自发性低颅压的MRI征象及脑脊液压力诊断价值

目的探讨自发性低颅压(SIH)的MRI征象及脑脊液压力分布,提高对自发性低颅压的认识.方法回顾性分析2016年1月至2018年3月浙江大学附属邵逸夫医院经临床诊断为SIH患者的头颅MRI、磁共振脊髓成像(MRM)表现及脑脊液压力测量结果,统计硬膜下积液(积血)、局部脑组织移位、硬脑膜强化、静脉窦扩张及脊髓脑脊液漏的发生率.结果共50例患者纳入最终研究,出现硬膜下积液或积血、局部脑组织移位、硬脑膜强化、静脉窦扩张、脊髓脑脊液漏中1种、2种、3种及4种征象的分别有1例(2%)、19例(38%)、21例(42%)、9例(18%).其中,20例(40%)出现硬膜下积液或积血;38例(76%)存在局部脑组织移位;50例(100%)患者均显示有异常的硬脑膜强化;31例(62%)出现静脉窦扩张;44例(88%)出现脊髓脑脊液漏.29例(58%)<60mmH2O;21例(42%)>60mmH2O,其中3例>200mmH2O.结论硬脑膜强化是自发性低颅压的最常见MRI征象,98%患者出现>2种影像学改变.脑脊液压力正常不能排除自发性低颅压的诊断.

Objective To investigate the MRI signs of spontaneous hypotension and the CSF pressure and to improve the understanding of spontaneous hypotension.Methods The cranial MRI,MRM manifestations and cerebrospinal fluid pressure measurement results of SIH patients clinically diagnosed by the affiliated Run Run Shaw hospital of Zhejiang university from January 2016 to March 2018 were retrospectively analyzed,the incidence of subdural effusion(or hematocele),local brain tissue displacement,dural enhancement,venous sinus dilatation and spinal cerebrospinal fluid leakage were recorded.Results A total of 50 patients were included in the final study,and in the above MR observation indicators,the probability of one,two,three or four signs occurring simultaneously is I case(2%),19(38%),21(42%),and 9(18%),respectively.20 cases(40%)had subdural effusion(hemorrhage),38 cases(76%)had local brain tissue displacement,50 cases(100%)had abnormal dural enhancement,31 cases(62%)had venous sinus dilatation,and 44 cases(88%)had spinal and cerebrospinal fluid leakage.21 patients(42%)had cerebrospinal fluid pressure>60mmH2O.Conclusion Dural enhancement is the most common sign of spontaneous hypotension on MRI.More than two kinds of imaging changes are found in 98%of patients.Normal cerebrospinal fluid pressure cannot exclude the diagnosis of spontaneous hypotension.