 weighted fast spin echo study with fat suppression in axial, coronal and sagittal projections. Criteria for positive results were demonstrable fistular tract connecting subarachnoid space to paranasal sinus/petrous bone, and/or dural discontinuity, and/or bone defect with pneumocephalus, and/or presence of brain herniation. Eighteen of the patients subsequently had exploratory surgery for fistula. Sensitivity analysis of the surgical results was compared with the findings at MR cisternography.

Result: MR cisternography showed significant correlation with surgical findings with sensitivity of 89%. Additional high resolution CT were complete agreement with site of fistular tract. The pathogenesis of CSF leakage was related to trauma (86%). The commonly found dural/bony defect and location of connecting fislular tract were cribriform plate and ethmoid sinus of 58%, 55% respectively.

Conclusion: In the presence of clinically diagnosed CSF leakage, the combination of MR cisternography and plain high-resolution CT are highly accurate in locating the site and extent of CSF fistula and should be considered a viable noninvasive alternative to CT cisternography and Tc-99m-DTPA cisternography.

Publication types

  • Historical Article

MeSH terms

  • Adolescent
  • Adult
  • Cerebrospinal Fluid Otorrhea / diagnosis*
  • Cerebrospinal Fluid Otorrhea / surgery
  • Cerebrospinal Fluid Rhinorrhea / diagnosis*
  • Cerebrospinal Fluid Rhinorrhea / surgery
  • Child
  • Child, Preschool
  • Female
  • Fistula / diagnosis*
  • Fistula / surgery
  • History, 18th Century
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Sensitivity and Specificity