CAJ | 학술논문

目的探讨双能量CT脊髓造影(CTM)检查在自发性颅内低压(SIH)脊髓脑脊液漏中的诊断价值.方法对6例诊断为SIH的患者行双能量脊髓CT造影检查,X线管电压分别设定为100和140 kVp(加锡过滤片),后处理获得虚拟平扫(VNC)、碘图等图像,并与合成的120 kVp CTM进行对比,比较2种方法在显示对比剂沿神经根外漏、C1～2椎体后方对比剂积聚、硬膜静脉丛扩张及椎管内硬膜下对比剂积聚等方面的情况.运用Kappa一致性检验比较2种方法诊断脑脊液漏点的差异.结果 6例患者合成的120 kVp CTM共显示43个漏点,其中的41个漏点在VNC和碘图上显示,2种方法在脊膜脑脊液漏点检出上有非常好的一致性(Kappa值=0.997,P＜0.01),并且2种方法均显示C1～2椎体后方对比剂积聚(2例)、硬膜外对比剂积聚(3例)及静脉丛扩张(1例),双能量CTM碘图和VNC图像视觉显示效果更佳.结论双能量CTM可用于SIH脊髓脑脊液漏的诊断.
목적 탐토쌍능량CT척수조영(CTM)검사재자발성로내저압(SIH)척수뇌척액루중적진단개치.방법 대6례진단위SIH적환자행쌍능량척수CT조영검사,X선관전압분별설정위100화140 kVp(가석과려편),후처리획득허의평소(VNC)、전도등도상,병여합성적120 kVp CTM진행대비,비교2충방법재현시대비제연신경근외루、C1～2추체후방대비제적취、경막정맥총확장급추관내경막하대비제적취등방면적정황.운용Kappa일치성검험비교2충방법진단뇌척액루점적차이.결과 6례환자합성적120 kVp CTM공현시43개루점,기중적41개루점재VNC화전도상현시,2충방법재척막뇌척액루점검출상유비상호적일치성(Kappa치=0.997,P＜0.01),병차2충방법균현시C1～2추체후방대비제적취(2례)、경막외대비제적취(3례)급정맥총확장(1례),쌍능량CTM전도화VNC도상시각현시효과경가.결론 쌍능량CTM가용우SIH척수뇌척액루적진단.
Objective To assess the value of dual-energy computed tomography myelography (CTM) on detecting leaks of cerebrospinal fluid (CSF) in patients with spontaneous intracranial hypotension (SIH). Methods Six patients with SIH underwent spinal CTM on a 2nd generation dual-source CT with tube voltage set at 100 and 140 kVp(with tin filter). The virtual non-contrast (VNC) and iodine map images were calculated from dual-energy images. The average weighted (AW) CTM images were mixed from two kVp images with mix factor of 0. 5. Two radiologists evaluated CSF leak using two sets of images respectively: VNC + iodine map images and AW-CTM images. The results from two reading methods were compared. The level of CSF leaks along the nerve roots, C1-2 retrospinal CSF collections, epidural CSF collections and spinal epidural venous plexus were marked. The consensus about leak sites and CSF collections was made by two radiologists in the third session Kappa statistics were used to measure the agreement between the two methods. Results Forty-one leaks were detected using VNC + iodine map images. Forty-three leaks were detected on AW images. The agreement between two methods was excellent (Kappa =0. 997 ,P ＜0. 01). There were no differences in the detection of C1-2 retrospinal CSF collections (n = 2), epidural CSF collections(n = 3) or spinal epidural venous plexus (n = 1). VNC and iodine map images demonstrated superior visual effects than AW images. Conclusion Dual-energy CTM can be used to diagnose spontaneous spinal cerebrospinal fluid leaks in SIH patient.