ECT在神经内窥镜诊断与治疗脑积水中的应用价值

Significance of ECT on diagnosis and treatment of hydrocephalus by neuroendoscope

目的探讨发射型计算机体层摄影术(emissioncomputedtomographyECT)在神经内窥镜诊断与治疗脑积水中的应用价值。方法选择1998～2002年经MRI检查确诊为脑积水的34例患者,施行ECT检查。采用99mTc-DTPA方法,于检查前8h禁食、水,经腰椎穿刺注入核素2mL(99mTc,15mCi),分别于注药后30min、3h、6h和24h摄取图像进行分析。结果34例患者中梗阻性脑积水30例,交通性脑积水4例。正常情况下,ECT前后位像脑脊液动力学表现为典型的上行三叉影像。根据脑脊液流体动力学变化,不同类型脑积水ECT的影像学诊断标准(1)梗阻性脑积水时上行三叉影像消失。(2)交通性脑积水表现为上行三叉影像圆钝,核素在脑表面和纵裂区蓄积且消散时间延长。结论ECT在不同类型脑积水的诊断、鉴别诊断和指导治疗方面具有重要意义。

Objective To study the significance of emission computed tomography(ECT) on diagnosis and treatment of hydrocephalus by neuroendoscope. Methods Thirty-four cases definitely diagnosed as hydrocephalus by magnetic resonance (MR) scanning during 1998 to 2002 were examinated with ECT. The 99mTc-DTPA was adopted in ECT examination, fasting and water deprivation were ordered 8 hours before examination. An amount of 2mL 99mTc(15 mCi) was injected through lumbar puncture and the images were collected and analyzed at 0.5, 3,6,24 h after injection respectively. Results Of the 34 cases, there were 30 patients with obstructive hydrocephalus and 4 communicating hydrocephalus. In normal condition, anteroposterior ECT scanning showed typical ascending tridentate imaging. Based on CSF hydrokinetic changes, the diagnostic standards of ECT images for different types of hydrocephalus were: 1) In obstructive hydrocephalus, ascending tridentate imaging was disappeared; 2) In communicating hydrocephalus, round-blunt ascending tridentate imaging was showed, the nuclide was accumulated on the surface of cerebrum and longitudinal fissure and dissipation time was delayed. Conclusion There is important significance of ECT in diagnosis,differentiation and guiding treatment for different types of hydrocephalus.