脊髓MR水成像和MR鞘内钆造影在自发性颅内低压脊髓脑脊液漏点定位的价值比较  

Comparison of spinal MR myelography and Gadolinium MR myelography in localizing spinal cerebrospinal fluid leaks in patients with spontaneous intracranial hypotension

作　　者：曹佑军[1,2] 王瑾[1] 龚向阳[1,3] 

机构地区：[1]浙江大学医学院附属邵逸夫医院放射科,杭州310016 [2]杭州市中医院放射科,310007 [3]浙江省人民医院放射科,杭州310014

出　　处：《中华放射学杂志》2015年第10期721-725,共5页Chinese Journal of Radiology

摘　　要：目的比较脊髓MR水成像（MRM）与MR鞘内钆造影（GdM）对自发性颅内低压（SIH）脊髓脑脊液漏的诊断价值。方法回顾性分析158例SIH患者影像资料，其中24例同时具备MRM和GdM检查资料，评估MRM和GdM对神经根袖形态异常、神经根袖脑脊液漏、脑脊液异常积聚的显示情况，对两种成像方法的评估结果采用配对χ2检验及Kappa检验进行分析。结果24例患者中，GdM与MRM检出神经根袖形态异常数分别为176、163个，GdM检出神经根袖形态异常数目较MRM多1g个，GdM对神经根袖形态异常检出率优于MRM（χ2=6．26，P=0．011）。MRM与GdM均检出漏点者15例，5例均未检出漏点，4例GdM检出漏点但MRM未检出，GdM与MRM检出漏点数分别67、55个，GdM检出神经根袖漏点数目较MRM多12个，GdM对神经根袖漏检出率优于MRM（χ2=6．05，P=0．012），MRM与GdM漏点检出率总体一致性较好（Kappa=0．837，P=0．001）。GdM与MRM对椎体旁脑脊液异常积聚检出数分别为6、14个，对肋骨旁脑脊液异常积聚检出数分别为12、28个，MRM对椎体旁、肋骨旁脑脊液异常积聚检出率高于GdM（χ2值分别为6．13、14．06，P值分别为0．008、0．001）；GdM与MRM对椎管内硬膜外脑脊液异常积聚检出数分别为11、10个，对C1—2椎体后方脑脊液异常积聚检出数分别为1、3个，MRM与GdM对椎管内硬膜外及C1—2椎体后方脑脊液异常积聚检出率差异无统计学意义（χ2值分别为0．01、0．50，P值分别为1．000、0．500）。结论MRM与GdM对检测SIH患者的神经根袖漏、神经根袖形态异常及脑脊液异常积聚方面各有优势，MRM联合GdM可以为准确定位SIH脊髓脑脊液漏提供更加丰富信息。Objective To compare the diagnostic value between spinal MR myelography （MRM） and intratheeal Gadolinium MR myelography （GdM） in detecting spinal cerebrospinal fluid （CSF） leaks of spontaneous intracranial hypotension （SIH）. Methods Retrospective analysis of imaging findings in 158 cases with SIH was performed. Both MRM and GdM were available in 24 cases, and MRM was performed first, followed by GdM within one week. Morphological abnormalities of nerve root, CSF leaks along the nerve roots, and abnormal CSF collections were observed and compared between the two methods by using McNemar statistics and Kappa test statistics. Results Morphological abnormalities of nerve root were detected in 176 lesions on GdM and 163 lesions on MRM, respectively, and GdM was more sensitive in the detection of morphological abnormalities of nerve root （χ2=6.26, P=0.011）. CSF leaks along nerve roots were identified in 15 patients on both GdM and MRM while in 5 cases on neither GdM nor MRM, and identified in 4 patients on GdM but not on MRM. CSF leaks along the nerve roots were detected in 67 lesions on GdM and 55 lesions on MRM, respectively, and GdM was more sensitive in the detection of CSF leaks along nerve （χ2=6.05, P=0.012）. MRM and GdM showed good consistency （Kappa =0.837, P=0.001）in detecting CSF leaks for patients with SIH. Six and 14 lesions of abnormal CSF collections in bony rims of spines were respectively detected by GdM and MRM, 12 and 28 lesions of abnormal CSF collections in bony rims of the ribs were respectively detected by GdM and MRM. MRM was more sensitive in the detection of abnormal CSF collections in bony rims of the spines and the ribs （χ2=6.13, 14.06, P=0.008,0.001 ）. Eleven and 10 lesions of CSF collections in epidural space were respectively detected by GdM and MRM, 1 and 3 lesions of CSF collections of C 1-2 retrospinal space were respectively detected by GdM and MRM. No statistically significant differences existed between MRM and GdM in detecting CSF collections of ep

关 键 词：颅内低压 脑脊髓液 脊髓造影术 

分 类 号：R445.2[医药卫生—影像医学与核医学]