颅脑MRI在无神经功能异常的慢性头痛中的诊断价值

BRAIN MRI IN THE EVALUATION OF CHRONIC HEADACHE IN PATIENTS WITHOUTNEUROLOGIC ABNORMALITY

摘要:

目的:评价颅脑MRI在慢性头痛而无神经功能异常的成年患者中发现异常的作用。方法:回顾性调查338例无神经功能异常的慢性头痛患者的临床资料和颅脑MRI检查结果,并根据MRI发现分成三组:颅脑MRI无异常组、次要异常组和重要异常组。结果:无异常组患者218例(64.5%),次要异常组113例(33.4%),重要异常组7例(2.1%,95%可信区间上限为4.2%)。其中,在55例不明原因头痛(无法明确分类的头痛)患者中MRI提示重要异常的有5例(9.1%,95%可信区间上限为20.0%)。造影增强扫描(n=16)或重复MRI检查(n=35)均无其它异常发现。结论:神经功能正常的慢性头痛的诊断可能不必要行颅脑MRI检查,造影增强扫描或重复MRI检查也无助于诊断,而不明原因头痛的诊断则有必要进行该检查。

Abstract:

Objective:To evaluate the ability of brain MRI to detect major abnormalities in adult patients with chronic headache and no neurologic abnormality.Methods:The medical records and MRI of 338 adult patients with normal neurologic findings and chronic headache were retrospectively reviewed.MRI results were classified as 'no abnormalities','minor abnormalities' or 'severe abnormalities'.Results:No abnormalities were found in 218 patients(64.5%),minor abnormalities were found in 113(33.4%) patients,and severe abnormalities were found in 7(2.1%) patients(upper 95% confidence bound,4.2%).Severe abnormalities were noted on MRI in 5(9.1%) of 55 patients(the headache features coucd not classified) with undefined headaches(upper 95% confidence bound,20.0%).Neither contrast material enhancement(n=16) nor repeated MRI(n=35) resulted in detection of additional abnormal findings.Conclusion:Brain MRI may be an unrewarding technique in patients with chronic headache and normal neurologic findings.Neither contrast enhancement nor repeated MRI contributed to diagnosis.However,patients with undefined headaches may benefit from brain MRI.