仰、俯卧位磁共振多平面扫描在脑脊液鼻漏诊断中的应用

Application of multiplanar MRI scan in diagnosis of cerebrospinal fluid rhinorrhea under supine and prone positions

目的探讨仰、俯卧位MR多平面扫描对脑脊液鼻漏的诊断价值。方法回顾性分析20例脑脊液鼻漏患者的仰、俯卧位MR多平面扫描资料,包括常规轴位、矢状位、冠状位图像。并与术中所见相对照。结果 MRI清晰显示17例(17/20,85.00%)脑脊液鼻漏;漏口位于筛板顶部15例(15/20,75.00%),蝶筛隐窝、蝶窦各1例(1/20,5.00%)。另3例漏口MRI显示不清。俯卧位图像显示鼻窦内及鼻孔处脑脊液信号较仰卧位增多17例(17/20,85.00%),体位改变后MRI表现无明显变化3例(3/20,15.00%)。5例(5/20,25.00%)同时伴有脑疝。结论仰、俯卧位MR多平面扫描可较准确地显示脑脊液鼻漏患者漏口位置,且可同时显示伴发的脑疝,变换体位有助于活动性脑脊液鼻漏的检出。

Objective To discuss the application value of multiplanar MR scans in the diagnosis of cerebrospinal fluid（CSF）rhinorrhea under supine and prone positions.Methods MR imaging data including axial,sagittal and coronal planes of 20 patients with CSF rhinorrhoea who underwent supine and prone positions scans were retrospectively analyzed.And the imaging findings were compared with the results of surgical operation.Results CSF rhinorrhoea was found in 17cases（17/20,85.00%）by MRI.CSF rhinorrhoea located in cribriform plates of the ethmoid bones in 15cases（15/20,75.00%）,recessus sphenoethmoidalis in 1case（1/20,5.00%）and sphenoid sinus in 1case（1/20,5.00%）.CSF rhinorrhoea in 3cases could not be detected.Compared with supine position scan,CSF signal of paranasal sinus and nostrils increased under prone position scan in 17cases（17/20,85.00%）.No significant changes of CSF signal between supine and prone positions in the other 3cases（3/20,15.00%）.Cerebral hernia was detected in 5patients（5/20,25.00%）.Conclusion Multiplanar MRI scans under supine and prone positions have high diagnostic accuracy in detecting the fistula location of CSF rhinorrhoe and cerebral hernia.Position change is helpful to diagnose the active CSF rhinorrhoea.