Purpose

To assess early renal pelvis opacification on postmyelography computed tomography (CT) as a marker for cerebrospinal fluid (CSF) loss in patients with spontaneous intracranial hypotension (SIH).

Methods

The SIH patients referred to our hospital between January 2012 and May 2018 were retrospectively reviewed and divided into 2 groups based on the presence of spinal longitudinal extrathecal CSF collection (SLEC): (1) SLEC(+) with, and (2) SLEC(−) without proof of SLEC on multimodal imaging. Non-SIH patients (n = 20) undergoing CT myelography served as controls. The renal pelvis density on postmyelography CT was measured in all patients. Mean difference in renal pelvis density between the groups was calculated.

Results

In total, 111 SIH patients (mean age 48 ± 13 years; 60% female) were included, 71 (64%) SLEC(+) and 40 (36%) SLEC(−). The adjusted renal pelvis density in the SLEC(+), SLEC(−), and the non-SIH group was 108 Hounsfield unit (HU), 83 HU, and 32 HU, respectively, resulting in a significant difference between SLEC(+) vs. control group 1 (75 HU, p < 0.001), SLEC(−) vs. control group 1 (50 HU, p < 0.001), and a tendency for higher density in SLEC(+) than SLEC(−) (25 HU, p = 0.16).

Conclusion

Increased renal pelvis opacification on postmyelography CT was observed in SIH patients, even in the absence of a CSF leak or a CSF venous fistula, when compared to non-SIH patients. Although the provenance of early renal opacification in SLEC (−) SIH patients remains unclear, our results suggest that it may be a surrogate for increased spinal CSF resorption via spinal arachnoid granulations and along spinal nerve sheaths occult to direct imaging.

中文翻译：

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脊髓造影后计算机断层扫描中肾盂混浊作为自发性颅内低血压脑脊液丢失的指标

目的

评估脊髓造影后计算机断层扫描 (CT) 上的早期肾盂混浊作为自发性低颅压 (SIH) 患者脑脊液 (CSF) 丢失的标志物。

方法

回顾性分析2012年1月至2018年5月间转诊至我院的SIH患者，根据脊柱纵向鞘外脑脊液积液（SLEC）分为2组：（1）SLEC（+）伴，（2）SLEC（ −) 没有多模态成像的 SLEC 证明。接受 CT 脊髓造影的非 SIH 患者 ( n  = 20) 作为对照。在所有患者中测量脊髓造影后 CT 上的肾盂密度。计算各组之间肾盂密度的平均差异。

结果

总共包括 111 名 SIH 患者（平均年龄 48 ± 13 岁；60% 女性），71 名（64%）SLEC（+）和 40（36%）名 SLEC（-）。SLEC(+)、SLEC(-) 和非 SIH 组的调整后肾盂密度分别为 108 亨斯菲尔德单位 (HU)、83 HU 和 32 HU，导致 SLEC(+) 之间存在显着差异对比对照组 1 (75 HU, p  < 0.001)，SLEC(-) 对比对照组 1 (50 HU, p  < 0.001)，并且 SLEC(+) 的密度倾向于高于 SLEC(-) (25胡，p  = 0.16）。

结论

与非 SIH 患者相比，即使在没有 CSF 渗漏或 CSF 静脉瘘的情况下，在脊髓造影后 CT 上也观察到 SIH 患者的肾盂混浊增加。尽管 SLEC (−) SIH 患者早期肾混浊的起源仍不清楚，但我们的研究结果表明，它可能是通过脊髓蛛网膜颗粒和沿脊神经鞘难以直接成像的脊髓脑脊液吸收增加的替代物。