目的:自发性低颅压(SIH)是一种未被诊断的疾病。描述准确的诊断可能是苛刻的;特别是CSF静脉瘘的检测提出了许多挑战。已通过非侵入性相位对比MRI在有限的SIH患者亚组中确定了潜在的动态生物标志物,并有脊髓纵向硬膜外收集的证据。这项研究旨在探索更广泛的SIH队列中与脊髓运动和CSF速度相关的这些生物标志物。
方法:回顾性研究,在2022年2月至2023年6月期间,我们对疑似患有SIH的患者进行了脊髓和脑脊液速度测量的相位对比MRI检查,这些患者在C2/C3段被称为三级中心.速度范围(mm/s),总位移(mm),并对进一步的衍生物进行评估,并与来自70名健康对照者数据库的数据进行比较.
结果:在117名患者中,发现了一个泄漏(54%的腹侧泄漏,20%侧漏,20%的脑脊液静脉瘘,6%的骶骨渗漏)。SIH患者的脊髓和CSF速度比健康对照组大:例如,速度范围7.6±3mm/svs.5.6±1.4mm/s,56±21mm/svs.42±10mm/s,p分别<0.001。患有侧漏和CSF-静脉瘘的患者表现出异常升高的脊髓运动水平(例如,速度范围8.4±3.3mm/s;8.2±3.1mm/svs.5.6±1.4mm/s,p分别<0.001)。
结论:相衬MRI可能成为SIH诊断的有价值的工具,尤其是在没有脊髓硬膜外积液证据的CSF静脉瘘患者中。
OBJECTIVE: Spontaneous intracranial hypotension (SIH) is an underdiagnosed disease. To depict the accurate diagnosis can be demanding; especially the detection of CSF-venous fistulas poses many challenges. Potential dynamic biomarkers have been identified through non-invasive phase-contrast MRI in a limited subset of SIH patients with evidence of spinal longitudinal extradural collection. This study aimed to explore these biomarkers related to spinal cord motion and CSF velocities in a broader SIH cohort.
METHODS: A retrospective, monocentric pooled-data analysis was conducted of patients suspected to suffer from SIH who underwent phase-contrast MRI for spinal cord and CSF velocity measurements at segment C2/C3 referred to a tertiary center between February 2022 and June 2023. Velocity ranges (mm/s), total displacement (mm), and further derivatives were assessed and compared to data from the database of 70 healthy controls.
RESULTS: In 117 patients, a leak was located (54% ventral leak, 20% lateral leak, 20% CSF-venous fistulas, 6% sacral leaks). SIH patients showed larger spinal cord and CSF velocities than healthy controls: e.g., velocity range 7.6 ± 3 mm/s vs. 5.6 ± 1.4 mm/s, 56 ± 21 mm/s vs. 42 ± 10 mm/s, p < 0.001, respectively. Patients with lateral leaks and CSF-venous fistulas exhibited an exceptionally heightened level of spinal cord motion (e.g., velocity range 8.4 ± 3.3 mm/s; 8.2 ± 3.1 mm/s vs. 5.6 ± 1.4 mm/s, p < 0.001, respectively).
CONCLUSIONS: Phase-contrast MRI might become a valuable tool for SIH diagnosis, especially in patients with CSF-venous fistulas without evidence of spinal extradural fluid collection.