- 期刊
軸切面磁振脊髓造影偵測顱內低壓病人腦脊髓液滲漏的重要性
Importance of Detecting the CSF Leakage Sites in the Cases of the Intracranial Hypotension by Using SSFSE Pulse Sequence in Axial MR Myelogram
摘要
自發性顱內低壓所引起的頭痛，臨床症狀是病人站立時會發生劇烈頭痛，但平躺則會緩解。主要的原因是由於脊椎硬脊膜破裂，造成腦脊髓液流失，而發生腦壓降低，腦部下沈的姿勢性頭痛。磁振造影當中的單次激發快速自旋回音(Single-Shot Fast Spin Echo, SSFSE)波序對液體具有高靈敏度，故我們以此波序對病患的脊椎除了作一般的傳統腦脊髓液磁振造影（包含矢狀切面、冠狀面及兩側斜位）外，再加切橫切面來個別評估兩者腦脊髓液的滲漏處是否能達到相同的診斷結果。自2006年1月至2008年11月止，收集臨床懷疑有腦脊髓液滲漏的患者共31位病例來做磁振造影檢查，針對患者的傳統腦脊髓液磁振造影與橫切面影像經由kappa statistics去檢定分析兩種方式的一致程度。結果對於是否看到腦脊髓液的滲漏，kappa值為0.423 (p=0.000)，表示這兩者的檢查方式的效力並不一致。若一般臨床上只以傳統腦脊髓液磁振造影影像來判別顱內低壓病人的腦脊髓液滲漏處是不夠的，一定要加切橫切面影像的腦脊髓液磁振造影才能清楚看到滲漏的情況。
並列摘要
The typical symptom of the spontaneous intracranial hypotension (SIH) is postural headaches, which is more severe in the upright position and is alleviated by supine position. It may be caused by dural rupture, the cerebrospinal fluid (CSF) depletion, and it may result in hypotension and brain descent. Magnetic resonance imaging (MRI) using single shot fast spin echo (SSFSE) has high sensitivity for the water molecules. We used conventional MR myelography (include sagittal、coronal and bilateral-oblique views) and MR axial myelography with SSFSE in patients having typical CSF leakage symptoms to compare the efficacy of these two methods. From January 2006 and November 2008, 31 patients who had clinical suspected CSF leakage were enrolled and underwent MRI examinations. Identical MR protocols including conventional MR myelography and axial myelography were performed and the results were analyzed by kappa statistics. Regarding whether detecting the CSF leakage or not, the kappa value between two examination protocols is 0.423 (p=0.000). It represented the potency is inconsistent in diagnosis of CSF leakage. In clinical practice, it is not enough by using only conventional MR myelography to detect SIH patients with CSF leakage. Axial MR myelography could be benefit to make the diagnosis of CSF leakage more easily and accurately.