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

Purpose: To 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 methods: Twenty patients clinically diagnosed to have CSF rhinorrhea; 8 spontaneous and 12 post-traumatic patients were evaluated using 64-rows MDCT with slice section 0.6 mm. CT is considered accurate if correctly determine the site and size of bony defect as matched with operative findings. Results: MDCT 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 (ρ=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 (ρ<0.001). Conclusion: Non-contrast MDCT is an accurate reliable non-invasive imaging modality for preoperative evaluation of CSF rhinorrhea