ABSTRACT
Objective:To investigate the characteristics of magnetic resonance myelography (MRM) and its application in the treatment of spontaneous intracranial hypotension (SIH).Methods:The clinical data, MRM characteristics, and treatment of 15 patients with SIH who underwent MRM examination in the First Affiliated Hospital of Zhengzhou University from August 2014 to August 2019 were retrospectively analyzed. According to treatment methods, nine patients were divided into conservative treatment group and six patients were divided into combined epidural blood patch treatment group. The gender, age, time interval from onset to MRM examination, cerebrospinal fluid pressure and MRM characteristics between the two groups were compared. SPSS 20.0 software was used for statistical description, and independent sample t-test was applied to compare the differences between groups. Results:All of the 15 cases reported orthostatic headache. Their cerebrospinal fluid pressure was (29.67±19.77, range 0-55) mmH 2O (1 mmH 2O=0.009 8 kPa), and onset-MRM interval was (33.07±24.22, range 7-90) days. The MRM characteristics were observed, including all 15 cases with periradicular leaks, four cases with anterior epidural fluid collections, six cases with posterior epidural fluid collections, and eight cases with high cervical (C 1-2 to C 2-3) retrospinal cerebrospinal fluid collections. There were 2 to 32 leak sites with an average of (10.20±7.87) sites. Among the 153 leak sites, 58(37.9%) sites were located at cervical vertebra, 77(50.3%) sites at thoracic vertebra, 18(11.8%) sites at lumbar vertebra, and 61(39.9%) sites at either the cervicothoracic junction (C 7-T 1 to T 1-2) or the upper thoracic region (T 2-3to T 6-7). Five patients responded well to one-time targeted autologous epidural blood patch on the basis of the location of the cerebrospinal fluid leakage. Besides, one patient improved with targeted epidural blood patch twice. There were no statistically significant differences in gender, age, onset-MRM interval, cerebrospinal fluid pressure, number and location of leak sites between the conservative treatment group and combined treatment group. Conclusions:The periradicular leaks of cerebrospinal fluid at cervical vertebra and thoracic vertebra are the most common feature of MRM in patients with SIH. MRM can identify the existence and location of cerebrospinal fluid leakage, assist in the diagnosis of SIH, and guide targeted epidural blood patch.
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Objective The purpose of this study was to evaluate whether whole-tumor histogram-based analysis of readout-segmented echo-planar diffusion-weighted imaging (RESOLVE-DWI) ADC map can help in the discrimination of parotid gland tumors(pleomorphic adenoma, Warthin tumor, malignant parotid gland tumor). Methods The MR images(pre / post-contrast enhanced MRI, RESOLVE-DWI, ADC map) of 47 patients with a biopsy-or surgery-proven pleomorphic adenomas, 25 patients with Warthin tumors and 36 patients with malignant parotid gland tumors were retrospectively analyzed. Histogram-based analysis was performed with the software MaZda. ROIs were drawn on every section of the ADC map containing the tumor, then 12 Parameters(Area, MinNorm, MaxNorm, Mean,Variance, Skewness, Kurtosis, Perc.1％, Perc.10％, Perc.50％, Perc.90％, Perc.99％) derived from histogram were calculated. Statistical analysis among the three groups (One-way ANOVA or Kruskal-Wallis test) were performed to find out the statistical significance of each histogram parameter. Then LSD test or Mann-Whitney U test was used for pairwise comparison between groups. And the differential efficiency of each parameter was determined using ROC analysis. Results Overall, 9 parameters (MinNorm, MaxNorm, Mean, Variance, Skewness, Perc. 10％, Perc. 50％, Perc. 90％, Perc. 99％) among three groups were shown to be statistically significant (P<0.05). Between the pleomorphic adenomas and Warthin tumors, these 9 parameters were of statistical significance. Perc.50％revealed the highest diagnostic efficiency, followed by Mean and Perc.10％. Between the pleomorphic adenomas and malignant parotid gland tumors, also all these 9 parameters were of statistical significance. Mean was revealed to have the highest diagnostic efficiency, followed by Perc. 10％ and Perc. 90％. However, between the Warthin tumors and malignant parotid gland tumors, only 5 parameters (MinNorm, Mean, Skewness, Perc. 10％, Perc. 50％) were statistically significant. MinNorm was revealed to have the highest diagnostic efficiency, followed by Perc. 50％ and Perc. 10％. Generally, Mean, Perc. 10％ and Perc. 50％ were more effective in the differential diagnosis of these three types common parotid neoplasms. Conclusion Whole-tumor histogram analysis of ADC maps are effective in differentiating common parotid neoplasms.
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Objective To evaluate the utility of susceptibility weighted imaging (SWI)in the evaluation of traumatic brain injury (TBI)severities.Methods 20 mild TBI patients,20 moderate TBI patients and 20 severe TBI patients were collected.The involving brain regions,numbers and areas of hemorrhagic lesions detected by SWI were analyzed and the differences of each group were com-pared.The correlation analysis between Glasgow coma scale(GCS)scores and each above parameters were underwent.Results The differences of involving regions’number,lesions’number,lesions’area were statistically significant(P <0.05 ).Severe TBI group got the maximum number of involving regions,lesions,and the largest areas,followed by moderate group and mild group.The GCS were highly negatively correlated with the number of involving regions,number of lesions,areas of lesions detected by SWI.In descending order of relevance:GCS with areas detected by SWI(r=-0.982,P=0.000),the number of lesions detected by SWI(r=-0.941,P=0.000),the number of involving regions detected by SWI(r=-0.900,P=0.000).Conclusion The clinical applications of SWI in diagnosing TBI and evalua-ting the TBI severity is of great significance.