MRI监测脑脊液动力学在外伤性脑静脉窦血栓形成临床诊治中的应用

Application of monitoring circulation dynamics of cerebrospinal fluid with MRI in the diagnosis and treatment of traumatic cerebral venous sinus thrombosis

目的探讨运用MRI监测脑脊液循环动力学异常在外伤性脑静脉窦血栓形成临床诊治中的价值。方法对75例脑外伤后临床颅脑血流动力学异常患者及健康志愿者40例,采用MRI 2D-PC cine法序列,以编码流速20cm/s,于颈1～2椎间隙水平测量患者的脑脊液流速、流量,在其接受尿激酶治疗过程中进行随访复查,并与腰穿脑脊液压力进行对照分析。结果颈1～2椎间隙水平脑脊液流动在一个心动周期内均表现为近似于正弦曲线的双向流动,脑外伤组治疗前收缩期、舒张期脑脊液峰值流速、流量均高于正常人群(P<0.05)。经尿激酶治疗后68例患者脑脊液压力恢复正常,其脑脊液收缩期、舒张期脑脊液峰值流速、流量均较治疗前降低(P<0.05)。脑脊液流速与脑脊液压力呈正相关(r=0.805,P<0.05),脑脊液向下净流量与脑脊液压力呈正相关(r=0.794,P<0.05)。结论静脉窦血栓形成前患者脑脊液循环动力学会发生相应改变,磁共振PC-cine法可以早期检测出其循环动力学改变,对脑外伤后患者颅内压改变的监测及预后评价有重要指导意义。

Objective To assess the value of monitoring cerebrospinal fluid circulation dynamics with 2D-phase contrast cine MRV in the diagnosis and treatment of traumatic cerebral venous sinus thrombosis. Methods MR 2D-phase contrast cine was performed in 75 patients with clinical suspicion of traumatic cerebral venous sinus thrombosis and 40 healthy vol- unteers. The velocity and the flow volume of cerebrospinal fluid flowing through the C1 ~ 2 intervertebral space in these two groups were compared. And then, the relationship between intracranial pressure and the average velocity of cerebro- spinal fluid was analysis. Results CSF in the C1~2 intervertebral space fluctuated in a sinusoidal mode. Among the 75 cerebral trauma patients before treatment, the peak velocity and flow in systole and diastolic period were higher than those of volunteer. The intracranial pressure, peak velocity and flow decreased after urokinase treatment. The average velocity and net flow of cerebrospinal fluid were positively correlated with intracranial pressure （ r =9.7~2, P 〈~）. 05）. Cone｜usioa Cerebrospinal fluid circulation dynamics will change secondary to venous sinus thrombosis. MR 2D-PC cine can quantita- tively monitor the changes of CSF circulation after trauma in prophase, and can be used to evalute the effect of clinical treatment.