相位对比法脑脊液电影磁共振成像在诊断脑室-腹腔分流装置梗阻中的应用

Application of cine phase contrast MRI to diagnosis of shunt catheter obstruction in patients with hydrocephalus after ventriculoperitoneal shunt

目的探讨相位对比法脑脊液电影磁共振成像(PC cine MRI)在诊断脑室-腹腔分流装置梗阻中的价值,为诊断脑室-腹腔分流装置梗阻提供一种新方法。方法体外试验中将生理盐水以0、2.17、10、20 ml/h速度流经脑室-腹腔分流管,应用PC cine MRI对引流管内液体进行定向观察,CSF-QFlow软件进行定量分析。应用同样的方法对8例怀疑分流管梗阻的病人进行流量检测并进行分析,将疑似梗阻病人的脑脊液的流速,与体外试验速度2.17 ml/h的检测结果进行对照分析。结果体外试验时,与流速为2.17、10、20 ml/h相应值比,流速为0 ml/h的MRI检测值均明显降低(P<0.01)。根据临床拔管指征(每天分流量小于50 ml,换算流速为2.17 ml/h)作为梗阻的标准,6例病人均低于此标准,可诊断为梗阻,此方法诊断结果与临床治疗结果吻合率为100%。结论 PC cine MRI技术简单、无创、可靠,可为诊断分流装置梗阻提供参考。

Objective To provide a method for diagnosing the obstruction of ventriculoperitoneal shunt （VPS） device in the patient with hydrocephalus. Methods The flow of normal saline was qualitatively observed and quantitatively analyzed respectively by cine phase contrast （PC） MRI and CSF-Q Flow software when it passed through the silicon catheter at speeds of 0 ml/h, 2.17 ml/h, 10 ml/h and 20 ml/h. The flow of CSF in the shunt catheters were determined and analyzed by cine PC MRI and CSF-Q Flow software in 8 patients with hydrocephalus, in whom the shunt catheters were suspected to be obstructed after the VPS. Results The velocity of fluid flow in the catheter was significantly higher in the 2.17 ml/h, 10 ml/h and 20 ml/h groups than that in 0 ml/h group （P〈0.01）. Of 8 patients with hydrocephalus examined by cine PC MRI and analyzed by CSF-Q Flow software, 6 had the shunt catheter obstruction and 2 not. The coincident rate of diagnosis made by cine PC MRI with that proved by the operation and treatment outcomes was 100%. Conclusion Cine PC MRI is a simple, noninvasive and reliable method to diagnose shunt catheter obstruction after VPS in the patients with hydrocephalus.