Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Radiology, Wan Fang Hospital, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei City, Taiwan, 110.
Neuroradiology. 2020 May;62(5):593-599. doi: 10.1007/s00234-019-02356-0. Epub 2020 Jan 29.
Cough-associated headache (CAH) is the most distinctive symptom of patients with Chiari I malformation (CMI) and indicates clinically significant disease. We determined the clinical utility of simple 2D anatomic measurements performed on a PACS workstation by assessing their diagnostic accuracy in predicting CAH in CMI patients.
Seventy-two consecutive CMI patients (cerebellar tonsillar herniation > 5 mm) with headache seen by neurosurgeons over 6 years were included. Sagittal T1 images were used by two readers to measure: extent of tonsillar herniation, lengths of the clivus and supra-occiput, McRae and pB-C2 lines, as well as clivus-canal, odontoid retroversion, and skull base angles. Neurosurgery notes were reviewed to determine presence of CAH. Mann-Whitney test was used to compare measurements between patients with and without CAH. Predictive accuracy was assessed by receiver operating characteristic (ROC) curve.
47/72 (65.3%) CMI patients reported CAH. Tonsillar herniation with CAH (10.2 mm, 7-14 mm; median, interquartile range) was significantly greater than those without CAH (7.9 mm, 6.3-10.9 mm; p = 0.02). Tonsillar herniation ≥ 10 mm showed sensitivity and specificity of 51% and 68%, and tonsillar herniation > 14 mm showed sensitivity and specificity of 30% and 100%, respectively, for predicting CAH. Other 2D measurements showed no statistically significant differences.
Among the 2D measurements used, only the extent of tonsillar herniation is different between CMI patients with and without CAH. Although CMI is diagnosed with tonsillar herniation of only 5 mm, we found that a much higher extent of herniation is needed to be predictive of CAH.
咳嗽相关头痛（CAH）是 Chiari I 畸形（CMI）患者最具特征性的症状，表明存在有临床意义的疾病。我们通过评估在 PACS 工作站上进行的简单 2D 解剖测量在预测 CMI 患者 CAH 中的诊断准确性，来确定其临床实用性。
在 6 年内，神经外科医生对 72 例连续的 CMI 患者（小脑扁桃体疝出>5mm）进行了头痛评估，包括头痛。两位读者使用矢状 T1 图像测量：扁桃体疝出程度、斜坡和枕骨上颈长度、McRae 线和 pB-C2 线、斜坡-椎管、齿状突后旋和颅底角度。回顾神经外科记录以确定 CAH 的存在。采用 Mann-Whitney 检验比较有和无 CAH 的患者之间的测量值。通过接收者操作特征（ROC）曲线评估预测准确性。
47/72（65.3%）CMI 患者报告有 CAH。伴有 CAH 的扁桃体疝出（10.2mm，7-14mm；中位数，四分位间距）明显大于无 CAH 的患者（7.9mm，6.3-10.9mm；p=0.02）。扁桃体疝出≥10mm 的敏感性和特异性分别为 51%和 68%，而扁桃体疝出>14mm 的敏感性和特异性分别为 30%和 100%，用于预测 CAH。其他 2D 测量值没有显示出统计学上的显著差异。
在所使用的 2D 测量中，只有伴有和不伴有 CAH 的 CMI 患者的扁桃体疝出程度不同。尽管 CMI 的诊断标准是扁桃体疝出 5mm，但我们发现需要更大程度的疝出才能预测 CAH。
