目的:硬膜外补血(EBP)是自发性低颅压(SIH)的主要治疗方法。MRI用于评估脊髓CSF漏。后EBPMRI已经。显示可有效预测EBP的疗效。然而,关于EBP后MRI表现如何随时间变化的报道很少.这项研究的目的是评估不同时间点的EBP后MRI表现与相应的EBP有效性之间的关系。
方法:我们回顾性分析了63例接受目标EBP的SIH患者。所有患者在10天内(EBP后MRI)和EBP后3个月(3个月MRI)接受MRI随访。在不同的EBP后MRI时间点(0-2、3-6和7-10天)进行亚组分析。评估EBP后MRI发现与EBP有效性之间的关系。
结果:35例(55.56%)患者被分配到EBP有效组,根据3个月的MRI将28例(44.44%)分配到EBP无效组。与EBP无效组相比,在EBPMRI后,EBP有效组的脊髓CSF漏数量显着降低(4.49vs.11.71;p=0.000)和更大的泄漏改善次数(7.66vs.2.96;p=0.003)。对于在0-10、0-2、3-6和7-10天期间接受EBP后MRI的患者,预测EBP衰竭的脊髓脑脊液漏数量的临界值分别为4、6、4和5。AUC高于0.77。
结论:通过使用EBP后MRI,只需要大约20分钟,在SIH患者中预测EBP疗效成为可能。这项研究提供了不同随访时间的脊髓CSF渗漏数量的临界值,以作为是否需要进一步EBP的线索。这提供了当前研究的新颖性。
OBJECTIVE: Epidural blood patching (EBP) is the mainstay therapy for spontaneous intracranial hypotension (
SIH). MRI is used for evaluating spinal CSF leakage. Post-EBP MRI has been. shown to be effective in predicting the efficacy of EBP. However, there are few reports on how post-EBP MRI findings may change with time. The aim of this study was to evaluate the relationship between post-EBP MRI findings at different time points and the corresponding effectiveness of EBP.
METHODS: We retrospectively reviewed 63
SIH patients who had received target EBP. All patients received an MRI follow-up within 10 days (post-EBP MRI) and at 3 months after EBP (3-month MRI). A sub-group analysis was performed at different post-EBP MRI time points (0-2, 3-6, and 7-10 days). The relationships between the post-EBP MRI findings and the EBP effectiveness were evaluated.
RESULTS: Thirty-five (55.56%) patients were assigned to the EBP-effective group, and 28 (44.44%) were assigned to the EBP non-effective group according to the 3-month MRI. Compared to the EBP non-effective group, the EBP-effective group had significantly lower numbers of spinal CSF leakage in the post-EBP MRI (4.49 vs. 11.71; p = 0.000) and greater numbers of leakage improvement (7.66 vs. 2.96; p = 0.003). For patients who received post-EBP MRI during periods of 0-10, 0-2, 3-6, and 7-10 days, the cutoff values of numbers of spinal CSF leakage for predicting EBP failure were 4, 6, 4, and 5, respectively, with an AUC above 0.77.
CONCLUSIONS: By using post-EBP MRI, which only takes approximately 20 min, predicting EBP efficacy became possible in
SIH patients. This study provides cutoff values of numbers of spinal CSF leakage at different follow-up times to serve as clues of if further EBP is needed, which provides the novelty of the current study.