放射性核素脑池造影对正常颅压性脑积水诊治的价值研究

Value of radionuclide cisternography in diagnosis and treatment of normal pressure hydrocephalus

目的探讨放射性核素脑池造影对正常颅压性脑积水术前诊断准确性的影响及对预测分流术疗效的价值。方法 2013年1月起至2015年1月期间,三六三医院神经外科收治的患者头颅MRI扫描显示脑室系统扩张符合脑积水形态学特征,并排除梗阻因素,入院初步考虑"交通性脑积水",入院后常规行放射性核素脑池造影。结果 65名脑室系统扩张的患者行放射性核素脑池造影,其中12名患者在动态扫描后发现放射性核素脑室内未显像,且吸收正常,结合症状排除脑积水诊断,仅考虑为脑室系统扩张而非脑积水;另53名患者发现放射性核素脑室内返流伴有核素明显延迟吸收,确诊为脑脊液吸收功能障碍,结合颅内压的测定及Tap试验,符合正常颅压性脑积水诊断,其中47名行分流术,术后6个月后其步态、认知及尿失禁等症状显著改善。结论头颅MRI常规扫描虽能明确大部分脑积水诊断,但对于脑萎缩后脑室系统扩张以及正常颅压性脑积水患者,若不能明确脑脊液在脑室系统中的循环及吸收情况,往往会造成误诊,放射性核素脑池造影可作为一种辅助手段应用于正常颅压性脑积水患者的术前疗效评估中。

Objective To investigate the influence of radionuclide cisternography on the accuracy of preoperative diagnosis of normal pressure hydrocephalus and its value in predicting the effect of shunt surgery. Methods The patients who were admitted to the Neurosurgery Department of The 363 Hospital from January 2013 to January 2015 were enrolled. Head MRI scan showed that ventricular dilation was in accordance with the morphological features of hydrocephalus and excluded the factors of obstruction. On admission,the patients were diagnosed with ＂communicating hydrocephalus＂,and radionuclide cisternography were performed for all patients after admission. Results A total of 65 patients with ventricular dilation underwent radionuclide cisternography. Among them,12 patients had no images of radionuclide in the ventricle,but the absorption of radionuclide was normal,and with reference to the symptoms,the diagnosis of hydrocephalus was excluded,and the patients were diagnosed with ventricular dilation rather than hydrocephalus; 53 patients showed radionuclide reflux in the ventricle and significantly delayed absorption of radionuclide and were diagnosed with absorption dysfunction of cerebrospinal fluid,and with reference to the measurement of intracranial pressure and Tap test,they met the diagnostic criteria of normal pressure hydrocephalus（ NPH）,among whom 47 patients underwent shunting surgery and showed significant improvements in the symptoms such as gait,cognitive function,and urinary incontinence at 6 months after surgery. Conclusions Routine MRI scan is used to obtain a definite diagnosis of most patients with hydrocephalus,but as for patients with ventricular dilation caused by brain atrophy or NPH,if the circulation and absorption of cerebrospinal fluid in the ventricle cannot be clarified,misdiagnosis might occur. Therefore,radionuclide cisternography can be used to assist preoperative evaluation of patients with NPH.