Wang Yu-Wei, Teng Chieh-Lin Jerry, Chai Jyh-Wen, Wu Chih-Cheng, Chen Po-Lin, Chen Hung-Chieh
Department of Radiology, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
Diagnostics (Basel). 2022 May 6;12(5):1158. doi: 10.3390/diagnostics12051158.
Epidural blood patching (EBP) is the mainstay therapy for spontaneous intracranial hypotension (SIH). MRI is used for evaluating spinal CSF leakage. Post-EBP MRI has been. shown to be effective in predicting the efficacy of EBP. However, there are few reports on how post-EBP MRI findings may change with time. The aim of this study was to evaluate the relationship between post-EBP MRI findings at different time points and the corresponding effectiveness of EBP.
We retrospectively reviewed 63 SIH patients who had received target EBP. All patients received an MRI follow-up within 10 days (post-EBP MRI) and at 3 months after EBP (3-month MRI). A sub-group analysis was performed at different post-EBP MRI time points (0-2, 3-6, and 7-10 days). The relationships between the post-EBP MRI findings and the EBP effectiveness were evaluated.
Thirty-five (55.56%) patients were assigned to the EBP-effective group, and 28 (44.44%) were assigned to the EBP non-effective group according to the 3-month MRI. Compared to the EBP non-effective group, the EBP-effective group had significantly lower numbers of spinal CSF leakage in the post-EBP MRI (4.49 vs. 11.71; = 0.000) and greater numbers of leakage improvement (7.66 vs. 2.96; = 0.003). For patients who received post-EBP MRI during periods of 0-10, 0-2, 3-6, and 7-10 days, the cutoff values of numbers of spinal CSF leakage for predicting EBP failure were 4, 6, 4, and 5, respectively, with an AUC above 0.77.
By using post-EBP MRI, which only takes approximately 20 min, predicting EBP efficacy became possible in SIH patients. This study provides cutoff values of numbers of spinal CSF leakage at different follow-up times to serve as clues of if further EBP is needed, which provides the novelty of the current study.
硬膜外血贴疗法（EBP）是自发性颅内低压（SIH）的主要治疗方法。MRI用于评估脊髓脑脊液漏。EBP术后MRI已被证明可有效预测EBP的疗效。然而，关于EBP术后MRI表现如何随时间变化的报道很少。本研究的目的是评估不同时间点的EBP术后MRI表现与相应的EBP疗效之间的关系。
我们回顾性分析了63例接受靶向EBP的SIH患者。所有患者在10天内（EBP术后MRI）和EBP后3个月（3个月MRI）接受了MRI随访。在不同的EBP术后MRI时间点（0 - 2天、3 - 6天和7 - 10天）进行亚组分析。评估EBP术后MRI表现与EBP疗效之间的关系。
根据3个月MRI结果，35例（55.56%）患者被归入EBP有效组，28例（44.44%）患者被归入EBP无效组。与EBP无效组相比，EBP有效组在EBP术后MRI中脊髓脑脊液漏的数量显著更少（4.49对11.71；P = 0.000），漏口改善的数量更多（7.66对2.96；P = 0.003）。对于在0 - 10天、0 - 2天、3 - 6天和7 - 10天期间接受EBP术后MRI检查的患者，预测EBP失败的脊髓脑脊液漏数量的截断值分别为4、6、4和5，曲线下面积（AUC）均高于0.77。
通过使用仅需约20分钟的EBP术后MRI，在SIH患者中预测EBP疗效成为可能。本研究提供了不同随访时间的脊髓脑脊液漏数量的截断值，作为是否需要进一步进行EBP的线索，这为本研究的新颖之处。
