- 期刊
使用各向同性三維脂肪抑制快速回復快速自旋回音脈衝序列偵測腦脊髓液滲漏的一個潛在陷阱－病例報告
A Potential Pitfall of Using 3D FRFSE Cube with Fat Suppression to Detect CSF Leakage-Case Report
摘要
本病例為一名30歲未婚女性，因持續一星期的姿勢性頭痛合併有輕度頭暈、噁心、兩耳塞住和耳鳴等症狀而求助急診。當時理學及神經學檢查並無異常，經轉介神經內科後臆診可能為自發性顱內低壓，於是緊急排檢胸椎磁振這影並且住院觀察，除了一般的傳統腦脊髓液磁振造影（含矢狀切面、冠狀切面及兩側斜位切面）外，亦使用各向同性三維脂肪抑制快速回復快速自旋回音（3D-FRFSE-Cube wilh Fat Sat）脈衝序列評估全脊椎腦脊髓渡的滲漏處，影像報告卻無任何異常。然而兩天後的腦部磁振造影檢查，卻出現瀰漫性硬腦膜之對比劑顯影增強，此特徵為自發性顱內低壓的診斷標準之一，故另外以二維T2脂肪抑制快速回復快速自旋回音脈衝序列篩驗頸椎及胸椎部位，亦發現於頸椎一、二節之滲漏處而證實診斷。雖然3D-FRFSE-Cube with Fat Sat脈衝序列的優點為以較少取像時間獲得較高解析度之影像和可任意平面重組，但是若病徵處太小且使用過大視野取像，則容易造成診斷遺漏。本文提出經驗分享，並亟需利用其偵測腦脊髓液滲漏診斷率的相關研究。
並列摘要
A 30-year-old single female suffered from postural headache with exacerbation, which was relieved after lying flat for one week before she visited our emergency department. She also had clinical symptoms include mild dizziness, nausea sensation, both ears fullness and tinnitus. Although there were no significant findings on physical and neurological examination, then she was referred to neurological outpatient department. Under the impression of spontaneous intracranial hypotension, she was referred to our department for thoracic spine MRI examination and admitted to the neurology ward. It was used conventional MR myelography (include sagittal, coronal and bilateral-oblique views) and 3D FRFSE cube with fat suppression sequences to detect the cerebrospinal fluid (CSF) leakage sites of whole spine. The image findings were negative. But two days later, the brain MRI image showed diffuse pachymeningeal gadolinium enhancement. This was one of diagnostic criteria for headache due to spontaneous spinal CSF leak and intracranial hypotension according to the international classification of headache disorders, 2nd ed. Therefore, she was also screened the cervical and thoracic spine by 2D T2 FRFSE with fat suppression. It showed CI-2 CSF leakage confirmed the diagnosis of intracranial hypotension. Compared with 2D FRFSE, 3D FRFSE cube provides superior image quality and improved 3D reconstructions in a shorter acquisition time and enables excellent visualization of the entire data set in any orientation. But due to too small lesion and using too large field-of-view to acquire image, it is very easy to makc a misdiagnosis. In addition to share our experience, the current case illustrates the need for additional research in the efficacy of 3D FRFSE cube with fat suppression detecting CSF leakage.