%0期刊文章%A Katharina Wolf %A Niklas Luetzen %A Hansjoerg Mast %A Nico Kremers %A Marco Reisert %A Saúl Beltrán %A Christian Fung %A Jürgen Beck %A Horst Urbach %T自发性颅内低血压患者脑脊液流动与脊髓运动%B A MRI相位对比研究%D 2023 %R 10.1212/WNL。背景与目的自发性颅内低血压(SIH)以脑半岛投注体育官网脊液容量减少为特征。我们假设在这种低容量的情况下，通过无创相位对比MRI可以测量到更大的脑脊液流量和脊柱上部的脊髓运动。方法于2021年10月至2022年2月对出现脊髓纵向硬膜外积液(SLEC)的SIH患者进行前瞻性、年龄、性别和体重指数(BMI)匹配的对照队列研究。在C2/C3段和C5/C6段获得心脏门控2D相位对比MRI序列，用于脑脊液流动和脊髓运动分析。数据处理完全自动化。脑脊液流量和脊髓运动分别通过峰值至峰值振幅、每节段总位移和心跳进行分析。临床资料包括年龄、身高、BMI、症状持续时间、dobroky等人的Bern评分、Schievink等人的脑脊液漏类型。组间比较采用Mann-Whitney U检验;采用多元线性回归分析分析可能的关系。结果对20例SIH患者和40例健康对照进行分析;每组都有70%的女性。 Eleven patients with SIH presented with type 1 leak, 8 with type 2, and 1 was indeterminate. CSF flow per heartbeat was increased at C2/C3 (peak-to-peak amplitude 65.68 ± 18.3 vs 42.50 ± 9.8 mm/s, total displacement 14.32 ± 3.5 vs 9.75 ± 2.7 mm, p < 0.001, respectively). Craniocaudal spinal cord motion per heartbeat was larger at segment C2/C3 (peak-to-peak amplitude 7.30 ± 2.4 vs 5.82 ± 2.0 mm/s, total displacement 1.01 ± 0.4 vs 0.74 ± 0.4 mm, p = 0.006, respectively) and at segment C5/C6 (total displacement 1.41 ± 0.7 vs 0.97 ± 0.4 mm, p = 0.021).Discussion SLEC-positive patients with SIH show higher CSF flow and higher spinal cord motion at the upper cervical spine. This increased craniocaudal motion of the spinal cord per heartbeat might produce increased mechanical strain on neural tissue and adherent structures, which may be a mechanism leading to cranial nerve dysfunction, neck pain, and stiffness in SIH. Noninvasive phase contrast MRI of CSF flow and spinal cord motion is a promising diagnostic tool in SIH.Trial Registration Information German Clinical Trials Register, identification number: DRKS00017351.Classification of Evidence This study provides Class III evidence that noninvasive phase contrast MRI of the upper spine identifies differences in CSF flow and spinal cord motion in patients with SIH compared with healthy controls.AUROC=area under the curve of receiver operating characteristic; BMI=body mass index; CNN=convolutional neural network; CSA=cross-sectional area; ICC=intraclass correlation coefficient; ICHD=International Classification of Headache Disorders; SIH=spontaneous intracranial hypotension; ROI=region of interest; SLEC=spinal longitudinal extradural fluid collection; VENC=velocity ENCoding (parameter) %U //www.ebmtp.com/content/neurology/100/7/e651.full.pdf