摘要
目的探讨自发性低颅压综合征(SIH)患者放射性核素脑脊液间隙显像(RNC)的影像学特点及其临床意义。方法回顾性分析2012年5月至2017年1月福建省立医院收治的19例SIH患者,均经腰椎穿刺脊髓蛛网膜下腔注射99Tc^m-DTPA,行多时相脑脊液间隙显像,对99Tc^m-DTPA异常分布处加做SPECT/CT断层融合显像及MRI扫描。综合分析RNC的影像学特点。计数资料的组间比较采用χ^2检验。结果RNC可通过显示脊髓或鼻部脑脊液漏点等直接征象诊断SIH;也可通过观察脑脊液循环过程异常,如:显像剂上升缓慢,难以抵达脑池、大脑凸面、上矢状窦等及膀胱、肾脏早期显像等间接征象诊断SIH. RNC检出脑脊液漏17例。直接脑脊液漏患者12例,其中颈、胸段9例,脑脊液鼻漏2例,大流量脑脊液漏(腰段)患者1例。RNC正常者2例。MRI[阳性率为58.8%(10/17)]与RNC[阳性率为88.2%(15/17)]对SIH低颅压诊断的差异无统计学意义(χ^2=0.101,P>0.05);12例RNC检出漏口的相应部位MRI仅检出1例。结论RNC可通过直接或间接征象协助SIH的病因诊断,在脑脊液漏口检出上明显优于MRI,并可反映脑脊液漏的流量,便于个体化治疗,在SIH的诊疗中有重要的应用价值。
Objective To investigate the imaging features and clinical significance of radionuclide cisternography(RNC) in patients with spontaneous intracranial hypotension(SIH). Methods Lumbar puncture was made on 19 patients with SIH(4 males and 15 females), and 99Tc^m-DTPA was injected into their spinal subarachnoid space. Multitemporal RNC was also performed. SPECT/CT tomography and MRI were added to examine abnormal distribution, and RNC image features were comprehensively analyzed.χ^2-test was conducted to compare the enumeration data between groups. Results RNC could be applied to diagnose SIH by showing direct signs such as spinal cord or nasal cerebrospinal fluid leak points or by revealing the abnormal circulation of the cerebrospinal fluid (CSF), such as a slow increase in imaging agents;difficulty in reaching the cistern, the cerebral convex surface, and the superior sagittal sinus;and early imaging of the bladder and the kidney. RNC could also be used to detect the CSF leaks in 17 cases and reveal a direct sign of CSF leaks in 12 cases. Its detection rate was 63.2%. Of these cases, 9 were located in the cervicothoracic junction or the thoracic region, 1 was found in the lumbar, and 2 were observed to have CSF rhinorrhea. A case of high-flow CSF leakage (lumbar segment) occurred in 1 patient. When conservative treatment was ineffective, the patients were treated with targeted epidural blood patch. Two more cases had a normal RNC. A comparison of the MRI findings of 17 patients showed no significant differences between MRI (positive rate of 58.8%[10/17]) and RNC (positive rate of 88.2%[15/17]) in the diagnosis of low intracranial pressure (P > 0.05). However, RNC was superior to MRI in detecting CSF leakage. Of the 12 cases subjected to RNC, only 1 case was found to have CSF leaks through MRI. Conclusions RNC can help diagnose SIH by determining direct or indirect signs and is superior to MRI in terms of detecting CSF leakage. RNC can also be used to show the amount of CSF leakage and facilitate individualized t
作者
林志毅
陈文新
余明钿
葛华
张艳敏
Lin Zhiyi;Chen Wenxin;Yu Mingdian;Ge Hua;Zhang Yanmin(Provincial Clinical Medical College of Fujian Medical University, Department of Nuclear Medicine, Fujian Provincial Hospital, Fuzhou 350001, China)
出处
《国际放射医学核医学杂志》
2019年第4期320-326,共7页
International Journal of Radiation Medicine and Nuclear Medicine
