磁共振电影成像与第三脑室底造瘘术后评估

The value of cine-MRI in evaluating the surgical outcome after the third ventriculostomy

目的探讨相位对比磁共振电影成像法在对非交通性脑积水患者行第三脑室底造瘘术后瘘口开通状况的评估价值。方法利用相位对比磁共振电影成像法对128例非交通性脑积水患者行神经内镜下第三脑室底造瘘术后进行瘘口的流速测定，并作为随访方法。对部分术后临床症状缓解不佳、或在随访期内再次出现高颅压症状的患者进行二次内镜下探查，结合术中探查及二次手术前磁共振电影成像检查结果来分析电影成像检查对判断造瘘口是否开通的准确性。结果3例术后临床症状缓解不佳，电影成像检查显示脑脊液流过瘘口良好，二次手术探查中亦证实造瘘口处于开通状况；16例患者术后再次出现高颅压的患者，磁共振电影成像检查显示造瘘口脑脊液流速明显减小，二次内镜下手术探查显示造瘘口闭塞或明显狭窄，重新造瘘后临床症状改善。电影成像检查结果和手术探查显示的结果符合率为100％。结论磁共振电影成像可以精确反映第三脑室底造瘘术后造瘘口开通情况，可以作为评估造瘘后造瘘口开通状况的金标准及重要的随访手段。

Objective To explore the value of magnetic resonance imaging （MRI） and cine magnetic resonance imaging （cine-MRI） in evaluating the open status of orificium fistulae after the third ventriculostomy in patients with noncommunicating hydrocephalus. Method Apply the magnetic resonance imaging （MRI） and cine magnetic resonance imaging （cine-MRI） method to determine stoma rates and flows in 128 patients with noncommunicating hydrocephalus after endoscopic third ventriculostomy, what＇s more, we also made it the follow-up method. Second look exploration might be necessary for patients whose clinical symptoms did not ease well or symptoms of intracranial hypertension recurred in the follow-up period, accuracy of cine-MRI in determining the open status of orificium fistulae could be analyzed combined with the intraoperative exploration and results of cine-MRI examination. Result Clinical symptoms in 3 cases did not ease well, and cine-MRI demonstrated that the flow of cerebrospinal fluid through stoma was good and the stoma was open during the second look exploration; intracranial hypertension recurred in 16 cases, and cine- MRI demonstrated that rates and flows of cerebrospinal fluid in stomas reduced greatly, the stomas was blocked or obviously narrowed, which would regress after the second ostomy. Coincidence rate of cine-MRl and exploration was 100%. Conclusion Cine-MRI can actually reflect the open status of orificium fistulae after the third ventriculostomy, and further, it will become the gold standard for evaluation of the open status for orificium fistulae after ostomy and an important follow-up method.