Kranz Peter G, Amrhein Timothy J, Choudhury Kingshuk Roy, Tanpitukpongse Teerath Peter, Gray Linda
1 Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
AJR Am J Roentgenol. 2016 Dec;207(6):1283-1287. doi: 10.2214/AJR.16.16381. Epub 2016 Aug 24.
The objective of our study was to determine whether the presence of individual imaging signs of spontaneous intracranial hypotension (SIH) is correlated with increasing duration of headache symptoms. Of particular interest is the relationship of symptom duration to dural enhancement because it is the most commonly identified imaging sign in patients with SIH.
Eighty-nine patients with SIH who underwent pretreatment brain MRI and total-spine CT myelography and whose medical record included data on the duration of clinical symptoms were included in this cross-sectional retrospective study. Brain imaging was reviewed for the presence of dural enhancement, brain sagging, and the "venous distention" sign. CT myelograms were assessed for CSF leak. If present, a leak was subcategorized as a high-flow or low-flow leak. Differences in headache duration between subjects with and those without individual imaging signs were compared.
Subjects without dural enhancement on brain MRI had a longer average duration of symptoms than those with dural enhancement present (average symptom duration: 45.3 ± 59.0 [SD] vs 15.1 ± 33.0 weeks, respectively; p = 0.002). No difference in symptom duration was observed between subjects whose MRI studies showed and those whose MRI studies did not show brain sagging (p = 0.10) or the venous distention sign (p = 0.21). The presence of a CSF leak on CT myelography was not associated with symptom duration (p = 0.56) except in the subgroup of patients with low-flow leaks.
Increasing symptom duration in SIH is associated with decreased prevalence of abnormal dural enhancement on brain MRI. Because dural enhancement is considered a hallmark imaging feature of this condition, its absence may exacerbate the problem of underdiagnosis in chronic cases of SIH.
我们研究的目的是确定自发性颅内低压（SIH）的个体影像学征象是否与头痛症状持续时间的延长相关。特别值得关注的是症状持续时间与硬脑膜强化之间的关系，因为它是SIH患者中最常识别的影像学征象。
本横断面回顾性研究纳入了89例接受预处理脑MRI和全脊柱CT脊髓造影且病历包含临床症状持续时间数据的SIH患者。对脑部影像学检查进行评估，以确定是否存在硬脑膜强化、脑下垂和“静脉扩张”征象。对CT脊髓造影评估脑脊液漏情况。如果存在脑脊液漏，则将其分类为高流量或低流量漏。比较有和没有个体影像学征象的受试者之间头痛持续时间的差异。
脑MRI上没有硬脑膜强化的受试者症状平均持续时间比有硬脑膜强化的受试者更长（平均症状持续时间分别为：45.3±59.0[标准差]周和15.1±33.0周；p=0.002）。MRI检查显示和未显示脑下垂（p=0.10）或静脉扩张征象（p=0.21）的受试者之间症状持续时间没有差异。CT脊髓造影显示脑脊液漏与症状持续时间无关（p=0.56），但低流量漏患者亚组除外。
SIH中症状持续时间的增加与脑MRI上硬脑膜强化异常的患病率降低相关。由于硬脑膜强化被认为是这种疾病的标志性影像学特征，其不存在可能会加剧SIH慢性病例中漏诊的问题。
