CT脊髓造影在自发性颅内低压脑脊液漏点检出中的价值

CT myelography： application in detecting the site of spontaneous cerebrospinal fluid leaks

目的探讨CT脊髓造影在自发性颅内低压脑脊液漏点检出中的价值及影像学表现。方法6例自发性颅内低压患者，男女各3例，均符合2004年国际头痛分类第2版自发性颅内低压的诊断标准。影像学资料包括5例全脊柱MRI检查和6例全脊柱CT脊髓造影。根据CT脊髓造影发现的脑脊液漏点，选择穿刺部位，透视下注射混合碘造影剂的自体静脉血，随访观察治疗效果。结果5例全脊柱MRI检查均未发现漏点。6例CT脊髓造影检查均发现了漏点，各例漏点数目为1～7个，总漏点数目25个，平均4．2个，其中颈椎和胸椎各12个，腰椎1个。CT脊髓造影表现包括造影剂线状漏出、椎旁软组织内片状造影剂蓄积及神经根袖呈鸟嘴样扩大等。6例患者经靶向硬膜外血贴治疗后获得临床痊愈。结论CT脊髓造影是一种有效和精确的自发性脊髓脑脊液漏点定位诊断手段。

Objective To evaluate the application of CT myelography （CTM） in detecting the site of spontaneous cerebrospinal fluid （CSF） leaks and analyze it＇ s imaging features. Methods Six patients （3 women and 3 men） with spontaneous intracranial hypotension （SIH） were included, who met the criteria of the International Headache Classification （2nd edition, 2004）. Five patients subsequently underwent whole spine MR/and all 6 patients underwent CTM. Autologous blood mixed with omnipaque （300 mg/ml） was injected followed by selective puncture at the leak site indicated by CTM. Results MR/was failed to find leak site in the 5 patients, whereas CTM successfully found leak sites in all 6 patients. There were 1 to 7 leak sites respectively with an average of 4. 2 sites （totally 25 points）. Leak sites at cervical （ 12 sites） and thoracic （ 12 sites） were more frequent than at lumbar （ 1 site）. CTM was featured by linear leakage of the contrast medium along the spinal nerve roots, paraspinal collections of hyper-density contrast medium and beak-like enlargement of the nerve sleeves. All patients responded well to the treatment, with complete resolution of symptoms. Conclusion CTM has been shown to be a study of choice to accurately define the location and extent of a CSF leak.