自发性颅内低压CT与MR椎管造影检查失败的影像学特征  

Imaging Features of Unsuccessful CT Myelography and Gadolinium-enhanced MR Myelography in Spontaneous Intracranial Hypotension

作　　者：许佳祺 王瑾[2] 龚向阳[3] 

机构地区：[1]浙江医院放射科,浙江杭州310013 [2]浙江大学医学院附属邵逸夫医院神经内科,浙江杭州310020 [3]浙江省人民医院放射科,浙江杭州310014

出　　处：《中国医学影像学杂志》2015年第10期721-724,共4页Chinese Journal of Medical Imaging

摘　　要：目的自发性颅内低压(SIH)临床少见,CT及MR脊髓造影是检测和定位脊髓脑脊液漏点最有效的方法,对疾病诊断及SIH后续靶向血贴治疗有重要价值。本文分析SIH脊髓造影检查对比剂意外注入硬膜外间隙导致检查失败的发生率及其影像学特征,指导临床迅速、正确地判断CT脊髓造影和MR脊髓造影成败。资料与方法回顾性分析121例SIH患者的脊髓造影资料,分析失败脊髓造影中对比剂形态、轮廓、密度或信号及其在脑池、脑室内的扩散等征象。结果 121例SIH患者共完成脊髓造影检查128例次,对比剂意外注入硬膜外间隙33例次,失败率为25.8%。33例次失败脊髓造影检查影像中,均可见硬膜囊两侧神经根穿行于对比剂中,均未见脊髓前后根穿行于对比剂中;29例(87.9%)未见马尾穿行于对比剂中;26例(78.8%)对比剂未扩散入脑池、脑室;16例(48.5%)椎管内对比剂影不连续;10例(30.3%)椎管内对比剂影不均匀;4例(12.1%)对比剂影内侧轮廓不光整。结论 SIH患者脊髓造影检查中,对比剂意外注入硬膜外间隙致造影检查失败的发生率较高,CT脊髓造影和MR脊髓造影具有特征性影像学表现,可对检查做出快速而准确的判断。Purpose CT myelography（CTM） and gadolinium-enhanced MR myelography（Gd-MRM） are essential methods used for localizing spinal cerebrospinal fluid leaks in patients with spontaneous intracranial hypotension（SIH） and are significant for diagnosis and guided epidural blood patches. This paper analyzes the rate and imaging features of unsuccessful myelography due to misinjection of contrast into epidural space to guide prompt and correct clinical judgment of unsuccessful myelography. Materials and Methods Myelography from 121 patients with SIH was retrospectively reviewed and the image features of the unsuccessful myelography were analyzed. Results A total of 128 myelography examinations were done. Contrast media was accidently injected into the epidural space in 33 examinations. The failure rate was 25.8%. In all 33 failed exams, bilateral spinal nerve roots on both sides of the dural sac passing through contrast media was observed without visualization of anterior and posterior nerve roots. Cauda equina was not seen within contrast media in 29 cases（87.9%）; non-diffusion of contrast media into cisterns and ventricles in 26 cases（78.8%）. Contrast was not continuous in spinal canal in 16 cases（48.5%）, heterogeneous in 10 cases（30.3%）. In 4 cases（12.1%） the inner contour of contrast was not smooth. Conclusion The unsuccessful rate of myelography is relatively high in SIH patients. A prompt and correct decision could be made based on the knowledge of contrast misinjection imaging features.

关 键 词：颅内低压 体层摄影术 X线计算机 磁共振成像 脊髓造影术 诊断和治疗物质外渗 

分 类 号：R742[医药卫生—神经病学与精神病学] R445[医药卫生—临床医学]