磁共振水成像在脑积水内镜治疗围手术期的应用

MR Fluid Imageology before and after CISS Sequence in the Evaluation for Endoscopic Treatment of Obstructive Hydrocephalus

目的探讨磁共振(MR)水成像技术对梗阻性脑积水患者的诊断意义,及其在脑积水内镜治疗围手术期的应用价值。方法回顾性观察和测量56例梗阻性脑积水患者的常规加三维稳态构成干扰(3D-CISS)序列MR影像,分析三脑室扩大程度与三脑室底厚度的相关性。对其中行内镜三脑室底造瘘手术(ETV)的15例患者和内镜辅助的脑室腹腔分流手术(EAVPS)的6例患者进行围手术期MR常规加3D-CISS扫描的影像学评价。结果梗阻性脑积水患者三脑室扩大程度与三脑室底的厚度有明显的负相关性。ETV术前3D-CISS扫描有助于充分了解三脑室扩大程度、三脑室底厚度、基底动脉的方位,可明确三脑室解剖变异;EAVPS术前3D-CISS扫描可了解分流管是否被黏连或异位,室间孔(Monro孔)的大小。术后行3D-CISS扫描可测量瘘口大小、观察脑脊液的流动方向、评价手术效果。结论MR水成像可精确显示脑脊液和脑室系统的结构,为脑积水内镜治疗围手术期评价提供了可靠依据。

Objective To study diagnostic significance of magnetic resonance （MR） fluid imaging technique in patients with obstructive hydrocephalus, and evaluate its preoperative and postoperative clinical value of endoscopic treatment. Methods The regular and three-dimensional constructive inference in steady state （3D-CISS） sequence MR images of 56 patients with obstructive hydrocephalus were retrospectively analyzed. The possible correlation between third ventricle enlargement （TVE） and third ventricle floor thickness （TVFT） was analyzed. In this group, 15 cases underwent endoscopic third ventriculostomy （ETV） and 6 cases endoscopic assisted ventriculo-peritoneal shunt （EAVPS）, and their 3D-CISS sequence MR images were evaluated pre- and post-operatively. Results There was a negative correlation between TVE and TVFT in this group. Before ETV, 3D-CISS imaging helped locating the incision on the scalp, finding out the enlargement degree of third ventricle and thickness of third ventricle floor, locating orientation of basic artery （BA） or posterior cerebral artery （PCA） to avoid trauma and define anatomic aberrancel Prior to EAVPS, 3D-CISS could realize orientation of V-P shunt pipe, the size of Monro foramen and whether the pipe had been conglutinated; Postoperatively, it could measure fistula, observe CSF fluid direction, and evaluate the outcome of operation. Conclusion 3D-CISS scanning could display third ventricle more easily and accurately, and would provide a credible method for evaluating ETV and EAVPS pre- and post-operatively.