xRead - September 2022

Cerebrospinal Fluid Rhinorrhea and Otorrhea

171

Table 1 Suggested imaging protocols for patients with suspected CSF leak

CT Paranasal Sinuses Without Contrast

1 2 3 4 5 1 2 3 4 5

Scout

Tip of nose to back of mastoid

Axial bone thin

0.625 mm (or 0.6 mm)

Axial soft

2.5 mm (or 3 mm)

Coronal bone Sagittal bone

0.625 mm (or 0.6 mm)

0.625 mm (or 0.6 mm) CT Cisternogram (CT Paranasal Sinuses Without and with Intrathecal Contrast)

Scout

Tip of nose to back of mastoid

Axial bone thin

Supine helical; 0.625 mm (or 0.6 mm) 2.5 mm (or 3 mm) reconstructed

Axial soft

Coronal bone Sagittal bone

0.625 mm (or 0.6)

0.625 mm (or 0.6) Patient to fluoroscopic suite for 5–7 mL of intrathecal iodinated myelographic contrast Before placing patient on CT table, head hanging/provocation techniques 6 Scout Tip of nose to back of mastoid 7 Coronal bone prone Prone (detail, direct coronal); 0.625 mm 8 Axial bone thin Supine; 0.625 mm 9 Axial soft postsupine 2.5 mm (reconstructed) 10 Coronal bone

0.625 or 0.6 mm (reconstructed from supine post data set) 0.625 or 0.6 mm (reconstructed from supine data set)

11

Sagittal bone

MR Cisternogram: MR Brain Without and with IV Contrast

#

Sequence

Plane

Comment

1 2 3 4 5 6

T1

Sagittal

Brain Brain

T2 FLAIR

Axial Axial

T1 T1

Top of frontal sinus to tip of clivus (3 mm) Tip of nose to back of mastoid (3 mm) Tip of nose to back of mastoid (1 mm) Tip of nose to back of mastoid (3 mm)

Coronal Coronal Coronal

3D T2 SPACE

T2

Administer IV contrast 7

T1 fat-saturated postcontrast T1 fat-saturated postcontrast

Axial

Top of frontal sinus to tip of clivus (3 mm)

8 Tip of nose to back of mastoid (3 mm) Gadolinium-Enhanced MR Cisternogram (MR Brain Without and with Intrathecal Contrast) # Sequence Plane Comment 1 T1 Sagittal Brain 2 T2 FLAIR Axial Brain 3 T2 SPACE Coronal Tip of nose to back of mastoid (1 mm) 4 T1 fat-saturated (VIBE) Axial Top of frontal sinus to tip of clivus (1 mm) 5 T1 fat-saturated (VIBE) Coronal Tip of nose to back of mastoid (1 mm) 6 MPRAGE Coronal Tip of nose to back of mastoid (1 mm) Patient to fluoroscopic suite for administration of intrathecal contrast: 0.5 mL of gadopentetate Dimeglumine diluted in 5 mL of CSF, injected slowly, rescanned 1–2 h later, again in 4–24 h 7 T1 fat-saturated (VIBE) postcontrast Axial Top of frontal sinus to tip of clivus (1 mm) 8 T1 fat-saturated (VIBE) postcontrast Coronal Tip of nose to back of mastoid (1 mm) 9 MPRAGE postcontrast Coronal Tip of nose to back of mastoid (1 mm) Abbreviations: FLAIR, fluid-attenuated inversion recovery; IV, intravenous; MPRAGE, magnetization-prepared rapid gradient echo; SPACE, sampling perfection with application optimized contrasts using different flip angle evolutions, siemens 3D T2 TSE sequence; VIBE, volume interpolated breathhold examination, 3D spoiled turbo gradient echo with fat saturation. Coronal

Downloaded for Anonymous User (n/a) at STANFORD UNIVERSITY from ClinicalKey.com by Elsevier on July 26, 2022. For personal use only. No other uses without permission. Copyright ©2022. Elsevier Inc. All rights reserved.