Superficial siderosis associated with duplicated dura mater detected by CISS reverse MRI
Superficial siderosis associated with duplicated dura mater detected by CISS reverse MRI
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DOI：
10.1016/j.jns.2018.07.001
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发表时间：
2018-09-15
影响因子：
4.4
通讯作者：
Ito, Hidefumi
中科院分区：
文献类型：
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作者：
Hosokawa, Maki;Murata, Ken-ya;Ito, Hidefumi
中枢神经系统浅表铁质沉着症(SS)是一种罕见的疾病，由蛛网膜下腔慢性或反复出血引起。硬脑膜缺损术是治疗SS的有效方法。然而，传统的磁共振成像(MRI)不能充分检测硬脑膜撕裂。为了更好地发现这些缺陷，我们分析了我科连续收治的SS患者的临床数据，并对大脑和脊髓的稳态(CISS)反向MRI进行了建设性干预。CISS反向方法强调硬脑膜和脑脊液之间的对比，能够比通常T2加权MRI更好地检测硬脑膜缺陷。在我们研究的7例SS患者中，有5例CISS反向MRI检测到充满液体的集合。这些图像显示，充满液体的集合被包装在复制的硬脑膜中。5例中有3例术中证实存在硬脑膜缺陷。我们推测，充满液体的标本实际上源自对硬脑膜的解剖。根据Monro-Kellie假说，我们认为脑脊液通过硬脑膜缺损转移到充满液体的集合中会导致血容量增加，并促进充血血管的渗出。在SS患者中，修复硬脑膜缺损以防止进一步相关的神经损害是非常重要的。对于这种硬脑膜缺陷，CISS反向MRI是一种有用的检查方法。
Superficial siderosis (SS) of the central nervous system is a rare disease caused by chronic or repeated hemorrhages in the subarachnoid space. Closure of dural defects is an effective therapy for SS. Conventional magnetic resonance imaging (MRI), however, cannot sufficiently detect dural tears. To better detect these defects, we analyzed the clinical data of consecutive patients admitted to our department with SS and performed constructive interference in steady-state (CISS) reverse MRI of the brain and spinal cord. CISS reverse method emphasizes the contrast between the dura and cerebrospinal fluid, enabling detection of dural defects better than usual T2-weighted MRI.CISS reverse MRI detected fluid-filled collections in five of the seven SS patients we studied. These images showed that the fluid-filled collections were packed within duplicated dura mater. In three of the five, dural defects were confirmed intraoperatively. We postulate that fluid-filled collections are actually derived from dissection of the dura mater. In accordance with the Monro-Kellie hypothesis, we propose that CSF transferal into the fluid-filled collections via dural defects induces an increase in blood volume and promotes the exudation of blood from engorged vessels.In patients with SS, it is very important to repair dural defects to prevent further associated neurological impairment. CISS reverse MRI is useful for detecting such dural defects.