[Comparison of the accuracy between magnetic resonance hydrography and CT myelography in diagnosing of spontaneous intracranial hypotension syndrome].

Objective

To compare the accuracy of spinal magnetic resonance myelography (MRM) and CT myelography (CTM) in the detection of spontaneous intracranial hypotension (SIH).

Methods

The clinica data of SIH patients at the Neurology Department of Zhongshan Hospital Affiliated to Fudan University between June 2021 and August 2023 were prospectively collected . MRM was performed first, CTM, followed by CTM. CTM results were used as the gold standard to verify the consistency of MRM and CTM examination, and the diagnostic results of epidural cerebrospinal fluid accumulation were observed. The abnormal accumulation of cerebrospinal fluid (CSF) was further recorded in 4 parts, namely, the posterior part of the cervical vertebra, the nerve root walking area, the side of the vertebra and the side of the ribs. Kappa consistency test was used to compare and analyze the evaluation results of the two examination methods.

Results

A total of 31 patients were included in the study, including 13 males and 18 females, aged (40.7±7.0) years. The positive rate of CSF leakage detected by MRM was 93.5%(29 cases), and that detected by CTM was 87.1% (27 cases). Kappa consistency analysis showed that there was a high consistency between MRM and CTM (Kappa=0.635, P<0.001). MRM had good consistency with CTM in detecting CSF accumulation along the nerve root area and paracostal area (Kappa values were 0.469 and 0.652, respectively). MRM had relatively low consistency with CTM in detecting CSF accumulation behind the C1-2 vertebrae and in the paravertebral area (Kappa values were 0.241 and 0.271, respectively), but the former had a higher sensitivity (0.833, 95%CI:0.436-0.991), and the latter had a higher specificity (0.963, 95%CI:0.817-0.998).

Conclusions

MRM has a comparable value to CTM in diagnosing epidural CSF accumulation in SIH patients, with good consistency. Besides, it is non-invasive and radiation-free, and may be a suitable alternative method for the initial assessment of SIH patients.