自发性颅内低压CT与MR椎管造影检查失败的影像学特征

发布时间：2018-07-14 17:17

【摘要】：目的自发性颅内低压(SIH)临床少见,CT及MR脊髓造影是检测和定位脊髓脑脊液漏点最有效的方法,对疾病诊断及SIH后续靶向血贴治疗有重要价值。本文分析SIH脊髓造影检查对比剂意外注入硬膜外间隙导致检查失败的发生率及其影像学特征,指导临床迅速、正确地判断CT脊髓造影和MR脊髓造影成败。资料与方法回顾性分析121例SIH患者的脊髓造影资料,分析失败脊髓造影中对比剂形态、轮廓、密度或信号及其在脑池、脑室内的扩散等征象。结果 121例SIH患者共完成脊髓造影检查128例次,对比剂意外注入硬膜外间隙33例次,失败率为25.8%。33例次失败脊髓造影检查影像中,均可见硬膜囊两侧神经根穿行于对比剂中,均未见脊髓前后根穿行于对比剂中;29例(87.9%)未见马尾穿行于对比剂中;26例(78.8%)对比剂未扩散入脑池、脑室;16例(48.5%)椎管内对比剂影不连续;10例(30.3%)椎管内对比剂影不均匀;4例(12.1%)对比剂影内侧轮廓不光整。结论 SIH患者脊髓造影检查中,对比剂意外注入硬膜外间隙致造影检查失败的发生率较高,CT脊髓造影和MR脊髓造影具有特征性影像学表现,可对检查做出快速而准确的判断。
[Abstract]:Objective spontaneous intracranial low pressure (SIH) is the most effective method for detecting and locating cerebrospinal fluid leakage sites. It is of great value in the diagnosis of the disease and in the subsequent treatment of SIH. In this paper, the incidence and imaging features of the failure of SIH myelography due to accidental injection of contrast agent into the epidural space were analyzed to guide the clinical diagnosis and to correctly judge the success or failure of CT myelography and Mr myelography. Materials and methods the myelography data of 121 patients with SIH were analyzed retrospectively. The morphology, contour, density or signal of the contrast medium in the failed myelography and its diffusion in the cisterns and ventricles were analyzed. Results in 121 patients with SIH, 128 myelography examinations were completed, 33 times the epidural space was accidentally injected with contrast agent. The failure rate was 25.8.33 failed myelography images. The nerve roots on both sides of the dural sac could be seen passing through the contrast medium. There were 29 cases (87.9%) with anterior and posterior roots of spinal cord passing through contrast medium, and 26 cases (78.8%) of contrast agent did not diffuse into the cistern. 16 cases (48.5%) had intrathecal contrast discontinuity (30. 3%), 4 cases (12. 1%) had inhomogeneous contrast medial contour. Conclusion in the myelography of patients with SIH, the rate of failure caused by accidental injection of contrast agent into epidural space is higher than that of CT myelography and Mr myelography.
【作者单位】：浙江医院放射科;浙江大学医学院附属邵逸夫医院神经内科;浙江省人民医院放射科;
【分类号】：R741;R445.2;R816.1

【参考文献】