摘要
目的 探讨低颅压综合征（IHS）的MRI征象和定量指标改变,以提高对本病的认识.方法 回顾性分析泰州市人民医院自2006年8月至2013年12月经腰穿确诊的26例IHS患者（患者组）及26例性别、年龄匹配的正常人（对照组）的MRI资料.2名医师分别评判MRI征象和测量定量指标,其中MRI征象包括硬脑膜增厚强化、垂体肿大、硬膜下积液（积血）、静脉窦扩张、脑下垂,定量指标包括乳头体桥脑距离和脑干桥脑角度.利用Kappa一致性检验分析2名医师对IHS患者MRI征象评判结果和测量数据的一致性;采用t检验分析患者组和对照组间乳头体桥脑距离和脑干桥脑角度的差异;利用受试者工作特征（ROC）曲线下面积判断乳头体桥脑距离和脑干桥脑角度的诊断效能,并分别确定最佳诊断阈值.结果 2名医师对硬脑膜增厚强化、垂体肿大、硬膜下积液（积血）、静脉窦扩张征象的评判以及对乳头体桥脑距离和脑干桥脑角度测量的一致性均极好（Kappa值分别为1.000、0.846、l.000、0.906、0.919、0.808,P＜0.05）,对脑下垂征象评判的一致性为中等（Kappa值为0.606,P＜0.05）.患者组乳头体桥脑距离和脑干桥脑角度[（5.4±1.6）mm、（47.8±8.7）°]均明显低于对照组[（6.9±1.1）mm、（61.0±6.1）°],差异均有统计学意义（P＜0.05）.乳头体桥脑距离和中脑桥脑角度的ROC曲线下面积分别为0.774、0.908,中脑桥脑角度的诊断价值较大.当乳头体桥脑距离取6.4 mm为诊断阈值时,敏感度为73.1％,特异度为73.1％;当中脑桥脑角度取51.7°为诊断阈值时,敏感度为76.9％,特异度为96.2％.结论 IHS具有特征性的MRI征象,且结合乳头体桥脑距离和脑干桥脑角度的测量有助于为其MRI的客观判断提供证据.
Objective To investigate the MRI findings and the variability of quantitative indicators in intracranial hypotension syndrome （IHS） to yield a deeper understanding of the disease.Methods The clinical data and MR imaging findings of 26 patients with IHS confirmed by lumbar puncture during August 2006 to December 2013 in our hospital were retrospectively analyzed.Other 26 healthy volunteers matched with gender and age were recruited as control group.The MRI findings （dural thickening and enhancement,pituitary enlargement,subdural collections,venous engorgement and sagging brain） and quantitative assessments （mamillopontine distance and pontomesencephalic angle） were evaluated retrospectively by two doctors,the consistency between the two doctors was assessed by Kappa consistency test.The difference of mamillopontine distance and pontomesencephalic angle between patient group and control group was assessed by t test.The receiver operating characteristic （ROC） curve was used to evaluate the diagnostic accuracy and assure the optimal diagnostic threshold.Results There were excellent interobserver agreements for dural thickening and enhancement,pituitary enlargement,subdural collections,venous engorgement and the measurement of mamillopontine distance and pontomesencephalic angle （Kappa=l.000,0.846,1.000,0.906,0.919 and 0.808,P〈0.05）.Sagging brain showed moderate agreement between readers （Kappa=0.606,P〈0.05）.The mamillopontine distance （5.4±1.6 mm） and pontomesencephalic angle （47.8±8.7 °） in patient group were significantly lower than those of control group （6.9±1.1 mm and 61.0±6.1 °,P〈0.05）.The area under ROC curve of mamillopontine distance and pontomesencephalic angle was 0.774 and 0.908,respectively,and the diagnostic value ofpontomesencephalic angle was higher than that of the mamillopontine distance.The sensitivity and specificity were 73.1% and 73.1%,respectively,when mamillopontine distance was 6.4 mm.The sensitivity and specificity were 76.9% and 96.2%,respectively,when pontomesencephalic angle was 51.7°.Conclusions The MR imaging findings present characteristic features of IHS.The quantitative indicators including mamillopontine distance and pontomesencephalic angle are helpful in clinical diagnosis of IHS.
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2015年第5期511-515,共5页
Chinese Journal of Neuromedicine
关键词
磁共振成像
低颅压综合征
乳头体桥脑距离
脑干桥脑角度
Magnetic resonance imaging
Intracranial hypotension
Mamillopontine distance
Pontomesencephalic angle
