CSF leaks: Correlation of high-resolution CT and multiplanar reformations with intraoperative endoscopic findings
CSF leaks: Correlation of high-resolution CT and multiplanar reformations with intraoperative endoscopic findings
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DOI：
10.3174/ajnr.a0885
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发表时间：
2008-03-01
影响因子：
3.5
通讯作者：
Hudgins, P. A.
中科院分区：
文献类型：
--
作者：
La Fata, V.;McLean, N.;Hudgins, P. A.
背景和目的：颅底缺陷可导致脑脊液漏，脑膜炎是潜在的并发症。外科医生现在正在常规地通过鼻内窥镜方法修复这些渗漏。准确的术前影像是外科手术计划的关键。已经采用了各种成像方案，包括轴位和直接冠状CT、加碘对比剂的CT脑池造影术、放射性核素脑池造影术和MR成像。既然有了多层螺旋CT，这项研究的目的是确定高分辨率轴位数据集生成的冠状和矢状面多平面重建(MPR)图像与一组临床证实的脑脊液漏患者术中发现的相关性如何。材料和方法：我们回顾了在2.5年期间到我们三级护理机构就诊的19名临床证实的脑脊液漏患者的影像表现和手术记录。术前行高分辨率螺旋CT扫描(层面准直10例，层厚0.625 mm，层厚1.25 mm 9例)，多平面重建图像由神经放射科医师在工作站上处理。两位神经放射科医生对术中发现视而不见，确定了颅底缺陷的位置和大小。所有患者均由经验丰富的鼻-鼻-鼻喉科医生进行鼻内窥镜检查，通过直接检查确定脑脊液渗漏的位置，并测量相应的骨缺损。如果正确定位脑脊液漏，CT被认为是准确的，并且在内窥镜测量的2 mm范围内。结果：在内窥镜下，19例患者中有18例发现了22个脑脊液漏。22例中20例(91%)CT准确预测漏口位置，20例术前定位15例(75%)准确(距内窥镜测量值2 mm以内)。20例中5例(25%)颅底缺损区的CT测量值与内窥镜下的大小不符，范围在术中测量值以下7.4 mm至上方13 mm之间。当分析仅限于10名拥有0.625 mm轴位图像的患者的分组时，准确度得到了提高，CT所描述的I I CSIF漏均在内窥镜下得到证实。此外，亚毫米CT准确测量了11例中9例(82%)骨缺损的大小。其余2例(18%)，CT最小限度高估了骨缺损的大小，仅为3 mm。结论：高分辨率轴位CT生成的冠状位、矢状位和斜位MPR图像在术前表现良好，可定位导致脑脊液漏的颅底缺损区。然而，在工作站上主动处理轴位数据集对于识别和正确描述这些病变是至关重要的。当有亚毫米准直时，骨缺陷的测量在大部分时间都是准确的。
BACKGROUND AND PURPOSE: Skull base defects can result in CSF leaks, with meningitis as a potential complication. Surgeons are now routinely repairing these leaks via a nasal endoscopic approach. Accurate preoperative imaging is essential for surgical planning. A variety of imaging regimens have been employed, including axial and direct coronal CT, CT cisternography with iodinated contrast, radionuclide cisternography, and MR imaging. Now that multidetector helical CT is available, the purpose of this study was to determine how well coronal and sagittal multiplanar reformatted (MPR) images generated from a high-resolution axial dataset correlate with intraoperative findings in a group of patients with clinically proved CSF leaks.MATERIALS AND METHODS: We retrospectively reviewed imaging findings and surgical records of 19 patients who presented to our tertiary care institution during a 2.5-year period with clinically proved CSF leak. Patients underwent preoperative imaging with high-resolution helical CT (section collimation, 10 patients with 0.625-mm and 9 patients with 1.25-mm images), with MPR images processed by a neuroradiologist at a workstation. Two neuroradiologists, blinded to the intraoperative findings, determined the location and size of the skull base defects. All patients underwent endoscopic evaluation by an experienced sinonasal otolaryngologist, who confirmed the site of the CSF leak by direct inspection and measured the corresponding osseous defect. CT was considered accurate if it correctly localized the CSF leak and was within 2 mm of the endoscopic measurement.RESULTS: At endoscopy, 22 leaks of CSF were identified in 18 of 19 patients. CT correctly predicted the site of the leak in 20 (91%) of 22 cases and was accurate (within 2 mm of the endoscopic measurement) in 15 (75%) of 20 cases preoperatively localized. The CT measurement of the skull base defect differed from the encloscopic size in 5 (25%) of 20 cases, ranging from 7.4 mm below to 13 mm above the intraoperative measurement. When analysis was limited to the subgroup of 10 patients who had 0.625-mm axial images, the accuracy was improved, and of the I I CSIF leaks described at CT, all were verified at endoscopy. In addition, the submillimeter CT accurately measured the size of the osseous defect in 9 (82%) of 11 cases. In the remaining 2 (18%) of 11 cases, CT minimally overestimated the size of the osseous defect by only 3 mm.CONCLUSION: Axial images, and coronal, sagittal, and oblique MPR images generated from high-resolution axial CT performed well preoperatively, localizing the skull base defect responsible for the CSF leak. However, active manipulation of the axial dataset at a workstation is crucial in identifying and correctly describing these lesions. When submillimeter collimation is available, measurement of the osseous defects are accurate most of the time.