Abstract：
BACKGROUND: Identifying spontaneous CSF leaks can be difficult on CT myelography (CTM) in patients with suspected spontaneous intracranial hypotension (SIH). The current study compared renal collecting system (RCS) density during CTM in patients with suspected SIH relative to non-SIH controls and evaluated the overall utility as an indirect sign of spontaneous CSF leak in patients with SIH.
METHODS: All CTM performed over an 8-year period (n = 392) were retrospectively reviewed and included cases (n = 295) were divided into groups consisting of SIH patients with (n = 35) or without (n = 77) confirmed CSF leak on CTM and non-SIH controls (n = 183). Average and relative average (relative to systemic contrast density) RCS densities were compared with multivariate analysis adjusting for patient characteristics and CTM technical differences.
RESULTS: Average RCS densities were greater for confirmed versus non-confirmed SIH groups and greater for both SIH groups relative to non-SIH controls. Correlations between RCS density and time from injection to CTM were higher within SIH patient groups compared to controls. Measured RCS density had a higher negative predictive value for excluding CSF leak both within the SIH patient groups as well as the overall cohort (84% and 96%, respectively), with optimized thresholds yielding 80% sensitivity and 70% specificity for the presence of leak in the overall cohort.
CONCLUSIONS: Accounting for RCS density may provide reliable additional indirect diagnostic value about the suspicion of a CSF leak in patients undergoing CTM for evaluation of SIH symptoms.
METHODS: All CTM performed over an 8-year period (n = 392) were retrospectively reviewed and included cases (n = 295) were divided into groups consisting of SIH patients with (n = 35) or without (n = 77) confirmed CSF leak on CTM and non-SIH controls (n = 183). Average and relative average (relative to systemic contrast density) RCS densities were compared with multivariate analysis adjusting for patient characteristics and CTM technical differences.
RESULTS: Average RCS densities were greater for confirmed versus non-confirmed SIH groups and greater for both SIH groups relative to non-SIH controls. Correlations between RCS density and time from injection to CTM were higher within SIH patient groups compared to controls. Measured RCS density had a higher negative predictive value for excluding CSF leak both within the SIH patient groups as well as the overall cohort (84% and 96%, respectively), with optimized thresholds yielding 80% sensitivity and 70% specificity for the presence of leak in the overall cohort.
CONCLUSIONS: Accounting for RCS density may provide reliable additional indirect diagnostic value about the suspicion of a CSF leak in patients undergoing CTM for evaluation of SIH symptoms.
摘要：
背景：对于疑似自发性颅内低血压（SIH）的患者，在CT脊髓造影（CTM）上难以识别自发性脑脊液漏。当前的研究比较了可疑SIH患者在CTM期间相对于非SIH对照组的肾脏收集系统（RCS）密度，并评估了总体效用，作为SIH患者自发性CSF渗漏的间接迹象。
方法：对8年期间所有CTM（n=392）进行回顾性分析，并将纳入的病例（n=295）分为SIH患者（n=35）或无（n=77）的CTM和非SIH对照（n=183）。将平均和相对平均（相对于全身对比密度）RCS密度与多变量分析进行比较，以调整患者特征和CTM技术差异。
结果：确认的SIH组与未确认的SIH组的平均RCS密度更大，而两个SIH组相对于非SIH对照组的平均RCS密度更大。与对照组相比，SIH患者组的RCS密度与从注射到CTM的时间之间的相关性更高。在SIH患者组和整体队列中，测量的RCS密度对于排除CSF泄漏具有较高的阴性预测值（84％和96％，分别)，优化的阈值对整个队列中存在渗漏的敏感性为80%,特异性为70%.
结论：考虑RCS密度可能为评估SIH症状提供可靠的额外间接诊断价值。
方法：对8年期间所有CTM（n=392）进行回顾性分析，并将纳入的病例（n=295）分为SIH患者（n=35）或无（n=77）的CTM和非SIH对照（n=183）。将平均和相对平均（相对于全身对比密度）RCS密度与多变量分析进行比较，以调整患者特征和CTM技术差异。
结果：确认的SIH组与未确认的SIH组的平均RCS密度更大，而两个SIH组相对于非SIH对照组的平均RCS密度更大。与对照组相比，SIH患者组的RCS密度与从注射到CTM的时间之间的相关性更高。在SIH患者组和整体队列中，测量的RCS密度对于排除CSF泄漏具有较高的阴性预测值（84％和96％，分别)，优化的阈值对整个队列中存在渗漏的敏感性为80%,特异性为70%.
结论：考虑RCS密度可能为评估SIH症状提供可靠的额外间接诊断价值。
