Abstract: Objective This paper aims to investigate the application of MR HT2-FSE sequence hydrography combined with CT cisternography in craniotomy for traumatic cerebrospinal fluid rhinorrhea.Methods A total of 31 patients with traumatic cerebrospinal fluid rhinorrhea admitted to the First Affiliated Hospital of Anhui Medical University in the past 3 years from October 2018 to October 2020 was selected as the research subject.Preoperative magnetic resonance HT2-FSE sequence hydrography and CT Cisternography were completed before the surgery.We set the position of intraoperative visual leakage as the gold standard.The diagnostic value of different preoperative imaging localization methods for cerebrospinal fluid rhinorrhea was compared,and the recurrence and complications of craniotomy for cerebrospinal rhinorrhea were observed at the same time.Results 35 leakages were found by preoperativeMR HT2-FSE sequence hydrography combined with CT cisternography on 31 patients with traumatic cerebrospinal fluid rhinorrhea,34 among which were consistent with intraoperative direct vision (97%).The sensitivity,specificity,Kappa value and Youden index of MR HT2-FSE sequence hydrography sequence were 86%,80%,0.49 and 0.66 respectively.In addition,CT cisternography showed 91% sensitivity,45% specificity,0.41 Kappa value,0.37 Youden index,while the sensitivity,specificity,Kappa value and Youden index of MR HT2-FSE sequence hydrography combined with CT cisternography were 97%,89%,0.86 and 0.86 respectively.MR HT2-FSE sequence hydrographycombined with CT cisternography had higher consistency with intraoperative direct vision.There was no significant difference between the three imaging localization methods in the localization of cerebrospinal fluid rhinorrhea and intraoperative direct vision (P＞0.05),and the sensitivity and specificity of combined examination were better than that of single examination.All patients were successfully repaired once,and no recurrent rhinorrhea was observed.Conclusion Magnetic resonance HT2-FSE sequence hydrography combined with CT cisternography can accurately locate the leak location of traumatic cerebrospinal fluid rhinorrhea,providing a basis for accurate intra-operative repair of the leakage.

Key words: Craniocerebral injury, Cerebrospinal fluid leakage, Cerebrospinal fluid water imaging, Cisternography

摘要： 目的 探讨磁共振重T2加权快速自旋回波(HT2-FSE)序列水成像结合CT脑池造影在外伤性脑脊液鼻漏手术中的应用。方法 选取2018年10月至2020年10月安徽医科大学第一附属医院收住的31例外伤性脑脊液鼻漏患者作为研究对象,术前完善磁共振HT2-FSE序列水成像扫描和CT脑池造影检查,以术中直视漏口位置为金标准,比较术前不同影像学定位方法对脑脊液鼻漏的诊断价值,同时观察开颅修补脑脊液鼻漏的复发情况及并发症。结果 31例外伤性脑脊液鼻漏患者,通过术前磁共振HT2-FSE序列水成像结合CT脑池造影检查发现漏口35处,与术中直视相符34处(97%);磁共振HT2-FSE序列水成像灵敏度86%,特异度80%,Kappa值0.49,约登指数0.66;CT脑池造影灵敏度91%,特异度45%,Kappa值0.41,约登指数0.37;磁共振HT2-FSE序列水成像结合CT脑池造影灵敏度97%,特异度89%,Kappa值0.86,约登指数0.86;磁共振HT2-FSE序列水成像结合CT脑池造影与术中直视一致性较好;三种影像学定位方法对脑脊液鼻漏口的定位与术中直视的差异无统计学意义(P>0.05),其中联合检查相比单独检查诊断的灵敏度和特异度都较好。31例患者均1次修补成功,随访均未见鼻漏复发。结论 磁共振HT2-FSE序列水成像结合CT脑池造影可较准确定位外伤性脑脊液鼻漏的漏口位置,为术中精准修补漏口提供依据。

关键词: 颅脑外伤, 脑脊液鼻漏, 脑脊液水成像, 脑池造影