From the Departments of Neurology and Neurophysiology (K.W., S.B.), Neuroradiology (N.L., H.M., N.K., H.U.), Radiology, Medical Physics (M.R.), and Neurosurgery (C.F., J.B.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
Neurology. 2023 Feb 14;100(7):e651-e660. doi: 10.1212/WNL.0000000000201527. Epub 2022 Nov 10.
BACKGROUND AND OBJECTIVES: Spontaneous intracranial hypotension (SIH) is characterized by loss of CSF volume. We hypothesize that in this situation of low volume, a larger CSF flow and spinal cord motion at the upper spine can be measured by noninvasive phase contrast MRI. METHODS: A prospective, age-, sex-, and body mass index (BMI)-matched controlled cohort study on patients with SIH presenting with spinal longitudinal extradural fluid collection (SLEC) was conducted from October 2021 to February 2022. Cardiac-gated 2D phase contrast MRI sequences were acquired at segment C2/C3, and C5/C6 for CSF flow, and spinal cord motion analysis. Data processing was fully automated. CSF flow and spinal cord motion were analyzed by peak-to-peak amplitude and total displacement per segment and heartbeat, respectively. Clinical data included age, height, BMI, duration of symptoms, Bern score according to Dobrocky et al., and type of the spinal CSF leak according to Schievink et al. Groups were compared via the Mann-Whitney test; multiple linear regression analysis was performed to address possible relations. RESULTS: Twenty patients with SIH and 40 healthy controls were analyzed; each group consisted of 70% women. Eleven patients with SIH presented with type 1 leak, 8 with type 2, and 1 was indeterminate. CSF flow per heartbeat was increased at C2/C3 (peak-to-peak amplitude 65.68 ± 18.3 vs 42.50 ± 9.8 mm/s, total displacement 14.32 ± 3.5 vs 9.75 ± 2.7 mm, < 0.001, respectively). Craniocaudal spinal cord motion per heartbeat was larger at segment C2/C3 (peak-to-peak amplitude 7.30 ± 2.4 vs 5.82 ± 2.0 mm/s, total displacement 1.01 ± 0.4 vs 0.74 ± 0.4 mm, = 0.006, respectively) and at segment C5/C6 (total displacement 1.41 ± 0.7 vs 0.97 ± 0.4 mm, = 0.021). DISCUSSION: SLEC-positive patients with SIH show higher CSF flow and higher spinal cord motion at the upper cervical spine. This increased craniocaudal motion of the spinal cord per heartbeat might produce increased mechanical strain on neural tissue and adherent structures, which may be a mechanism leading to cranial nerve dysfunction, neck pain, and stiffness in SIH. Noninvasive phase contrast MRI of CSF flow and spinal cord motion is a promising diagnostic tool in SIH. TRIAL REGISTRATION INFORMATION: German Clinical Trials Register, identification number: DRKS00017351. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that noninvasive phase contrast MRI of the upper spine identifies differences in CSF flow and spinal cord motion in patients with SIH compared with healthy controls.
背景和目的：自发性颅内低血压（SIH）的特征是脑脊液（CSF）容量减少。我们假设在这种低容量的情况下，通过非侵入性相位对比 MRI 可以测量到上脊柱更高的 CSF 流量和脊髓运动。
方法：对 2021 年 10 月至 2022 年 2 月期间因脊髓纵向硬脊膜外积液（SLEC）就诊的 SIH 患者进行前瞻性、年龄、性别和体重指数（BMI）匹配的对照队列研究。在 C2/C3 和 C5/C6 节段采集心脏门控 2D 相位对比 MRI 序列，用于 CSF 流量和脊髓运动分析。数据处理完全自动化。通过峰峰值幅度和每个心动周期的段内总位移分别分析 CSF 流量和脊髓运动。临床数据包括年龄、身高、BMI、症状持续时间、根据 Dobrocky 等制定的 Bern 评分以及根据 Schievink 等制定的脊髓 CSF 漏类型。通过曼-惠特尼 U 检验比较组间差异；进行多元线性回归分析以确定可能的关系。
结果：分析了 20 例 SIH 患者和 40 例健康对照者；每组各有 70%的女性。11 例 SIH 患者表现为 1 型漏，8 例为 2 型漏，1 例不确定。C2/C3 节段的每个心动周期 CSF 流量增加（峰峰值幅度 65.68 ± 18.3 比 42.50 ± 9.8 mm/s，总位移 14.32 ± 3.5 比 9.75 ± 2.7 mm，均<0.001）。C2/C3 节段每个心动周期的脊髓颅尾运动幅度增加（峰峰值幅度 7.30 ± 2.4 比 5.82 ± 2.0 mm/s，总位移 1.01 ± 0.4 比 0.74 ± 0.4 mm，均=0.006），C5/C6 节段的总位移也增加（1.41 ± 0.7 比 0.97 ± 0.4 mm，=0.021）。
讨论：SLEC 阳性的 SIH 患者上颈椎 CSF 流量更高，脊髓运动幅度更大。这种每个心动周期脊髓颅尾运动幅度的增加可能会对神经组织和附着结构产生更大的机械应变，这可能是导致 SIH 颅神经功能障碍、颈部疼痛和僵硬的机制。非侵入性相位对比 MRI 对 CSF 流量和脊髓运动的评估是 SIH 有前途的诊断工具。
证据分类：本研究提供了 III 级证据，表明与健康对照组相比，非侵入性上脊柱相位对比 MRI 可识别 SIH 患者 CSF 流量和脊髓运动的差异。
J Magn Reson Imaging. 2018-2-13
Fluids Barriers CNS. 2025-7-1
AJNR Am J Neuroradiol. 2025-2-3
Neuroophthalmology. 2024-1-26
Neuroradiology. 2021-11
Radiographics. 2020
Zotero 插件