应用磁共振相衬技术对ChiariⅠ型畸形合并脊髓空洞症的脑脊液动力学研究

目的应用磁共振相衬技术评估脑脊液动力学改变对ChiariⅠ型畸形脑脊液动力学的影响。方法选取ChiariⅠ型畸形合并脊髓空洞症病人17例（CMⅠ组）和同期健康志愿者16名（对照组）为研究对象，病人均行后颅窝减压术，并于术前及术后12个月分别针对颅颈交界区行磁共振相衬技术检查，志愿者仅检查一次，分析中脑导水管中央段、第四脑室出口段及第二颈椎水平脑脊液流速、流量等参数的改变。结果与对照组比较，CMⅠ组病人各被检处脑脊液峰流速均增快（P < 0.05~P < 0.01），且总体流量减少（P < 0.01）。病人术后各处流速较术前明显变缓（P < 0.01），流量增加（P < 0.01）。不同预后病人的中脑导水管中段脑脊液流量、流速和第二颈椎腹侧脑脊液流速差异均有统计学意义（P < 0.05~P < 0.01）。结论Chiari畸形Ⅰ型伴脊髓空洞症病人存在脑脊动力学变化，表现为脑脊液流动受阻，而脑脊液动力学的改善与病人预后具有相关性，应用磁共振相衬技术监测脑脊液动力学变化有助于评估病人预后。

Study on the applicaton value of the PC-MRI on the cerebrospinal fluid dynamics in Chiari malformation type Ⅰ complicated with syringomyelia

ObjectiveTo explore the effects of the cine phase-contrast magnetic resonance imaging(PC-MRI) in evaluating the change of dynamics of cerebrospinal fluid(CSF) on the CSF dynamics in patients with Chiari malformation type Ⅰ(CMⅠ).MethodsSixteen healthy volunteers and 17 CMⅠ and syringomyelia patients were divided into the control goup and CMⅠgroup, respectively.The region between canium and neck of CMⅠ group was detected using PC-MRI scans before and after 12 months of operation, and the control group was checked only once.The changes of CSF velocity and flow at the central segment of midbrain aqueduct, exit segment of the fourth ventricle and second cervical spine level were analyzed.ResultsCompared with the control group, the peak flow velocity of CSF in each examined site in CMⅠ group increased(P < 0.05 to P < 0.01), and the overall flow decreased(P < 0.01).After operation, the peak velocity of CSF in CMⅠ group slowed significantly down(P < 0.01), and the flow increased(P < 0.01).The differences of the peak flow velocity and flow of CSF between the central segment of midbrain aqueduct and second cervical spine level among different prognosis patients were statistically significant(P < 0.05 to P < 0.01).ConclusionsThe improvement of CSF dynamics is related to the prognosis of patients.The application of PC-MRI in monitoring the dynamics of CSF is helpful to evaluate the prognosis of patients with CMⅠ complicated with syringomyelia.