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自发性低颅压综合征(spontaneous intracranial hypotension,SIH)是一组无特殊诱因(如颅脑外伤、硬膜外穿刺等)的、脑脊液压力降低引起的、以体位性头痛为主要临床表现的,并可伴有颈部僵硬、恶心、呕吐、听觉改变、复视和视野缺损等其他症状的临床综合征[1]。该病病因尚不清楚,目前大多数学者认为自发性脊髓脑脊液漏是SIH的根本病因[2-4]。然而,临床常用的CT及MRI等神经影像学检查对脊髓脑脊液漏点的检出较为困难。本研究通过对19例临床诊断为SIH患者的放射性核素脑脊液间隙显像(radionuclide cisternography,RNC)的检查结果进行回顾性分析,描述和总结其影像学特点,分析该检查对SIH脑脊液漏的检出价值和意义。
自发性低颅压综合征脑脊液间隙显像的影像学特征分析
Analysis the imaging characteristics of radionuclide cisternography in spontaneous intracranial hypotension
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摘要:
目的 探讨自发性低颅压综合征(SIH)患者放射性核素脑脊液间隙显像(RNC)的影像学特点及其临床意义。 方法 回顾性分析2012年5月至2017年1月福建省立医院收治的19例SIH患者,均经腰椎穿刺脊髓蛛网膜下腔注射99Tcm-DTPA,行多时相脑脊液间隙显像,对99Tcm-DTPA异常分布处加做SPECT/CT断层融合显像及MRI扫描。综合分析RNC的影像学特点。计数资料的组间比较采用 χ 2 检验。 结果 RNC可通过显示脊髓或鼻部脑脊液漏点等直接征象诊断SIH;也可通过观察脑脊液循环过程异常,如:显像剂上升缓慢,难以抵达脑池、大脑凸面、上矢状窦等及膀胱、肾脏早期显像等间接征象诊断SIH。RNC检出脑脊液漏17例。直接脑脊液漏患者12例,其中颈、胸段9例,脑脊液鼻漏2例,大流量脑脊液漏(腰段)患者1例。RNC正常者2例。MRI[阳性率为58.8%(10/17)]与RNC[阳性率为88.2%(15/17)]对SIH低颅压诊断的差异无统计学意义(χ2=0.101,P>0.05);12例RNC检出漏口的相应部位MRI仅检出1例。 结论 RNC可通过直接或间接征象协助SIH的病因诊断,在脑脊液漏口检出上明显优于MRI,并可反映脑脊液漏的流量,便于个体化治疗,在SIH的诊疗中有重要的应用价值。 -
关键词:
- 脑脊液漏 /
- 放射性核素脑脊液间隙显像 /
- 自发性低颅压综合征
Abstract:Objective To investigate the imaging features and clinical significance of radionuclide cisternography(RNC) in patients with spontaneous intracranial hypotension(SIH). Methods Lumbar puncture was made on 19 patients with SIH(4 males and 15 females), and 99Tcm-DTPA was injected into their spinal subarachnoid space. Multitemporal RNC was also performed. SPECT/CT tomography and MRI were added to examine abnormal distribution, and RNC image features were comprehensively analyzed. χ2-test was conducted to compare the enumeration data between groups. Results RNC could be applied to diagnose SIH by showing direct signs such as spinal cord or nasal cerebrospinal fluid leak points or by revealing the abnormal circulation of the cerebrospinal fluid (CSF), such as a slow increase in imaging agents; difficulty in reaching the cistern, the cerebral convex surface, and the superior sagittal sinus; and early imaging of the bladder and the kidney. RNC could also be used to detect the CSF leaks in 17 cases and reveal a direct sign of CSF leaks in 12 cases. Its detection rate was 63.2%. Of these cases, 9 were located in the cervicothoracic junction or the thoracic region, 1 was found in the lumbar, and 2 were observed to have CSF rhinorrhea. A case of high-flow CSF leakage (lumbar segment) occurred in 1 patient. When conservative treatment was ineffective, the patients were treated with targeted epidural blood patch. Two more cases had a normal RNC. A comparison of the MRI findings of 17 patients showed no significant differences between MRI (positive rate of 58.8% [10/17]) and RNC (positive rate of 88.2% [15/17]) in the diagnosis of low intracranial pressure (P > 0.05). However, RNC was superior to MRI in detecting CSF leakage. Of the 12 cases subjected to RNC, only 1 case was found to have CSF leaks through MRI. Conclusions RNC can help diagnose SIH by determining direct or indirect signs and is superior to MRI in terms of detecting CSF leakage. RNC can also be used to show the amount of CSF leakage and facilitate individualized treatment, which is important for the diagnosis and treatment of SIH. -
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