Quantitative analysis of thecal sac volume and morphology as a diagnostic tool in intracranial hypotension.

IF 4 2区医学 Q1 CLINICAL NEUROLOGY

Headache Pub Date : 2025-09-01 Epub Date: 2025-07-21 DOI:10.1111/head.15014

Kerry Knievel, Lea Alhilali, Raza Mushtaq, Kelly McCormick, Rachel Stancl, Karissa Secora, Jennifer Robblee

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引用次数: 0

Abstract

Objectives/background: This study was undertaken to determine whether thecal sac volume and morphometry can be used to differentiate patients with spontaneous intracranial hypotension (SIH). The mechanisms underlying SIH appear to be multifactorial. Association with connective tissue disorders is established, suggesting that increased thecal sac compliance and volume may contribute to SIH.

Methods: This study is an observational cross-sectional study that used magnetic resonance imaging (MRI) to compare thecal sac volume between patients with SIH and healthy controls. Patients with SIH and matched controls were prospectively recruited from December 1, 2020 to March 1, 2022. All participants underwent volumetric MRI of the entire spine. Semiautomated segmentation was used to extract three-dimensional volumetric models of the thecal sac. A single average thecal sac model was created for each group. Signed model to model distance function was used to compute and visualize the correspondent vectors that quantify the localized differences, including shape, between control and SIH thecal sacs.

Results: Twenty-eight patients with SIH (mean age = 45.9 years, mean body mass index = 27.7, 57% male) and 28 controls (mean age = 44.4 years, mean body mass index = 26.8, 57% male) were recruited. The thecal sac was significantly larger in patients with SIH (mean = 131.7 cm³, 95% confidence interval [CI] = 108.1-155.3) than controls (mean = 116.5 cm³, 95% CI = 105.1-127.9, p < 0.001). Thecal sac volume demonstrated excellent discrimination for SIH (area under the curve = 0.91, 95% CI = 0.83-0.98, p < 0.001). Volume > 122 cm³ was 82% sensitive and 82% specific for SIH; volume > 126 cm³ was 100% specific. Regional thoracic volume was slightly higher in patients with SIH (61.6 and 57.8 cm³, respectively, p = 0.020), and lumbar volume was notably higher (46.6 and 33.0 cm³, respectively, p < 0.001).

Conclusion: Patients with SIH have a significantly larger thecal sac than controls, which can be an effective tool to diagnose these patients.

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脑膜囊体积和形态的定量分析作为颅内低血压的诊断工具。

目的/背景：本研究旨在确定鞘囊体积和形态测量是否可以用于区分自发性颅内低血压（SIH）患者。SIH的机制似乎是多因素的。与结缔组织疾病相关，提示鞘囊顺应性和体积增加可能导致SIH。方法：本研究是一项观察性横断面研究，使用磁共振成像（MRI）比较SIH患者和健康对照组的鞘囊体积。从2020年12月1日至2022年3月1日，前瞻性招募SIH患者和匹配的对照组。所有参与者都接受了整个脊柱的体积MRI检查。采用半自动分割法提取鞘囊三维体积模型。每组建立一个平均的鞘囊模型。使用签名模型到模型距离函数来计算和可视化相应的向量，这些向量量化了控制组和SIH鞘囊之间的局部差异，包括形状。结果：共纳入28例SIH患者（平均年龄45.9岁，平均体重指数27.7，男性57%）和28例对照组（平均年龄44.4岁，平均体重指数26.8，男性57%）。SIH患者的鞘囊明显大于对照组（平均= 116.5 cm3, 95%可信区间[CI] = 108.1-155.3）（平均= 116.5 cm3, 95% CI = 105.1-127.9， p122 cm3对SIH敏感82%，特异82%）；体积bbb126cm3为100%特异。SIH患者局部胸廓容积略高（分别为61.6和57.8 cm3, p = 0.020），腰椎容积显著高于对照组(分别为46.6和33.0 cm3， p结论：SIH患者鞘囊明显大于对照组，可作为诊断SIH患者的有效工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Headache 医学-临床神经学

CiteScore

9.40

自引率

10.00%

发文量

172

审稿时长

3-8 weeks

期刊介绍： Headache publishes original articles on all aspects of head and face pain including communications on clinical and basic research, diagnosis and management, epidemiology, genetics, and pathophysiology of primary and secondary headaches, cranial neuralgias, and pains referred to the head and face. Monthly issues feature case reports, short communications, review articles, letters to the editor, and news items regarding AHS plus medicolegal and socioeconomic aspects of head pain. This is the official journal of the American Headache Society.