International Forum of Allergy & Rhinology

ORIGINAL ARTICLE

Usefulness of imaging studies for diagnosing and localizing cerebrospinal fluid rhinorrhea: A systematic review and meta-analysis

Do Hyun Kim MD, PhD

Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

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Sung Won Kim MD, PhD,

Sung Won Kim MD, PhD

Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

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So-Hyun Kim MD,

So-Hyun Kim MD

Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

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Jae Hoon Jung MD,

Jae Hoon Jung MD

Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

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Se Hwan Hwang MD, PhD,

Corresponding Author

Se Hwan Hwang MD, PhD

[email protected]

orcid.org/0000-0002-2838-7820

Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence

Se Hwan Hwang, MD, PhD, Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Bucheon-si, Gyeonggi-do 14647, Korea.

Email: [email protected]

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Do Hyun Kim MD, PhD,

Do Hyun Kim MD, PhD

Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Search for more papers by this author

Sung Won Kim MD, PhD,

Sung Won Kim MD, PhD

Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Search for more papers by this author

So-Hyun Kim MD,

So-Hyun Kim MD

Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Search for more papers by this author

Jae Hoon Jung MD,

Jae Hoon Jung MD

Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Search for more papers by this author

Se Hwan Hwang MD, PhD,

Corresponding Author

Se Hwan Hwang MD, PhD

[email protected]

orcid.org/0000-0002-2838-7820

Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence

Email: [email protected]

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First published: 08 December 2021

https://doi.org/10.1002/alr.22932

Citations: 4

Additional Supporting Information may be found in the online version of this article.

Potential conflict of interest: None provided.

The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see: http://www.textcheck.com/certificate/hK0p97

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Abstract

Background

Our aim in this study was to determine the usefulness of diagnosis by imaging studies for the localization of cerebrospinal fluid (CSF) rhinorrhea.

Methods

PubMed, SCOPUS, Embase, Web of Science, and Cochrane Library databases were searched up to July 2021. True and false positive and negative data were collected along with the characteristics of each study. Methodologic quality was assessed using the QADAS-2 tool.

Results

Sixteen studies involving 472 patients were included. The diagnostic odds ratio (DOR) of imaging studies was 13.6195 (95% confidence interval [CI], 7.4756-24.8129; I²= 28.1%). The area under the summary receiver-operating characteristic curve was 0.712. Sensitivity, specificity, negative predictive value, and positive predictive value were 0.8507 (0.7773-0.9029), 72.1%; 0.7827 (0.6865-0.8556), 26.8%; 0.5828 (0.4398-0.7132), 67.4%; and 0.9407 (0.8935-0.9678), 59.1%, respectively. In the subgroup analysis, there were significant differences for sensitivity (computed tomography [CT], 0.7421; computed tomography cisternography [CTC], 0.8872; magnetic resonance imaging [MRI], 0.8365; magnetic resonance cisternography [MRC], 0.8565; intrathecal gadolinium magnetic resonance cisternography [GaMRC], and 0.9307; radionuclide cisteronography [RNC], 0.7097; p = 0.0481) and for negative predictive value among imaging modalities (CT, 0.3028; CTC, 0.4848; MRI, 0.4658; MRC, 0.7465; GaMRC, 0.8611; and RNC, 0.5263; p = 0.0046). There were no significant differences among imaging modalities for specificity, positive predictive value, or DOR (p > 0.05).

Conclusion

Imaging studies can be used in the diagnosis of CSF rhinorrhea. Gadolinium magnetic resonance cisternography showed the highest diagnostic accuracy. MRC showed fair diagnostic accuracy without intrathecal injection.

Supporting Information

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Citing Literature

Volume12, Issue6

June 2022

Pages 828-837

Filename	Description
alr22932-sup-0002-TableS1.docx21 KB	TABLE S1 Search terms and queries
alr22932-sup-0003-TableS2.docx18.3 KB	TABLE S2 Study characteristics
alr22932-sup-0004-TableS3.docx17.5 KB	TABLE S3 Methodologic quality of the included studies
alr22932-sup-0005-TableS4.docx18.8 KB	TABLE S4 GRADE assessment results
alr22932-sup-0001-FigureS1.tif1.1 MB	FIGURE S1 Forest plots of (A) sensitivities, (B) specificities, (C) negative predictive values, and (D) positive predictive values.

Usefulness of imaging studies for diagnosing and localizing cerebrospinal fluid rhinorrhea: A systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusion

Supporting Information

REFERENCES

Citing Literature

References

Information

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Usefulness of imaging studies for diagnosing and localizing cerebrospinal fluid rhinorrhea: A systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusion

Supporting Information

REFERENCES

Citing Literature

References

Related

Information