Muñoz A, Hinojosa J, Esparza J
Section of Pediatric Neuroradiology, Hospital Materno-Infantil 12 de Octubre, Madrid, Spain.
AJNR Am J Neuroradiol. 2007 May;28(5):889-94.
Complex CSF diseases may be underdiagnosed or poorly understood on conventional CT or MR imaging. Although intrathecal CT cisternography with water-soluble iodinated contrast medium has been used, very few studies have dealt with the intrathecal use of gadopentate dimeglumine (Gd-DTPA), though it appears superior to CT. We report our experience with the intrathecal use of Gd-DTPA for MR cisternography and ventriculography in pediatric patients referred for study and treatment of complex CSF-related diseases.
Ten patients (range, 1 month-16 years of age) were selected after we obtained specific informed consent. Intrathecal gadolinium injection was performed via transfontanelle ventriculostomy, ventriculoperitoneal shunt reservoir, or lumbar puncture. Cases included spontaneous CSF leaks (n=1), complex traumatic frontoethmoidal fractures with suspected CSF leak (n=2), multiloculated congenital or acquired hydrocephalus (n=3), intraventricular tumor (n=1), suspected postoperative arachnoiditis (n=1), complex midline defect (n=1), and acquired orbital meningoencephalocele (n=1).
No patient showed biologic, behavioral, or neurologic alterations. In complex hydrocephalus or intraventricular cysts, ventriculography Gd-DTPA MR imaging helped to differentiate isolation of a ventricle or noncommunicating cyst in all 4 patients. In suspected posttraumatic CSF leaks, the procedure established with precision the place of the leak in 1 patient and excluded it in the other. In 1 patient who underwent surgery for spinal cord neoplasm, the procedure excluded arachnoiditis. In the other 3 patients with complex CSF-related diseases, the procedure showed distinctive radiologic findings for the understanding and treatment of the disease. Altogether, in 8 patients, imaging findings influenced or changed clinical decisions and surgical planning.
Our preliminary results showed no side effects and potential useful clinical applications in the evaluation of CNS diseases involving the ventricular system or the subarachnoid space in selected pediatric patients.
复杂的脑脊液疾病在传统CT或MR成像上可能诊断不足或理解不充分。尽管已经使用水溶性碘化造影剂进行鞘内CT脑池造影，但很少有研究涉及钆喷酸葡胺（Gd-DTPA）的鞘内使用，尽管它似乎优于CT。我们报告了在因复杂脑脊液相关疾病转诊进行研究和治疗的儿科患者中鞘内使用Gd-DTPA进行MR脑池造影和脑室造影的经验。
在获得特定知情同意后，选择了10例患者（年龄范围为1个月至16岁）。通过经囟门脑室造瘘术、脑室腹腔分流管储液器或腰椎穿刺进行鞘内钆注射。病例包括自发性脑脊液漏（n = 1）、伴有疑似脑脊液漏的复杂创伤性额筛窦骨折（n = 2）、多房性先天性或后天性脑积水（n = 3）、脑室内肿瘤（n = 1）、疑似术后蛛网膜炎（n = 1）、复杂中线缺损（n = 1）和后天性眶内脑膜脑膨出（n = 1）。
没有患者出现生物学、行为或神经学改变。在复杂脑积水或脑室内囊肿中，脑室造影Gd-DTPA MR成像有助于在所有4例患者中区分脑室或非交通性囊肿的孤立情况。在疑似创伤后脑脊液漏中，该操作精确确定了1例患者漏口的位置，而在另一例中排除了漏口。在1例接受脊髓肿瘤手术的患者中，该操作排除了蛛网膜炎。在其他3例患有复杂脑脊液相关疾病的患者中，该操作显示出独特的影像学表现，有助于理解和治疗该疾病。总体而言，在8例患者中，影像学结果影响或改变了临床决策和手术规划。
我们的初步结果表明，在选定的儿科患者中，鞘内使用Gd-DTPA在评估涉及脑室系统或蛛网膜下腔的中枢神经系统疾病时没有副作用，且具有潜在的临床应用价值。
