From the Department of Radiology (J.L.H., T.J.A., P.G.K.), Duke University Medical Center, Durham, North Carolina.
Department of Biostatistics and Bioinformatics (S.M., S.P.), Duke University School of Medicine, Durham, North Carolina.
AJNR Am J Neuroradiol. 2023 Sep;44(9):1096-1100. doi: 10.3174/ajnr.A7962. Epub 2023 Aug 10.
The Bern score is a quantitative scale characterizing brain MR imaging changes in spontaneous intracranial hypotension. Higher scores are associated with more abnormalities on brain MR imaging, raising the question of whether the score can serve as a measure of disease severity. However, the relationship between clinical symptom severity and the Bern score has not been evaluated. Our purpose was to assess correlations between Bern scores and clinical headache severity in spontaneous intracranial hypotension.
This study was a single-center, retrospective cohort of patients satisfying the International Classification of Headache Disorders-3 criteria for spontaneous intracranial hypotension. Fifty-seven patients who completed a pretreatment headache severity questionnaire (Headache Impact Test-6) and had pretreatment brain MR imaging evidence of spontaneous intracranial hypotension were included. Pearson correlation coefficients (ρ) for the Headache Impact Test-6 and Bern scores were calculated. Receiver operating characteristic curves were used to assess the ability of Bern scores to discriminate among categories of headache severity.
We found low correlations between clinical headache severity and Bern scores (ρ = 0.139; 95% CI, -0.127-0.385). Subgroup analyses examining the timing of brain MR imaging, symptom duration, and prior epidural blood patch showed negligible-to-weak correlations in all subgroups. Receiver operating characteristic analysis found that the Bern score poorly discriminated subjects with greater headache severity from those with lower severity.
Pretreatment Bern scores show a low correlation with headache severity in patients with spontaneous intracranial hypotension. This finding suggests that brain imaging findings as reflected by Bern scores may not reliably reflect clinical severity and should not replace clinical metrics for outcome assessment.
Bern 评分是一种用于描述自发性颅内低血压患者脑 MRI 改变的定量评分系统。较高的分数与脑 MRI 上更多的异常相关，这引发了一个问题，即该评分是否可以作为疾病严重程度的衡量标准。然而，临床症状严重程度与 Bern 评分之间的关系尚未得到评估。我们的目的是评估自发性颅内低血压患者的 Bern 评分与临床头痛严重程度之间的相关性。
本研究为单中心、回顾性队列研究，纳入符合自发性颅内低血压国际头痛分类-3 标准的患者。共纳入 57 例完成治疗前头痛严重程度问卷（头痛影响测试-6）且有治疗前脑 MRI 证据的自发性颅内低血压患者。计算头痛影响测试-6 与 Bern 评分之间的 Pearson 相关系数（ρ）。使用受试者工作特征曲线评估 Bern 评分区分头痛严重程度的能力。
我们发现临床头痛严重程度与 Bern 评分之间相关性较低（ρ=0.139；95%置信区间，-0.127-0.385）。对脑 MRI 检查时间、症状持续时间和既往硬膜外血贴治疗进行亚组分析，在所有亚组中相关性均较弱。受试者工作特征曲线分析发现，Bern 评分对区分头痛严重程度较高的患者与头痛严重程度较低的患者的能力较差。
自发性颅内低血压患者的治疗前 Bern 评分与头痛严重程度相关性较低。这一发现表明，Bern 评分所反映的脑影像学表现可能无法可靠地反映临床严重程度，不应替代临床指标来评估预后。
