Department of Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
Department of Neuroradiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
J Neurol. 2024 Jul;271(7):4336-4347. doi: 10.1007/s00415-024-12365-6. Epub 2024 Apr 21.
Spontaneous intracranial hypotension (SIH) is an underdiagnosed disease. To depict the accurate diagnosis can be demanding; especially the detection of CSF-venous fistulas poses many challenges. Potential dynamic biomarkers have been identified through non-invasive phase-contrast MRI in a limited subset of SIH patients with evidence of spinal longitudinal extradural collection. This study aimed to explore these biomarkers related to spinal cord motion and CSF velocities in a broader SIH cohort.
A retrospective, monocentric pooled-data analysis was conducted of patients suspected to suffer from SIH who underwent phase-contrast MRI for spinal cord and CSF velocity measurements at segment C2/C3 referred to a tertiary center between February 2022 and June 2023. Velocity ranges (mm/s), total displacement (mm), and further derivatives were assessed and compared to data from the database of 70 healthy controls.
In 117 patients, a leak was located (54% ventral leak, 20% lateral leak, 20% CSF-venous fistulas, 6% sacral leaks). SIH patients showed larger spinal cord and CSF velocities than healthy controls: e.g., velocity range 7.6 ± 3 mm/s vs. 5.6 ± 1.4 mm/s, 56 ± 21 mm/s vs. 42 ± 10 mm/s, p < 0.001, respectively. Patients with lateral leaks and CSF-venous fistulas exhibited an exceptionally heightened level of spinal cord motion (e.g., velocity range 8.4 ± 3.3 mm/s; 8.2 ± 3.1 mm/s vs. 5.6 ± 1.4 mm/s, p < 0.001, respectively).
Phase-contrast MRI might become a valuable tool for SIH diagnosis, especially in patients with CSF-venous fistulas without evidence of spinal extradural fluid collection.
自发性颅内低血压（SIH）是一种诊断不足的疾病。准确诊断可能具有挑战性；特别是检测脑脊液-静脉瘘具有很大的挑战性。在具有脊髓纵向硬膜外积液证据的有限 SIH 患者亚组中，通过非侵入性相位对比 MRI 已经确定了一些潜在的动态生物标志物。本研究旨在探索更广泛的 SIH 患者队列中与脊髓运动和 CSF 速度相关的这些生物标志物。
对 2022 年 2 月至 2023 年 6 月期间转诊至三级中心进行脊髓和 CSF 速度测量的相位对比 MRI 的疑似 SIH 患者进行回顾性、单中心汇总数据分析。评估并比较了速度范围（mm/s）、总位移（mm）和进一步的导数，并与来自 70 名健康对照者数据库的数据进行了比较。
在 117 名患者中，定位了一个漏口（54%的腹侧漏口、20%的侧漏口、20%的脑脊液-静脉瘘、6%的骶骨漏口）。SIH 患者的脊髓和 CSF 速度大于健康对照组：例如，速度范围 7.6±3mm/s 与 5.6±1.4mm/s，56±21mm/s 与 42±10mm/s，p<0.001。侧漏口和脑脊液-静脉瘘患者的脊髓运动水平异常升高（例如，速度范围 8.4±3.3mm/s；8.2±3.1mm/s 与 5.6±1.4mm/s，p<0.001）。
相位对比 MRI 可能成为 SIH 诊断的一种有价值的工具，特别是在没有脊髓硬膜外积液证据但存在脑脊液-静脉瘘的患者中。
