3.0 T MRI对中脑导水管脑脊液流动的研究

目的应用MR相位对比法分析对照组、梗阻性脑积水组(脑积水组)中脑导水管平面脑脊液流量、流速及流动曲线。材料与方法对照组30例,脑积水组16例,均应用3.0 T MR扫描仪、相位对比电影序列对导水管平面脑脊液进行定性观察和定量测定。结果对照组导水管平面脑脊液呈与心脏搏动相关的双向节律性流动。对照组脑脊液流动曲线呈平滑倒"U"形29例,波浪形1例。脑积水组呈欠规则倒"U"形1例,波浪形15例。对照组头侧与足侧脑脊液平均流量分别为(0.0311+0.0201)ml/s、(0.0366+0.0196)ml/s,流速分别为(4.027+1.174)cm/s、(4.107+1.433)cm/s脑积水组头侧与足侧脑脊液平均流量分别为(0.0070+0.0069)ml/s、(0.0078+0.0044)ml/s,流速分别为(0.550+0.327)cm/s、(0.599+0.606)cm/s。两组头侧与足侧脑脊液平均流量、流速两两比较均具有统计学义(P0.05)。结论 MR相位对比法能显示导水管平面脑脊液的流动节律,流速。对照组、脑积水组导水管平面的脑脊液流动节律、头侧及足侧的脑脊液平均流量、流速均不同。     

MRI相位对比电影评价中颅窝蛛网膜囊肿脑池造瘘术的疗效

目的 评价MRI相位对比电影判断中颅窝蛛网膜囊肿脑池造瘘术疗效的价值.方法 对16例中颅窝蛛网膜囊肿患儿行造瘘术前后均行MRI常规序列扫描及相位对比电影检查,定性定量评估造瘘口脑脊液(CSF)流动,测量CSF动力学指标(峰值流速、流量及流动波形).结果 造瘘术前16例中颅窝蛛网膜囊肿与邻近蛛网膜下腔未见沟通,经CT脑池造影进一步证实诊断.囊肿与基底池造瘘术后,16例造瘘口CSF流动均为阳性,在一个心动周期内表现为双向运动,与正常导水管流动波形相似,提示造瘘口CSF流动通畅.术后1周16例蛛网膜囊肿均较术前缩小.对其中10例分别于术后3个月及半年复查,见蛛网膜囊肿均进一步缩小.结论 MRI相位对比电影是评价囊肿脑池造瘘术治疗中颅窝蛛网膜囊肿的疗效以及术后观察造瘘口是否通畅的直观可靠的影像学手段.     

经神经内镜手术治疗脑积水

目的：探讨神经内镜治疗脑积水的适应症，方法及技巧。方法：回顾性总结了经神经内镜手术治疗的脑积水52例，手术方法包括三脑室底造瘘术，透明膈造瘘术，脉络丛烧灼术及内镜下置分流管。结果：随访2月－48月。16例原发性导水管狭窄性脑积水15例疗效满意；12例肿瘤压迫导水管性脑积水10例疗效满意；7例单侧室间孔堵塞性脑积水均有效。3月后复查CT提示脑室缩小30例。17例交通性脑积水术后症状均有明显改善。结论：神经内镜手术治疗脑积水微创，安全，疗效好，适用于所有类型的脑积水；三脑室底造瘘术应作为梗阻性脑积水的首选方法，内镜引导下脑室腹腔分流术治疗交通性脑积水可降低分流管堵塞的机会。     

儿童急性梗阻性脑积水Ommaya储液囊植入术的护理

目的探讨Ommaya储液囊在儿童急性梗阻性脑积水中的应用及护理。方法回顾性分析2006-2009年温州医科大学附属第二医院收治的维生素K依赖因子缺乏性脑室出血和结核性脑膜炎所致急性梗阻性脑积水患儿22例的临床资料。所有患儿均行Ommaya储液囊植入手术,术前认真评估病情,积极做好各项术前准备,术后总结并发症的观察与采取的护理措施。结果经治疗,15例脑出血伴急性梗阻性脑积水患儿无一例发生颅内感染,仅1例患儿因持续脑积水行脑室-腹腔分流手术。结核性脑膜炎伴急性梗阻性脑积水患儿中有6例经治疗脑脊液恢复正常,无复发;1例患儿治疗4个月后脑脊液常规白细胞20×106/L~40×106/L,无临床症状,取出Ommaya储液囊2个月后脑脊液复查正常。结论 Omrnaya储液囊植入术治疗儿童急性梗阻性脑积水效果良好,手术简便、创伤小、并发症少,值得临床广泛应用。     

