自发性脑脊液鼻漏定位诊断的影像学征象分析

目的 通过总结自发性脑脊液鼻漏患者的影像学直接征象和间接征象，为脑脊液鼻漏修补术前瘘点的影像学定位诊断提供依据。方法 回顾性分析2017年1月—2021年3月中南大学湘雅医院耳鼻咽喉头颈外科诊治的48例患者的临床资料，所有患者术前行鼻窦颅底高分辨CT(HRCT)和核磁共振(MRI)水成像检查。术前分析其影像学直接征象和间接征象，并结合术中情况证实其瘘点位置。结果 48例患者术前经影像学瘘点判断并经手术证实瘘点位于筛板20例(41.7%)，蝶窦外侧隐窝16例(33.3%)，筛顶8例(16.7%)，额窦后壁2例(4.2%)，斜坡2例(4.2%)。研究发现不同区域的自发性脑脊液鼻漏直接征象和间接征象存在明显不同，间接征象如左右侧不对称，引流通道水肿，窦腔黏膜增厚和积液征可以用于寻找瘘点。瘘口在影像学上根据直接征象颅底骨质缺损的诊断符合率为66.7%，而联合应用CT与MRI水成像根据直接征象和间接征象联合应用的诊断符合率为100%。结论 自发性脑脊液鼻漏患者影像学的间接征象对于术前准确判断瘘点具有重要价值。

Imaging sign analysis of localization diagnosis of spontaneous cerebrospinal fluid rhinorrhea

Objective To summarize the direct and indirect imaging signs of patients with spontaneous cerebrospinal fluid (CSF) rhinorrhea, so as to provide basis for the imaging localization diagnosis of leakage points before CSF rhinorrhea repair.Methods Clinical data of 48 patients suffering from spontaneous CSF rhinorrhea surgically repaired in the Department of Otorhinolaryngology, Xiangya Hospital, Central South University from Jan 2017 to March 2021 were analyzed retrospectively. All patients underwent preoperative high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) of nasal sinus and skull base. The direct and indirect imaging signs of the leakage point were analyzed before operation, and the location of the leakage point was confirmed intraoperatively.Results All the leak points of the 48 patients were determined by imaging and confirmed by operation. The leak points were located in cribriform plate in 20 cases (41.7%), lateral recess of sphenoid sinus in 16 (33.3%), the ethmoid roof in 8 (16.7%), posterior wall of frontal sinus in 2 (4.2%) and clivus of skull base in 2 (4.2%). The direct and indirect signs of spontaneous CSF rhinorrhea in different regions were significantly different. Indirect signs such as left-right asymmetry, drainage channel edema, sinus mucosal thickening and effusion signs could be used to find the leak point. The diagnostic coincidence rate of the leak according to the direct signs of skull base bone defect in imaging was 66.7%. When the combination of CT and MRI was used to image the leakage points according to the combination of direct and indirect signs, the diagnostic coincidence rate was 100%.Conclusion The indirect imaging signs of patients with spontaneous CSF rhinorrhea are of great value for accurate localization of the leakage point before operation.