Intrathecal use of gadobutrol for gadolinium-enhanced MR cisternography in the evaluation of patients with otorhinorrhea
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DIAGNOSTIC NEURORADIOLOGY
Intrathecal use of gadobutrol for gadolinium-enhanced MR cisternography in the evaluation of patients with otorhinorrhea Sebahat Nacar Dogan 1 & Vefa Salt 2 & Bora Korkmazer 2 & Serdar Arslan 2 & Civan Islak 2 & Naci Kocer 2 & Osman Kizilkilic 2 Received: 26 March 2020 / Accepted: 20 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Intrathecal gadolinium-enhanced MR cisternography (IGE-MRC) has a high sensitivity to detect accurate localization of cerebrospinal fluid (CSF) leakage in otorhinorrhea patients. Our purpose in this study was to describe our experience in analyzing clinically suspected CSF leakage by IGE-MRC by using gadobutrol with emphasis on its safety and diagnostic performance. Methods We retrospectively reviewed our imaging and clinical database for the evaluation of patients admitted to our clinic with complaints of otorhinorrhea between 2017 and 2019. Two radiologists evaluated the imaging studies independently. Consensus data was used in the analysis. Medical record review and phone call were used for the follow-up. Results Of the 85 patients included in the retrospective analysis, 82 (96.5%) had rhinorrhea and 3 (3.5%) had otorrhea. Overall, 29 patients (34.1% of all patients) underwent operation for repair of the CSF leakage site. Beta-transferrin test was available and positive in 33 patients (38.8%). Five (5.9%) patients complained headaches after the procedure and complaints were resolved with increased water intake. Postprocedurally, 3 patients (3.5%) had vertigo and 1 patient (1.2%) complained nausea but spontaneous regression were observed in a few hours. None of the patients experienced a significant complication or adverse reaction during follow-up period. Sixty-seven patients (78.8%) had medical record and telephone follow-up. Mean follow-up duration with call was 14.2 months. Conclusion IGE-MRC is a minimally invasive and highly sensitive imaging technique. The current results during our follow-up demonstrate the relative safety and feasibility of IGE-MRC by using gadobutrol to evaluate CSF leakage. Keywords Cisternography . Gadobutrol . Intrathecal . Otorhinorrhea . Magnetic resonance imaging
Introduction Cerebrospinal fluid (CSF) leakage is observed when an osteodural defect develops between subarachnoid space and paranasal sinuses or temporal bone. Although the underlying etiology can be traumatic, spontaneous, or iatrogenic in origin, the most common etiology is trauma [1–3]. The majority of traumatic CSF leakages ceases spontaneously without any intervention. However, when conservative treatment fails, surgery is performed due to pneumocephalus, and risk of central nervous
* Osman Kizilkilic [email protected] 1
Gaziosmanpaşa Training and Research Hospital, Department of Radiology, University of Health Sciences Turkey, 34098 Istanbul, Turkey
2
Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey
system infection such as meningitis, abscess.
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