Kashefiolasl Sepide, Brawanski Nina, Platz Johannes, Bruder Markus, Senft Christian, Marquardt Gerhard, Seifert Volker, Tritt Stephanie, Konczalla Juergen
Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany.
Institute of Neuroradiology, Goethe-University, Frankfurt am Main, Germany.
PLoS One. 2017 Apr 3;12(4):e0174734. doi: 10.1371/journal.pone.0174734. eCollection 2017.
Up to 15% of all spontaneous subarachnoid hemorrhages (SAH) have a non-aneurysmal SAH (NASAH). The evaluation of SAH patients with negative digital subtraction angiography (DSA) is sometimes a diagnostic challenge. Our goal in this study was to reassess the yield of standard MR-imaging of the complete spinal axis to rule out spinal bleeding sources in patients with NASAH.
We retrospectively analyzed the spinal MRI findings in 190 patients with spontaneous NASAH, containing perimesencephalic (PM) and non-perimesencephalic (NPM) SAH, diagnosed by computer tomography (CT) and/or lumbar puncture (LP), and negative 2nd DSA.
190 NASAH patients were included in the study, divided into PM-SAH (n = 87; 46%) and NPM-SAH (n = 103; 54%). Overall, 23 (22%) patients had a CT negative SAH, diagnosed by positive LP. MR-imaging of the spinal axis detected two patients with lumbar ependymoma (n = 2; 1,05%). Both patients complained of radicular sciatic pain. The detection rate raised up to 25%, if only patients with radicular sciatic pain received an MRI.
Routine radiological investigation of the complete spinal axis in NASAH patients is expensive and can not be recommended for standard procedure. However, patients with clinical signs of low-back/sciatic pain should be worked up for a spinal pathology.
在所有自发性蛛网膜下腔出血（SAH）中，高达15%为非动脉瘤性蛛网膜下腔出血（NASAH）。对数字减影血管造影（DSA）结果为阴性的SAH患者进行评估有时是一项诊断挑战。我们在本研究中的目标是重新评估完整脊柱轴标准磁共振成像（MRI）在排除NASAH患者脊柱出血源方面的检出率。
我们回顾性分析了190例自发性NASAH患者的脊柱MRI检查结果，这些患者包括经计算机断层扫描（CT）和/或腰椎穿刺（LP）诊断为中脑周围（PM）和非中脑周围（NPM）SAH且第二次DSA结果为阴性的患者。
190例NASAH患者纳入研究，分为PM-SAH组（n = 87；46%）和NPM-SAH组（n = 103；54%）。总体而言，23例（22%）患者CT显示SAH阴性，但经LP检查呈阳性而确诊。脊柱轴MRI检查发现2例腰椎室管膜瘤患者（n = 2；1.05%）。这两名患者均主诉有坐骨神经痛。如果仅对有坐骨神经痛的患者进行MRI检查，检出率可提高至25%。
对NASAH患者进行完整脊柱轴的常规放射学检查费用高昂，不建议作为标准程序。然而，有腰/坐骨神经痛临床体征的患者应进行脊柱病变检查。