神经内镜治疗脑囊虫型脑积水的围手术期护理

目的探讨脑囊虫型脑积水神经内镜手术治疗的观察和护理要点。方法总结7例脑囊虫型脑积水在内镜下手术的临床治疗护理资料。结果7例脑囊虫型脑积水的患者安全度过围手术期,临床症状缓解。脑脊液电影成像：术后6个月中脑导水管脑脊液最大流速较术前增加（2．18±0．34）cm／s,最大流量较术前增加（0．22±0．07）cm／s。结论掌握脑囊虫型脑积水临床症状和以往患者治疗病史,根据神经内镜手术特点,进行有针对性地观察和护理,可减少并发症,使患者安全度过围手术期。     

软性神经内镜治疗小儿梗阻性脑积水的围手术期护理

目的 探讨应用软性神经内镜治疗小儿梗阻性脑积水手术前后的护理要点.方法 回顾性分析2004年9月-2007年6月应用软性神经内镜治疗小儿梗阻性脑积水80例手术前的护理.结果 术后80例均恢复良好,脑积水症状明显减轻或消失.术后并发症包括硬膜下积液1例,发热41例,4例颅内感染,癫痫3例,头皮下积液1例.结论 软性神经内镜下行第三脑室底造瘘是治疗小儿梗阻性脑积水安全有效的方法,护理人员在术前需根据患儿的年龄特点有针对性地做好心理指导、术前宣教,让患儿家长对该病治疗方法知情充分,保持平和心态,积极配合是术后康复及减少并发症的重要保障.     

神经内镜下第三脑室底造瘘术的护理配合

采用神经内镜行第三脑室底脚间池造瘘治疗导水管梗阻性脑积水是一种新的手术方法.报告了对12例导水管梗阻性脑积水患者实施该术式的手术中护理配合,认为巡回护士要正确摆放患者体位,根据视野清晰度和出血情况严格控制冲洗速度,注意保持引流管道通畅;器械护士要协助术者保护好器械,避免碰撞和弯折.本组手术顺利,效果良好.     

儿童后颅窝囊肿伴梗阻性脑积水的内镜治疗

目的 探讨软性神经内镜治疗儿童后颅窝囊肿的应用价值.方法 对15例不同类型的儿童后颅窝囊肿伴梗阻性脑积水的患者采用经枕下入路或经幕上额部穿刺入路方式,在软性内镜下分别进行囊壁切除、囊肿一脑池或囊肿一脑室造瘘、第三脑室底造瘘、导水管重建等治疗.结果 10例蛛网膜囊肿及3例Druidy-walker囊肿治疗获得成功,脑脊液循环梗阻得到解除,术前颅高压症状消失,脑功能障碍得到不同程度改善,无效2例,没有死亡及严重并发症出现.结论 由于软性内镜特有的性能特征,在后颅窝囊肿内及蛛网膜下腔探查及治疗中几乎没有盲区或死角,可根据囊肿的具体情况采用不同术式进行内镜下治疗,在对儿童后颅窝囊肿伴梗阻性脑积水的治疗中,软性神经内镜与其他术式相比具有明显优势,可提高治疗效果,减9-并发症的发生,值得推广.     

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。     

神经内镜治疗小儿梗阻性脑积水的临床护理

小儿梗阻性脑积水是最常见的先天性神经系统畸形疾病之一,严重影响患儿的神经系统发育.近年来,随着神经内镜技术的发展和普及,内镜下第三脑室底造瘘术(endoscopic third ventriculostomy,ETV)已成为治疗梗阻性脑积水的首选方法.ETV术有效避免了分流管堵塞、过度分流等并发症,并且不必因患儿身体长高多次手术更换分流管[1].我院神经外科2006年9月～2012年8月对194例梗阻性脑积水患儿进行了ETV术治疗,取得了良好效果.现报告如下.     

