Use of HRCT-MRI Fusion Imaging in the Detection of Cerebrospinal Fluid Leaks

Abstract

Objective: 1) Determine the accuracy of high resolution computed tomography and magnetic resonance fused imaging in detecting skull base cerebrospinal fluid leaks. 2) Develop a comprehensive algorithm for the diagnostic workup of anterior skull base cerebrospinal fluid leaks.

Method: We retrospectively reviewed 16 cases of patients who underwent HRCT-MRI fusion studies with intraoperative fluorescein localization for the evaluation and repair of CSF leaks during a 3-year period between 2008 and 2011 at the Mount Sinai Medical Center.

Results: Sixteen HRCT-MRI fusion studies were evaluated from 16 different patients suspected of having CSF leaks. Eleven out of the 16 subjects had a confirmed diagnosis of CSF leak on intraoperative nasal endoscopy. HRCT-MRI fusion imaging accurately identified the CSF leak and its location in each of the 11 subjects yielding a sensitivity of 100%. Three of the 16 patients were found to have no signs of active leak or skull base defect on intraoperative nasal endoscopy, 2 of which correlated with negative findings on fusion imaging.

Conclusion: HRCT-MRI fusion is an excellent imaging modality that not only provides accurate identification and localization of CSF leaks but also acts as a great adjunct for intraoperative localization and repair. HRCT-MRI fusion should be incorporated into the diagnostic algorithm for management of CSF leaks.