磁共振三维稳态构成干扰序列和相位对比电影序列鉴别非肿瘤性脑积水

目的 探讨MR三维稳态构成干扰（3D-CISS）序列和相位对比电影（cine PC）序列鉴别诊断非肿瘤性脑积水的价值。方法 选取常规MR平扫及增强扫描显示脑室系统扩大的非肿瘤性脑积水患者65例及健康志愿者30名（对照组），对中脑导水管区进行3D-CISS和cine PC序列扫描。依据3D-CISS序列所见中脑导水管有无梗阻，将患者分为梗阻组和交通组，动态播放矢状位cine PC图像，观察各组中脑导水管处脑脊液（CSF）流动情况；对轴位cine PC测得的中脑导水管处CSF流速、流量与对照组进行统计学分析。结果 3D-CISS序列清晰显示22例中脑导水管梗阻（梗阻组），43例无梗阻（交通组）。矢状位cine PC图像示梗阻组仅2例中脑导水管见微弱CSF流动信号，余均无明显CSF流动；而交通组CSF流动信号明显。轴位cine PC测得交通组中脑导水管CSF流速和流量较对照组增多（P均<0.05）。结论 3D-CISS序列结合cine PC序列可无创定性、定量观察CSF流动，有助于鉴别非肿瘤性脑积水的类型。

Application of MR three-dimensional constructive inference in steady state and cine phase contrast sequence for differentiation of non-neoplastic hydrocephalus

Objective To investigate the value of MR three-dimensional constructive inference in steady state (3D-CISS) and cine phase contrast (cine PC) sequence for differential diagnosis of non-neoplastic hydrocephalus. Methods MR 3D-CISS and cine PC sequences were performed in 30 healthy volunteers (control group) and 65 patients with non-neoplastic hydrocephalus and ventricular system on routine plain and enhanced MRI. The patients were divided into obstructive and communicating group based on whether 3D-CISS sequence showing obstruction in midbrain aqueduct or not. Sagittal cine PC images were dynamically played to observe cerebrospinal fluid (CSF) flow in midbrain aqueduct. CSF flow volume and velocity obtained by axial cine PC in each group was compared. Results 3D-CISS sequence clearly showed the midbrain aqueduct obstruction in 22 patients (obstructive group), while no obstruction was detected in 43 patients (communicating group). Faint CSF flow in saggittal cine PC images were noticed in only 2 cases in obstructive group, and the rest in that group showed no CSF flow, while all 43 patients in communicating group showed obvious CSF flow, and the flow velocity and quantity of communicating group in midbrain aqueduct were much higher than those in control group (all P<0.05). Conclusion Combined with cine PC sequence, 3D-CISS can be used as a noninvasive technique to estimate CSF flow, providing useful information for differentiating hydrocephalus.