A new approach for simple radioisotope cisternography examination in cerebrospinal fluid leakage detection
A new approach for simple radioisotope cisternography examination in cerebrospinal fluid leakage detection
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简单放射性同位素脑池造影检查脑脊液漏的新方法
DOI：
10.1007/s12149-015-1030-2
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发表时间：
2015
影响因子：
2.6
通讯作者：
Y. Tsushima
中科院分区：
文献类型：
--
作者：
Hiromitsu Hoshino;T. Higuchi;Arifudin Achmad;A. Taketomi;H. Fujimaki;Y. Tsushima
方法采用放射性同位素脑池显像（111 In-DTPA RIC）技术，对临床疑诊为自发性脑脊液低血容量症（SCH）的患者，于注射放射性同位素后0、1、3、6、24 h进行RIC显像。在3小时图像上选择感兴趣区域（ROI），包括脑、脊柱、膀胱或全身。计算累积放射性计数用于定量分析。根据Schievink等人最近提出的诊断标准建立SCH的最终诊断。结果35例患者被集中在，21例（60.0%）患者被诊断为SCH根据Schievink标准。在3 h图像上，21例SCH患者中有9例（42.9%）检测到直接脑脊液漏征，还有3例疑似医源性漏。与非SCH患者相比，SCH患者在3小时图像中显示出更高的膀胱积聚（P= 0.0002），并且在6小时和24小时图像之间显示出更高的脑清除率（P< 0.0001）。特别是，24小时脑清除率的诊断比24小时全脑池清除率更具决定性。结合直接征象和24小时脑内累积，在32例未观察到医源性渗漏的患者中，准确率为100%。1-结论一种新的简单的ROI设置方法，其中只需要3 h全身和24 h脑图像，足以诊断SCH。
ObjectiveWe developed a new quantitative interpretation technique of radioisotope cisternography (RIC) for the diagnosis of spontaneous cerebrospinal fluid hypovolemia (SCH).MethodsRIC studies performed for suspected SCH were evaluated.111In-DTPA RIC images were taken at 0, 1, 3, 6, and 24-h after radioisotope injection following the current protocol. Regions of interest (ROI) were selected on 3-h images to include brain, spine, bladder or the whole body. The accumulative radioactivity counts were calculated for quantitative analysis. Final diagnoses of SCH were established based on the diagnostic criteria recently proposed by Schievink and colleagues.ResultsThirty-five patients were focused on. Twenty-one (60.0 %) patients were diagnosed as having SCH according to the Schievink criteria. On the 3-h images, direct cerebrospinal fluid leakage sign was detected in nine of 21 SCH patients (42.9 %), as well as three patients with suspected iatrogenic leakage. Compared to non-SCH patients, SCH patients showed higher bladder accumulation at 3-h images (P= 0.0002), and higher brain clearance between the 6- and 24-h images (P< 0.0001). In particular, the 24-h brain clearance was more conclusive for the diagnosis than 24-h whole cistern clearance. The combination of direct sign and 24-h brain accumulation resulted in 100 % of accuracy in the 32 patients in whom iatrogenic leakage was not observed. 1- and 6-h images did not provide any additional information in any patients.ConclusionsA new simple ROI setting method, in which only the 3-h whole body and 24-h brain images were necessary, was sufficient to diagnose SCH.