Purpose:To evaluate the role of non-contrast multidetector CT (MDCT) reliability in localizing CSF leaksand skull base defects in correlation to operative findings.Materials and methods:Twenty patients clinically diagnosed to have CSF rhinorrhea; 8 spontaneous and12 post-traumatic patients were evaluated using 64-rows MDCT with slice section 0.6 mm. CT is consid-ered accurate if correctly determine the site and size of bony defect as matched with operative findings.Results:MDCT accurately detected the site of presumed CSF leak in 19 out of 20 cases with sensitivity95%. Cribriform plate defect is the most common site of defect in 40% of cases with 75% of cases catego-rized as Keros type II. The consensus image with fair agreement (K = 0.38) shows that coronal reformathas the highest diagnostic performance in 75% of cases while the least diagnostic value is encounteredwith the axial plane in 15% of cases (p = 0.095). There is almost a perfect agreement (K = 0.810) betweenthe MDCT measurements and operative size of bony defect with minimal difference in 10% of patients(P < 0.001).Conclusion:Non-contrast MDCT is an accurate reliable non-invasive imaging modality for preoperativeevaluation of CSF rhinorrhea