Use of cerebrospinal fluid flow rates measured by phase-contrast MR to predict outcome of ventriculoperitoneal shunting for idiopathic normal-pressure hydrocephalus

OBJECTIVE: To determine whether favorable clinical response and magnitude of improvement are associated with increased aqueductal cerebrospinal fluid (CSF) flow rates in patients who undergo ventriculoperitoneal shunting (VPS) for idiopathic normal-pressure hydrocephalus (NPH). PATIENTS AND METHODS: Between January 1995 and June 2000, 49 patients (14 men and 35 women; mean age, 72.9 years; range, 54-88 years) underwent magnetic resonance quantification of aqueductal CSF flow followed by VPS for presumed idiopathic NPH at the Mayo Clinic, Rochester, Minn. Logistic regression models for the odds of any improvement in score as a function of aqueductal CSF flow and separate models for any improvement in gait, incontinence, cognition, and total score were constructed. RESULTS: Forty-two patients (86%) had improvement in gait at postoperative follow-up (mean, 10 months). Of the 32 patients with incontinence, 27 (69%) improved. Of the 36 patients with cognitive impairment, 16 (44%) improved. In univariate and fully adjusted models, increased CSF flow through the aqueduct was not significantly associated with improvement or the magnitude of improvement in gait, cognition, or incontinence. Thirty-six patients underwent high-volume lumbar puncture preoperatively, of whom 5 (14%) had no response. The aqueductal CSF flow rates of these 5 patients were significantly higher than those of the patients who improved after lumbar puncture. Postoperative complications occurred in 15 patients. The aqueductal CSF flow rates in these 15 patients were not significantly different from those of patients who experienced no complications. CONCLUSION: Among patients who underwent VPS for the treatment of NPH, measurement of CSF flow through the cerebral aqueduct did not reliably predict which patients would improve after shunting or the magnitude of improvement.     

Asymmetric Ventriculomegaly,Interhemispheric Cyst,and Dysgenesis of the Corpus Callosum (AVID)

A series of 20 cases from 2 academic institutions is presented with a characteristic imaging triad of asymmetric ventriculomegaly, a large interhemispheric cyst, and partial or complete agenesis of the corpus callosum. Most cases were initially referred as aqueduct stenosis and hydrocephalus or focal porencephaly. We describe the imaging findings that identify an abnormal or absent corpus callosum associated with a type 1 interhemispheric cyst in fetuses initially thought to have hydrocephalus attributable to aqueductal stenosis. We suggest that the acronym AVID (asymmetric ventriculomegaly, interhemispheric cyst, and dysgenesis of the corpus callosum) may be useful in recognition of these cases. All cases presented with markedly asymmetric ventriculomegaly on initial sonography, with progressive hydrocephalus throughout gestation. Fetal magnetic resonance imaging was performed in 15 of 20 cases. Thirteen of 20 cases were identified in male fetuses. Associated fetal and postnatal abnormalities are also reported. Technological improvements in sonography and fetal magnetic resonance imaging allow improved characterization of associated intracranial anomalies in the setting of hydrocephalus. Accurate diagnosis can aid parental counseling, especially because isolated aqueductal stenosis suggests a better prognosis than hydrocephalus with anomalies. Markedly asymmetric ventriculomegaly in this series was the key to excluding isolated aqueductal stenosis and was associated with callosal malformation with a type 1a interhemispheric cyst.     

A mathematical model for predicting intracranial pressure based on noninvasively acquired PC-MRI parameters in communicating hydrocephalus

To develop and validate a mathematical model for predicting intracranial pressure (ICP) noninvasively using phase-contrast cine MRI (PC-MRI). We performed a retrospective analysis of PC-MRI from patients with communicating hydrocephalus (n?=?138). The patients were recruited from Shenzhen Second People’s Hospital between November 2017 and April 2020, and randomly allocated into training (n?=?97) and independent validation (n?=?41) groups. All participants underwent lumbar puncture and PC-MRI in order to evaluate ICP and cerebrospinal fluid (CSF) parameters (i.e., aqueduct diameter and flow velocity), respectively. A novel ICP-predicting model was then developed based on the nonlinear relationships between the CSF parameters, using the Levenberg–Marquardt and general global optimisation methods. There was no significant difference in baseline demographic characteristics between the training and independent validation groups. The accuracy of the model for predicting ICP was 0.899 in the training cohort (n?=?97) and 0.861 in the independent validation cohort (n?=?41). We obtained an ICP-predicting model that showed excellent performance in the noninvasive diagnosis of clinically significant communicating hydrocephalus.

