背景:存在浅表铁质沉着症(SS)的病例,其中脊髓腹侧液体填充在椎管(VFCC)中。在我们之前的研究中,平衡的稳态自由进动序列磁共振成像有助于识别硬膜缺损的位置。然而,由于其扫描区域窄和扫描时间长,在一些小的硬脑膜缺损患者中,它不能很容易地检测到缺损的位置。在这项研究中,我们应用了四维动态计算机断层扫描(4DCT)成像,包括时间轴成像,使用最新的CT成像设备进行脊髓造影,可以进行短时间连续成像,以确定硬膜缺损部位。
方法:20例SSVFCC患者(9例男性,11名女性;平均年龄61.6岁)接受了4DCT脊髓造影(4D-CTM)。192排螺旋CT(SOMATOMForce,具有高速扫描能力的SIEMENS)用于在低剂量下每分钟获得9-11次扫描,同时将造影剂流入蛛网膜下腔。然后,确定了造影剂渗漏部位。
结果:20例均可确定造影剂渗漏部位:C7/Th1,2例;Th1/2,5例;Th2/3,9例;Th3/4,1例;Th5/6,1例;Th7/8,1例;Th8/9,1例。18例接受外科手术,并在造影剂渗漏部位确认了实际的硬脑膜缺损。造影剂注射的渗漏时间的平均值±标准偏差为19.0±9.2s。
结论:4D-CTM可用于可靠地识别脊髓液漏的位置。在SS案例中,硬脑膜缺损可以在平均19秒内显现。
BACKGROUND: There are cases of superficial siderosis (SS) with spinal ventral fluid-filled collection in the spinal canal. In our previous study, the balanced steady-state free precession sequence magnetic resonance imaging is useful in identifying the location of dural defects. However, because of its narrow scan area and long scan time, it cannot easily detect the defect location in some patients with small dural defect. In this study, we applied 4-dimensional (4D) dynamic computed tomography (CT) imaging, including time-axis imaging, to myelography using the latest CT imaging equipment, which can perform short-time continuous imaging, to identify the dural defect site.
METHODS: Twenty SS patients with ventral fluid-filled collection in the spinal canal (9 males, 11 females; mean age 61.6 years) underwent 4D dynamic CT myelography. A 192-row helical CT (SOMATOM Force, SIEMENS, Munich, Germany) with high-speed scanning capability was used to obtain 9-11 scans per minute at low dose while passing contrast medium into the subarachnoid space. Then, contrast leakage sites were identified.
RESULTS: The contrast leakage sites could be identified in all 20 cases: C7/Th1, 2 cases; Th1/2, 5 cases; Th2/3, 9 cases; Th3/4, 1 case; Th5/6, 1 case; Th7/8, 1 case; and Th8/9, 1 case. Eighteen cases underwent surgical operation, and actual dural defects were confirmed at the contrast leakage sites. The mean ± standard deviation of leakage time from contrast agent injection was 19.0 ± 9.2 s.
CONCLUSIONS: The 4D dynamic CT myelography can be used to reliably identify the location of spinal fluid leakage. In SS cases, dural defects could be visualized in an average of 19 seconds.