Cryptogenic Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension: Role of Dynamic CT Myelography
Cryptogenic Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension: Role of Dynamic CT Myelography
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DOI：
10.1148/radiol.2018180732
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发表时间：
2018-12-01
期刊：
影响因子：
19.7
通讯作者：
Piechowiak, Eike I.
中科院分区：
文献类型：
--
作者：
Dobrocky, Tomas;Mosimann, Pascal J.;Piechowiak, Eike I.
目的：提出一种改进的动态 CT 脊髓造影技术，用于定位自发性颅内低血压 (SIH) 患者的脑脊液 (CSF) 漏，也称为隐源性漏，这些患者之前的影像学检查未显示硬脑膜破裂。材料和方法：这项回顾性分析包括 74 名连续的 SIH 患者和脊髓造影证实的 CSF 漏，这些患者在 2013 年 2 月至 2017 年 10 月期间进行了评估。14对于患者，在先前成像失败后，俯卧位或侧卧位的动态 CT 脊髓造影显示了准确的渗漏点。在图像分析过程中，显示鞘外造影剂的第一个时间点被定义为硬脑膜破裂点的部位。 结果：平均人口年龄为 44 岁（范围，2565 岁[9 名女性；平均年龄，44 岁；年龄范围，2565 岁][5 名男性；平均年龄，46 岁；年龄范围，2961 岁]）。所有患者之前均接受过脊柱 MRI、常规动态脊髓造影和 CT 脊髓造影。随后的动态 CT 脊髓造影覆盖了七个椎骨水平的平均范围。 10 名患者的渗漏是由钙化的微刺引起的，其余 4 名患者的渗漏是由脊神经根腋下的硬膜撕裂引起的。动态CT脊髓造影的平均体积CT剂量指数为107 mGy（范围12246 mGy），平均剂量长度乘积为1347 mGy。 cm（范围，5503750 mGy.cm）。结论：动态 CT 脊髓造影是一种有价值的辅助工具，可在其他检查不成功时确定硬脑膜撕裂的精确位置。 (C) 北美放射学会，2018。
Purpose: To propose a modified dynamic CT myelographic technique to locate cerebrospinal fluid (CSF) leaks, also known as cryptogenic leaks, in patients with spontaneous intracranial hypotension (SIH) in whom previous imaging did not show the dural breach.Materials and Methods: This retrospective analysis included 74 consecutive patients with SIH and a myelographically proven CSF leak who were evaluated between February 2013 and October 2017. In 14 patients, dynamic CT myelography in the prone or lateral position showed the exact leakage point after unsuccessful previous imaging. During image analysis, the first time point showing extrathecal contrast material was defined as the site of dural breach point.Results: Mean population age was 44 years (range, 2565 years [nine women; mean age, 44 years; age range, 2565 years] [five men; mean age, 46 years; age range, 2961 years]). All patients had previously undergone spine MRI, conventional dynamic myelography, and CT myelography. Subsequent dynamic CT myelography covered a mean range of seven vertebral levels. The leak was caused by a calcified microspur in 10 patients and by a dural tear at the axilla of a spinal nerve root in the remaining four. The mean volume CT dose index of dynamic CT myelography was 107 mGy (range, 12246 mGy), and the mean dose-length product was 1347 mGy . cm (range, 5503750 mGy.cm).Conclusion: Dynamic CT myelography is a valuable adjunctive tool with which to identify the precise location of a dural tear when other examinations are unsuccessful. (C) RSNA, 2018.