     

基于PC-MRI的无创测量颅内压方法

目的 结合人体神经生理学、流体力学原理和电影相位对比磁共振成像(PC-MRI)特点,研究一种非侵入式无创性颅内压(ICP)测量方法.方法 从颅内压强与颅内容积的一阶指数关系出发,推出单位容积内的颅内压强变化(弹性)与ICP之间成线性比例关系;利用速度编码的血液和脑脊液(CSF)的PC-MRI数据、压强变化与压强梯度变化间的关系,计算出弹性的值,最后根据弹性、弹性与ICP的线性关系式计算出ICP,并对2例颅脑疾病患者和3名健康人进行了试验测量.结果 对2例颅脑疾病患者和3名健康人的测量均有效地估算出了ICP.结论 基于PC-MRI的测量颅内压方法安全无创,对颅脑疾病患者和健康人ICP的测量均较为有效.     

Phase-contrast cine MR angiography detection of thoracic aortic dissection

Purpose: To assess prospectively the accuracy of phase-contrast cine MR angiography in the detection of thoracic aortic dissection with operative correlation. Materials and methods: One hundred and ninety-seven symptomatic patients suspected of having thoracic aortic dissection or aneurysm as well as 13 patients suspected of having thoracic aortic coarctation and 20 asymptomatic normals (as controls) were examined prospectively with phase-contrast cine MR angiography on a 1.5-T MR imager. Seventy-eight of these patients had operative correlation, and only these 78 patients were included in the statistical analysis. Results: There were 51 true positive and 27 true negative findings of thoracic aortic dissection in this study for an accuracy of 100%. Conclusion: Phase-contrast cine MR angiography is an accurate non-invasive imaging technique for evaluating patients suspected of having thoracic aortic dissection.     

Evaluation of pulmonary blood supply by multiplanar cine magnetic resonance imaging in patients with pulmonary atresia and severe pulmonary stenosis

The purpose of this study was to assess the capability of multiplanar cine magnetic resonance imaging (MRI) for evaluating pre- and post-operative pulmonary circulation in patients with pulmonary atresia and severe pulmonary stenosis. Seventy-three multiplanar cine MRIs were performed in 30 patients, aged 1 month to 7 years (mean age, 27 months). The morphology and size of the central pulmonary arteries (PA), source of the major aortopulmonary collateral arteries (MAPCA), patency of Blalock–Taussig (BT) shunt vessels, and the post-operative pulmonary circulation were assessed. The accuracy of cine MRI was compared with that of angiography in all patients. The PA was visualized to the first hilar branch in 21 patients, but not in 8 patients in whom the central PA was absent. On follow-up MRI, PA growth was measured, and the results showed excellent correlation with the results obtained by angiography. In 17 patients who had undergone 23 BT shunt operations, cine MRI correctly demonstrated all patient shunts and 5 of 6 stenotic lesions. Multiplanar cine MRI provided excellent detail of the peripheral PA in all patients, 7 of 8 peripheral pulmonary stenoses, 3 of 4 nonconfluent pulmonary arteries, and 2 of 3 PA obstructions. Although the sources of MAPCA were identified in 7 of 9 patients, the distal connection of the MAPCA was not detected in all patients. Seven patients were reexamined after pulmonary plasty; they exhibited normal pulmonary flow patterns. Multiplanar cine MRI provides high-resolution imaging of PA with dynamic visualization of flow and is an effective noninvasive technique for evaluating pre- and post-operative patients with pulmonary atresia and severe pulmonary stenosis.     

MR imaging of the thoracic aorta

MR imaging has been incorporated into the diagnostic algorithm for suspected thoracic aortic pathology, challenging CT and invasive catheter angiography as investigations of choice. Techniques, including spin echo, 3-D steady-state free precession, cardiac cine imaging, phase-contrast flow quantification, and high-resolution contrast-enhanced magnetic resonance angiography, are poised to trump other single competitive modalities. The proliferation of 3-tesla systems has advanced the performance of magnetic resonance, aided by parallel imaging techniques, multiarray surface coils, and powerful gradient coils. This article considers the current status of MR imaging in evaluation of the thoracic aorta, with reference to common clinical indications in clinical practice.