脊髓磁共振水成像和CT脊髓造影诊断自发性低颅压综合征的准确性比较  

Comparison of the accuracy between magnetic resonance hydrography and CT myelography in diagnosing of spontaneous intracranial hypotension syndrome

作　　者：张昱雯 徐慰幸子 林江 丁晶 汪昕 Zhang Yuwen;Xu Weixingzi;Lin Jiang;Ding Jing;Wang Xin(Department of Neurology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院神经内科,上海200032 [2]复旦大学附属中山医院放射诊断科,上海200032

出　　处：《中华医学杂志》2025年第13期1004-1009,共6页National Medical Journal of China

基　　金：上海市卫生健康委员会科研项目(202140297)。

摘　　要：目的比较脊髓磁共振水成像(MRM)和CT脊髓造影(CTM)诊断自发性低颅压综合征(SIH)的准确性。方法前瞻性收集2021年6月至2023年8月于复旦大学附属中山医院神经内科住院治疗的SIH患者的临床资料,首先进行MRM检查,随后进行CTM检查。以CTM检查作为金标准,验证MRM与CTM检查的一致性,观察硬膜外脑脊液积聚诊断结果,进一步将脑脊液异常积聚分为C 1~2椎体后方、神经根走行区、椎体旁及肋骨旁4个部位分别记录,采用Kappa一致性检验对两种检查方法的评估结果进行比较分析。结果共有31例患者被纳入研究,男13例,女18例,年龄(40.7±7.0)岁。MRM发现脑脊液渗漏阳性率93.5%(29例),CTM检查发现脑脊液渗漏阳性率87.1%(27例),Kappa一致性分析显示MRM与CTM具有高度一致性(Kappa=0.635,P<0.001)。MRM在检测脑脊液聚集沿神经根走行区和脑脊液聚集沿肋骨旁分布与CTM相比具有良好一致性(Kappa分别为0.469和0.652)。MRM在检测脑脊液积聚在C 1~2椎体后方和椎体旁与CTM相比具有较低一致性(Kappa分别为0.241和0.271),但前者具有较高的灵敏度(0.833,95%CI:0.436~0.991),后者具有较高特异度(0.963,95%CI:0.817~0.998)。结论MRM对诊断SIH患者硬膜外脑脊液积聚的价值与CTM相当,具有良好一致性,且无创、无辐射,可能是SIH患者初步评估的合适替代方法。Objective To compare the accuracy of spinal magnetic resonance myelography(MRM)and CT myelography(CTM)in the detection of spontaneous intracranial hypotension(SIH).Methods The clinica data of SIH patients at the Neurology Department of Zhongshan Hospital Affiliated to Fudan University between June 2021 and August 2023 were prospectively collected.MRM was performed first,CTM,followed by CTM.CTM results were used as the gold standard to verify the consistency of MRM and CTM examination,and the diagnostic results of epidural cerebrospinal fluid accumulation were observed.The abnormal accumulation of cerebrospinal fluid(CSF)was further recorded in 4 parts,namely,the posterior part of the cervical vertebra,the nerve root walking area,the side of the vertebra and the side of the ribs.Kappa consistency test was used to compare and analyze the evaluation results of the two examination methods.Results A total of 31 patients were included in the study,including 13 males and 18 females,aged(40.7±7.0)years.The positive rate of CSF leakage detected by MRM was 93.5%(29 cases),and that detected by CTM was 87.1%(27 cases).Kappa consistency analysis showed that there was a high consistency between MRM and CTM(Kappa=0.635,P<0.001).MRM had good consistency with CTM in detecting CSF accumulation along the nerve root area and paracostal area(Kappa values were 0.469 and 0.652,respectively).MRM had relatively low consistency with CTM in detecting CSF accumulation behind the C 1-2 vertebrae and in the paravertebral area(Kappa values were 0.241 and 0.271,respectively),but the former had a higher sensitivity(0.833,95%CI:0.436-0.991),and the latter had a higher specificity(0.963,95%CI:0.817-0.998).Conclusions MRM has a comparable value to CTM in diagnosing epidural CSF accumulation in SIH patients,with good consistency.Besides,it is non-invasive and radiation-free,and may be a suitable alternative method for the initial assessment of SIH patients.

关 键 词：颅内压 自发性低颅压综合征 脊髓磁共振水成像 CT脊髓造影 脑脊液漏 横断面研究 

分 类 号：R741[医药卫生—神经病学与精神病学] R651.1[医药卫生—临床医学]