三维稳态构成干扰序列联合MR相位对比技术在诊断儿童脑积水膜性梗阻中的价值

Value of combined three dimensional constructive interference in steady state with phase-contrast MR in diagnosis of hydrocephalus children

目的探讨三维稳态构成干扰序列（3D-CISS）联合MR相位对比技术（PC-MR）对儿童脑积水中膜性梗阻的诊断价值。方法回顾性搜集2012年5月至2013年10月因膜性梗阻导致脑积水患儿28例，所有患儿均进行常规MRI扫描，以及三维稳态构成干扰序列（3D—ciss）和PC—MR技术扫描，以造瘘术中所见和脑室造影结果为金标准，分析不同序列诊断膜性梗阻的情况。采用χ2检验比较常规MRI扫描及3D-CISS序列联合PC-MR技术诊断膜性梗阻的差异。结果28例患儿中16例为脑室内膜性梗阻，12例为脑室外膜性梗阻。常规MRI序列诊断脑室内、外膜性梗阻15例，其中诊断准确11例、假阳性4例；3D-CISS序列诊断脑室内、外膜性梗阻40例，其中假阳性12例；3D-CISS序列联合PC-MR技术准确诊断28例膜性梗阻患儿，其诊断脑积水膜性梗阻的准确率为100％（28／28），显著高于常规序列的诊断结果[39．3％（11／28）1，差异具有统计学意义（χ2=24．410，P=0．001）。结论3D-CISS序列联合PC-MR技术可以准确判断脑积水患者膜性梗阻位置，可为选择合适治疗方案和手术方式提供可靠依据。

Objective To investigate the value of combined 3D-constructive interference in steady state（3D-CISS） with phase-contrast MR（PC-MR） in diagnosis of hydrocephalus children. Methods We collected retrospectively 28 children with hydrocephalus who caused by obstructive membranes.They all underwent MR imaging examination with a 1.5 T consisting of 3D-CISS, conventional sequences and PC-MR. With the result of surgery and CT cisteruography as gold standard,we analysised different sequence in the diagnosis of membranous obstruction. The results of obstructive were analysed by X2 test between 3D-CISS combined with PC-MR and conventional sequences. Results The study included 28 children, of whom 16 showed obstructive membranes in CSF pathways of ventricle and 12 displayed obstructive membranes in CSF pathways of cistern. Conventional sequences diagnosed obstructive membranes of 15 children, and obstructive membranes of 11 children were consistent with gold standard, and 4 cases were false positive. The 3D-CISS diagnosed obstructive membranes of 40, and 12 cases were false positive.There were significant difference between 3D-CISS combined with PC-MR and conventional sequence about obstructive membranes diagnosis of CSF pathways（χ2=24.410, P=0.001）. Conclusions Making use of jointing 3D-CISS sequence and PC-MR sequence successively, and we can diagnose the position of obstructive membrane for hydrocephalus, which can be helpful to select a perfect surgical approach.