非小细胞肺癌软脑膜转移患者MR测量与脑脊液压力的相关性研究

目的：探讨非小细胞肺癌（non-small cell lung cancer，NSCLC）软脑膜转移（leptomeningeal metastases，LM）患者磁共振（magnetic resonance，MR）测量视神经鞘直径（optic nerve sheath diameter，ONSD）和头颅外周脑脊液体积/全脑容积（peripheral cerebrospinal fluid volume/intracranial volume，PCSFV/ICV）比值与脑脊液压力（cerebrospinal fluid pressure，CSFP）的相关性，评估ONSD和PCSFV/ICV联合诊断CSFP升高的准确性。方法：共收集63例NSCLC-LM患者，所有患者同时进行视神经和颅脑 MR 扫描，测量双眼ONSD、颅脑PCSFV和ICV。随后对所有患者行腰椎穿刺测量CSFP，并定期进行鞘内化疗。采用Pearson 相关分析法分析CSFP 与MR 表现的相关性。通过受试者工作特征（receiver operating characteristic，ROC）曲线评估ONSD 和 PCSFV/ICV联合诊断CSFP升高的准确性。结果：所有NSCLC-LM患者双眼平均ONSD与CSFP呈正相关（r=0.567，P ＜ 0.001）， PCSFV/ICV 与 CSFP 呈负相关（r=-0.365，P=0.003）。ROC 曲线分析显示 ONSD、PCSFV/ICV 及 ONSD 联合 PCSFV/ICV 诊断颅内高压（CSFP＞15 mmHg）的性能分别为0.81（95%CI：0.71~0.91）、0.76（95%CI：0.64~0.89）和0.91（95%CI：0.84~0.99）。ONSD、 PCSFV/ICV 及 ONSD 联合 PCSFV/ICV 诊断颅内高压（CSFP＞20 mmHg）的性能分别为 0.70（95%CI：0.58~0.82）、0.72（95%CI： 0.57~0.88）和0.81（95%CI：0.70~0.93）。结论：经MR测量ONSD和PCSFV/ICV可以评估NSCLC-LM患者CSFP的变化，二者联合能够提高诊断颅内高压的准确性，有较好的临床应用价值。

Correlation study of MR measurement and cerebrospinal fluid pressure in non⁃small cell lung cancer patients with leptomeningeal metastasis

Objective：To explore the correlation between magnetic resonance（MR）findings[optic nerve sheath diameter（ONSD） and peripheral cerebrospinal fluid volume/intracranial volume ratio（PCSFV/ICV）]and cerebrospinal fluid pressure（CSFP）in patients with leptomeningeal metastases（LM）from non - small cell lung cancer（NSCLC）. And to assess the diagnostic accuracy of combined ONSD and PCSFV/ICV in diagnosing elevated CSFP. Methods：A total of 63 patients with NSCLC-LM were enrolled. Both optic nerve and cranial MR scans were performed to measure bilateral ONSD，cranial PCSFV and ICV. Subsequently，CSFP was measured in all patients through lumbar puncture，and intrathecal chemotherapy was administered regularly. Pearson correlation analysis was used to analyze the correlation between CSFP and MR findings. The accuracy of combined ONSD and PCSFV/ICV in diagnosing elevated CSFP was evaluated through receiver operating characteristic（ROC）curve analysis. Results：In patients with NSCLC-LM，the average ONSD of bilateral eyes was positively correlated with CSFP（r=0.567，P ＜ 0.001）. PCSFV/ICV was negatively correlated with CSFP （r=-0.365，P=0.003）. ROC curve analysis showed that the performance of ONSD，PCSFV/ICV，and combined ONSD with PCSFV/ICV in diagnosing intracranial hypertension（CSFP＞15 mmHg）were 0.81（95%CI：0.71-0.91），0.76（95%CI：0.64-0.89），and 0.91（95%CI：0.84-0.99），respectively. The performance of ONSD，PCSFV/ICV，and combined ONSD with PCSFV/ICV in diagnosing intracranial hypertension（CSFP＞20 mmHg）were 0.70（95%CI：0.58-0.82），0.72（95%CI：0.57-0.88），and 0.81（95%CI：0.70-0.93），respectively. Conclusion：The utilization of MR for measuring ONSD and PCSFV/ICV provides a valuable means to assess variations in CSFP among patients diagnosed with NSCLC -LM. Additionally，the combination of these two measurements enhances the diagnostic accuracy for evaluating CSFP，demonstrating its potential clinical significance.