Rupa V, Jasper Anitha, Abraham Lisa, Rajshekhar Vedantam
Department of Otorhinolaryngology, Christian Medical College, Vellore, India.
Department of Radiodiagnosis, Christian Medical College, Vellore, India.
Neuroradiology. 2022 May;64(5):949-958. doi: 10.1007/s00234-021-02840-6. Epub 2021 Oct 22.
The purpose of this study is to document the prevalence of MR findings suggestive of idiopathic intracranial hypertension (IIH) in patients undergoing endoscopic repair of spontaneous CSF rhinorrhea (SCSFR).
In a retrospective study, MR images of 117 consecutive patients who had undergone endoscopic repair of SCSFR were evaluated for features suggestive of IIH (empty sella, widened optic nerve sheath, tortuous optic nerve, flattened posterior globe, and enlarged Meckel's cave). Pituitary height was used to diagnose partial and complete empty sella. MR images were independently evaluated by two of the authors without knowledge of the clinical findings. Consensus method was used to resolve differences between the two evaluators.
Empty or partially empty sella was diagnosed in the MR of 105 (89.7%) patients. In 38/105 (36.2%) patients with empty/partial empty sella, no additional MR findings were present. In 43/105 (41%) patients, one or more of the MR features with high specificity for diagnosis of IIH (flattened posterior globe and enlarged Meckel's cave) were seen. In the other 24 (22.9%) additional MR findings, less specific for IIH (widened optic nerve sheath, tortuous optic nerve) were noted. Papilledema was seen in 11 of 60 (18.3%) patients who underwent funduscopic examination. All patients with papilledema had empty/partial empty sella, and 9/11 (81.8%) had an additional MR finding suggestive of IIH.
The majority of patients with SCSFR have MR imaging features of IIH. These imaging features should be a major component of previously published modified diagnostic criteria for IIH in patients with SCSFR.
本研究旨在记录在接受自发性脑脊液鼻漏（SCSFR）内镜修复术的患者中，提示特发性颅内高压（IIH）的磁共振成像（MR）表现的患病率。
在一项回顾性研究中，对117例连续接受SCSFR内镜修复术的患者的MR图像进行评估，以寻找提示IIH的特征（空蝶鞍、视神经鞘增宽、视神经迂曲、眼球后部扁平、梅克尔腔扩大）。垂体高度用于诊断部分和完全空蝶鞍。两位作者在不了解临床结果的情况下独立评估MR图像。采用共识方法解决两位评估者之间的差异。
105例（89.7%）患者的MR检查诊断为空蝶鞍或部分空蝶鞍。在105例空蝶鞍/部分空蝶鞍患者中，38例（36.2%）没有其他MR表现。在105例患者中的43例（41%）中，可见一种或多种对IIH诊断具有高特异性的MR特征（眼球后部扁平、梅克尔腔扩大）。在另外24例（22.9%）患者中，发现了对IIH特异性较低的其他MR表现（视神经鞘增宽、视神经迂曲）。在60例接受眼底检查的患者中，11例（18.3%）出现视乳头水肿。所有出现视乳头水肿的患者均有空蝶鞍/部分空蝶鞍，其中9/11（81.8%）还有其他提示IIH的MR表现。
大多数SCSFR患者具有IIH的MR成像特征。这些成像特征应成为先前发表的SCSFR患者IIH改良诊断标准的主要组成部分。
