Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
Neurology. 2010 Nov 9;75(19):1730-4. doi: 10.1212/WNL.0b013e3181fc2997.
We sought to evaluate radioisotope cisternography (RICG)-related postpuncture CSF leakage by MRI.
We conducted a prospective 3-day imaging study. Ten patients with orthostatic headache and other symptoms underwent pre-RICG brain and spinal MRI, magnetic resonance myelography (MRM), RICG, and post-RICG spinal MRI and MRM. For RICG, we used a 25-gauge pencil point spinal needle at the L3/4 or L4/5 level after which subjects took bed rest for 2.5 hours.
On pre-RICG MRI and MRM, none of the 10 patients showed CSF leakage. However, 5 subjects (50%) showed epidural abnormalities suggesting CSF leakage on MRI after lumbar puncture for RICG. On RICG and subsequent MRM, 4 of the subjects showed definite findings of CSF leakage and 1 showed minimal leakage.
RICG carries a risk of iatrogenic CSF leakage even with careful puncturing using a fine needle. This leakage produces abnormal RICG and MRM findings at the lumbosacral level. Therefore, abnormal RICG findings restricted to the lumbosacral level should be carefully interpreted when diagnosing SIH.
我们试图通过 MRI 评估放射性核素脑池造影（RICG）相关的穿刺后脑脊液漏。
我们进行了一项为期 3 天的前瞻性影像学研究。10 名出现直立性头痛和其他症状的患者接受了 RICG 前脑和脊髓 MRI、磁共振脊髓造影（MRM）、RICG 以及 RICG 后脊髓 MRI 和 MRM 检查。RICG 采用 25 号笔尖脊髓针在 L3/4 或 L4/5 水平进行穿刺，之后患者卧床休息 2.5 小时。
在 RICG 前 MRI 和 MRM 上，10 名患者均未显示脑脊液漏。然而，5 名患者（50%）在 RICG 腰椎穿刺后 MRI 上显示硬膜外异常，提示存在脑脊液漏。在 RICG 和随后的 MRM 上，4 名患者显示明确的脑脊液漏，1 名患者显示轻微漏。
即使使用细针小心穿刺，RICG 也存在医源性脑脊液漏的风险。这种漏出会在腰骶部产生异常的 RICG 和 MRM 表现。因此，在诊断 SIH 时，应仔细解释仅局限于腰骶部的异常 RICG 表现。
