双能量CT脊髓造影诊断自发性颅内低压脊髓脑脊液漏的初步研究  

Dual-energy CT myelography on detection of spontaneous spinal cerebrospinal fluid leaks：initial study

作　　者：张峭巍[1] 王丹[1] 张锦华[2] 王谨[2] 章士正[1] 

机构地区：[1]浙江大学邵逸夫临床医学研究所浙江大学医学院附属邵逸夫医院放射科,杭州310016 [2]浙江大学邵逸夫临床医学研究所浙江大学医学院附属邵逸夫医院神经内科,杭州310016

出　　处：《中华放射学杂志》2011年第3期235-239,共5页Chinese Journal of Radiology

摘　　要：目的探讨双能量CT脊髓造影（CTM）检查在自发性颅内低压（sin）脊髓脑脊液漏中的诊断价值。方法对6例诊断为SIH的患者行双能量脊髓CT造影检查，X线管电压分别设定为100和140kVp（加锡过滤片），后处理获得虚拟平扫（VNC）、碘图等图像，并与合成的120kVp CTM进行对比，比较2种方法在显示对比剂沿神经根外漏、C1～2椎体后方对比剂积聚、硬膜静脉丛扩张及椎管内硬膜下对比剂积聚等方面的情况。运用Kappa一致性检验比较2种方法诊断脑脊液漏点的差异。结果6例患者合成的120kVpCTM共显示43个漏点，其中的41个漏点在VNC和碘图上显示，2种方法在脊膜脑脊液漏点检出上有非常好的一致性（Kappa值=0．997，P〈0．01），并且2种方法均显示C1～2椎体后方对比剂积聚（2例）、硬膜外对比剂积聚（3例）及静脉丛扩张（1例），双能量CTM碘图和VNC图像视觉显示效果更佳。结论双能量CTM可用于SIH脊髓脑脊液漏的诊断。Objective To assess the value of dual-energy computed tomography myelography （CTM） on detecting leaks of cerebrospinal fluid （CSF） in patients with spontaneous intraeranial hypotension （SIH）. Methods Six patients with SIH underwent spinal CTM on a 2nd generation dual-source CT with tube voltage set at 100 and 140 kYp（with tin filter）. The virtual non-contrast （VNC） and iodine map images were calculated from dual-energy images. The average weighted （AW） CTM images were mixed from two kVp images with mix factor of 0. 5. Two radiologists evaluated CSF leak using two sets of images respectively： VNC ＋ iodine map images and AW-CTM images. The results from two reading methods were compared. The level of CSF leaks along the nerve roots, C1-2 retrospinal CSF eollections, epidural CSF collections and spinal epidural venous plexus were marked. The consensus about leak sites and CSF collections was made by two radiologists in the third session. Kappa statistics were used to measure the agreement between the two methods. Results Forty-one leaks were detected using VNC ＋ iodine map images. Forty-three leaks were detected on AW images. The agreement between two methods was excellent （Kappa = 0. 997,P 〈 0. 01 ）. There were no differences in the detection of C1-2 retrospinal CSF collections （ n = 2 ） , epidural CSF collections （ n = 3 ） or spinal epidural venous plexus （ n = 1 ）. VNC and iodine map images demonstrated superior visual effects than AW images. Conclusion Dual-energy CTM can be used to diagnose spontaneous spinal cerebrospinal fluid leaks in SIH patient.

关 键 词：体层摄影术 X线计算机 脊髓造影术 颅内低压 

分 类 号：R816.1[医药卫生—放射医学]