自发性颅内低压患者脑脊液的定量测量
Quantitative Measurement of CSF in Patients with Spontaneous Intracranial Hypotension.
作者信息
Chen H-C, Chen P-L, Tsai Y-H, Chen C-H, Chen C C-C, Chai J-W
机构信息
From the Departments of Radiology (H.-C.C., C.-H.C., C.C.-C.C., J.-W.C.).
Department of Medicine (H.-C.C.), National Yang-Ming University, Taipei, Taiwan.
出版信息
AJNR Am J Neuroradiol. 2017 May;38(5):1061-1067. doi: 10.3174/ajnr.A5134. Epub 2017 Apr 6.
BACKGROUND AND PURPOSE
CSF hypovolemia is a core feature of spontaneous intracranial hypotension. Spontaneous intracranial hypotension is characterized by orthostatic headache and radiologic manifestations, including CSF along the neural sleeves, diffuse pachymeningeal enhancement, and/or venous engorgement. However, these characteristics are only qualitative. Quantifying intraspinal CSF volumes could improve spontaneous intracranial hypotension diagnosis and evaluation of hypovolemic statuses in patients with spontaneous intracranial hypotension. The purpose of this study was to compare intraspinal CSF volumes across spontaneous intracranial hypotension stages and to test the clinical applicability of these measures.
MATERIALS AND METHODS
A cohort of 23 patients with spontaneous intracranial hypotension and 32 healthy controls was subjected to brain MR imaging and MR myelography with 1.5T imaging. An automatic threshold-based segmentation method was used to calculate intraspinal CSF volumes at initial hospitalization (spontaneous intracranial hypotension-initial), partial improvement (spontaneous intracranial hypotension-intermediate), and complete recovery (spontaneous intracranial hypotension-recovery) stages.
RESULTS
The mean intraspinal CSF volumes observed were the following: 95.31 mL for healthy controls, 72.31 mL for spontaneous intracranial hypotension-initial, 81.15 mL for spontaneous intracranial hypotension-intermediate, and 93.74 mL for spontaneous intracranial hypotension-recovery. Increased intraspinal CSF volumes were related to disease recovery ( < .001). The intraspinal CSF volumes of patients before complete recovery were significantly lower than those of healthy controls. With the estimated intradural CSF volumes as a reference, the intraspinal CSF volume percentage was lower in patients with spontaneous intracranial hypotension with venous engorgement than in those without it ( = .058).
CONCLUSIONS
With a threshold-based segmentation method, we found that spinal CSF hypovolemia is fundamentally related to spontaneous intracranial hypotension. Intraspinal CSF volumes could be a sensitive parameter for the evaluation of treatment response and follow-up monitoring in patients with spontaneous intracranial hypotension.
背景与目的
脑脊液容量减少是自发性颅内低压的核心特征。自发性颅内低压的特点是体位性头痛和影像学表现，包括沿神经袖的脑脊液、硬脑膜弥漫性强化和/或静脉充血。然而，这些特征只是定性的。量化脊髓内脑脊液体积可以改善自发性颅内低压的诊断以及对自发性颅内低压患者血容量减少状态的评估。本研究的目的是比较自发性颅内低压各阶段的脊髓内脑脊液体积，并测试这些测量方法的临床适用性。
材料与方法
对23例自发性颅内低压患者和32名健康对照者进行1.5T脑磁共振成像和磁共振脊髓造影检查。采用基于自动阈值的分割方法计算初次住院（自发性颅内低压-初始阶段）、部分改善（自发性颅内低压-中期阶段）和完全恢复（自发性颅内低压-恢复阶段）时的脊髓内脑脊液体积。
结果
观察到的平均脊髓内脑脊液体积如下：健康对照者为95.31 mL，自发性颅内低压-初始阶段为72.31 mL，自发性颅内低压-中期阶段为81.15 mL，自发性颅内低压-恢复阶段为93.74 mL。脊髓内脑脊液体积增加与疾病恢复相关（P<0.001）。完全恢复前患者的脊髓内脑脊液体积显著低于健康对照者。以估计的硬膜内脑脊液体积为参考，有静脉充血的自发性颅内低压患者的脊髓内脑脊液体积百分比低于无静脉充血的患者（P=0.058）。
结论
通过基于阈值的分割方法，我们发现脊髓脑脊液容量减少与自发性颅内低压密切相关。脊髓内脑脊液体积可能是评估自发性颅内低压患者治疗反应和随访监测的敏感参数。
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