Intrathecal use of gadobutrol for gadolinium-enhanced MR cisternography in the evaluation of patients with otorhinorrhea

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.

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Funding

No funding was received for this study.

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Authors

Contributions

Osman Kizilkilic conceived of the presented idea. Osman Kizilkilic and Sebahat Nacar Dogan developed the theory and evaluated all DWI on PACS system independently. Both Bora Korkmazer and Serdar Arslan the analytical methods. Vefa Salt reviewed the medical records. All authors discussed the results and contributed to the final manuscript.

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Correspondence to Osman Kizilkilic.

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Dogan, S., Salt, V., Korkmazer, B. et al. Intrathecal use of gadobutrol for gadolinium-enhanced MR cisternography in the evaluation of patients with otorhinorrhea. Neuroradiology (2020). https://doi.org/10.1007/s00234-020-02463-3

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Keywords

  • Cisternography
  • Gadobutrol
  • Intrathecal
  • Otorhinorrhea
  • Magnetic resonance imaging