Department of Neurosciences; University of Padova Medical School, Padova, Italy.
Neurology. 2011 Nov 22;77(21):1873-6. doi: 10.1212/WNL.0b013e318238ee78. Epub 2011 Nov 9.
To explore the efficacy of spinal MRI study with subtraction analysis as a rapid, reliable, and noninvasive procedure to detect epidural CSF collection in spontaneous intracranial hypotension (SIH) syndrome.
Seventeen patients (mean age 42 years, age range 17-65 years; 11 female) with SIH diagnosed using the International Classification of Headache Disorders criteria and 13 age-matched control subjects underwent standard sagittal spinal MRI. Postprocessing image analysis with subtraction of T1-weighted from T2-weighted MRI scans was performed and tested for the detection of the CSF leak.
The CSF epidural collection was visible in all patients with SIH and was detected at the dorsal (16 of 17), cervical (13 of 17), lumbar (13 of 17), and sacral (12 of 17) levels. None of the control subjects showed a CSF leak. Diverticula were present in 23% of patients, whereas the actual site of the CSF leak was recognized in only one patient. Eight patients were treated conservatively, whereas 9 patients required an epidural blood patch, performed at a fixed L2-L3 or L3-L4 spinal level, with complete recovery.
Spinal MRI with dedicated subtraction analysis could represent the first-line diagnostic tool in the management of patients with SIH, thus leaving invasive investigation for selected patients, such those requiring dural surgery.
探索脊髓 MRI 研究与减影分析相结合作为一种快速、可靠、无创的方法，用于检测自发性颅内低血压（SIH）综合征中的硬膜外 CSF 积聚。
17 例符合国际头痛疾病分类标准诊断的 SIH 患者（平均年龄 42 岁，年龄范围 17-65 岁；11 名女性）和 13 名年龄匹配的对照组受试者接受了标准矢状面脊髓 MRI 检查。对 T1 加权和 T2 加权 MRI 扫描进行减影后的图像分析，并对 CSF 漏的检测进行了测试。
所有 SIH 患者的硬膜外 CSF 积聚均可见，并在背部（17 例中的 16 例）、颈部（17 例中的 13 例）、腰部（17 例中的 13 例）和骶部（17 例中的 12 例）检测到。对照组无一例显示 CSF 漏。23%的患者存在憩室，而仅在 1 例患者中识别出 CSF 漏的实际部位。8 例患者接受保守治疗，而 9 例患者需要硬膜外血贴，在固定的 L2-L3 或 L3-L4 脊柱水平进行，均完全恢复。
专门的脊髓 MRI 减影分析可能成为 SIH 患者管理的一线诊断工具，从而将有创性检查留给特定患者，例如需要硬脑膜手术的患者。
