PC-MRI在Ⅰ型Chiari畸形枕大池成形术后疗效评估中的应用

Clinical application of phase-contrast magnetic resonance image in postoperative evaluation of Chiari malformation typeⅠ

目的探讨磁共振相位对比电影成像(PC-MRI)技术在Ⅰ型Chiari畸形枕大池成形术后疗效评估中的应用价值。方法2018年6月至2020年12月前瞻性收集Ⅰ型Chiari畸形21例,均行枕大池成形术治疗,术前及术后6个月行PC-MRI检查,分析中脑导水管及脑桥腹侧脑脊液平均流量(MF)、头向峰值流速(Vumax)及足向峰值流速(Vdmax)。术后6个月,根据症状缓解与否,分为症状缓解组和无缓解组。结果术后6个月,15例术后症状消失或缓解(缓解组),6例症状无明显改善(无缓解组)。缓解组中脑导水管、脑桥腹侧Vdmax和Vumax较术前均明显降低(P<0.05),而MF则明显增加(P<0.05)。无缓解组手术前后中脑水管及脑桥腹侧脑脊液MF、Vdmax和Vumax均明显变化(P>0.05)。结论PC-MRI可定量分析脑脊液流动情况,对Ⅰ型Chiari畸形术后疗效评估具有一定价值。

Objective To explore the application value of phase-contrast magnetic resonance image(PC-MRI)in the evaluation of postoperative efficacy of cisternaplasty for the patients with Chiari malformation typeⅠ(CM-Ⅰ).Methods A total of 21 patients with CM-Ⅰwere prospectively recruited from June 2018 to December 2020.All the patient underwent cisternaplasty.The PC-MRI examination was performed before and 6 months after the surgery to evaluate the cerebrospinal fluid(CSF)flow in the aqueduct of midbrain and ventral pons,and the parameters included mean flux(MF),maximum peak velocity(Vmax),Vumax and Vdmax.Results Six months after the operation,symptom relief was achieved in 15 patients(symptom relief group),and 6 not(no relief group).The MF,Vumax and Vdmax of CSF flow in the aqueduct of midbrain and ventral pons of the patients in symptom relief group were significantly decreased and MF was significantly increased 6 moths after the operation(P<0.01).The MF,Vmax,Vumax and Vdmax of CSF flow in the aqueduct of midbrain and ventral pons of the patients in no relief group did not change significantly 6 months after the surgery(P>0.05).Conclusions PC-MRI can quantitatively analyze the CSF flow,which has certain value in evaluating the postoperative curative effect of the cisternaplasty for the patients with CM-Ⅰ.