MRI可变翻转角的三维快速自旋回波序列对梗阻性脑积水诊断和手术策略的影响  

Magnetic resonance three dimensional sampling perfection with application optimized contrasts using different flip angle evolution sequence for obstructive hydrocephalus： impact on diagnosis and surgical strategy modification

作　　者：宋志军 陈晓雷[2] 唐运林 余新光[2] 李莎恩 陈曦 彭俊 李昉晔[2] 周定标[2] 

机构地区：[1]解放军第四五八医院神经外科,广州510062 [2]解放军总医院神经外科 [3]解放军第四五八医院医务处,广州510062

出　　处：《中华外科杂志》2015年第11期860-864,共5页Chinese Journal of Surgery

摘　　要：目的 探讨MRI可变翻转角的三维快速自旋回波（3D-SPACE）序列在梗阻性脑积水诊断中的价值和其对手术策略的影响.方法 收集2013年3月至2014年7月解放军总医院神经外科收治的152例脑积水患者的临床资料,男性86例,女性64例,年龄8个月至79岁.所有患者术前均行MRI T2WI常规序列和3D-SPACE特殊序列扫描,根据3D-SPACE检查结果决定手术策略,对非交通性脑积水行脑室镜辅助造瘘治疗,对交通性脑积水采用分流治疗.根据MRI影像上能否直接观察到梗阻部位确定脑积水梗阻部位的检出率.术后定期随访,随访时复查3D-SPACE或头颅CT.结果 3D-SPACE对脑积水梗阻部位的检出率为98.3％ （114/116）,T2WI的检出率为72.4％（84/116）.152例患者中脑导水管薄膜梗阻36例,松果体区、第三脑室后部、四叠体区占位22例,Dandy-Walker综合征10例,桥前池蛛网膜囊肿18例,囊虫病16例,侧脑室囊肿4例,第四脑室囊肿2例,室间孔占位2例,室间孔闭锁2例,颅咽管瘤4例,交通性脑积水36例.随访1 -18个月,平均（14±9）个月,共有112例（73.7％）患者无需分流管而通过神经内镜治疗获得了脑积水的治愈.结论 MRI 3D-SPACE序列能提供比常规影像更清晰的解剖影像信息,有助于梗阻性脑积水患者的检出,可以帮助医师选择最佳手术策略,提高治疗效果.Objective To investigate the value of magnetic resonance three dimensional sampling perfection with application optimized contrasts using different flip angle evolution （3 D-SPACE） sequences in diagnosis and surgical strategy modification for obstructive hydrocephalus.Methods From March 2013 to July 2014, there were 152 cases admitted in People＇s Liberation Army General Hospital suffered from hydrocephalus, including 88 male patients and 64 female patients aging from 8 months to 79 years.All patients were performed magnetic resonance T2WI and 3D-SPACE sequence scanning before operation.Surgical strategy was made after evaluation of 3D-SPACE sequence.Non-communicating hydrocephalus was treated with endoscopic third ventriculostomy （ETV） and communicating hydrocephalus was treated with ventriculo-peritoneal shunt.According to MR images of direct observation to site of obstruction to determine the detection rate.MRI 3D-SPACE and cranial CT examination were performed in regular follow-up studies.Results The relevance ratio of 3D-SPACE for the diagnosis of non-communicating hydrocephalus was 98.3% （114/116）, while the relevance ratio of conventional T2-weighted MRI was 72.4% （84/116）.Among the 152 patients, there were 36 cases with cerebral aqueduct film obstruction, 22 cases with spaceoccupying lesions in pineal region, posterior part of the third ventricle, or space-occupying lesions in quadrigeminal bodies area,10 cases with Dandy-Walker symptom, 18 cases with cyst of the anterior pool of the bridge, 16 cases with cysticercosis, 4 cases with cyst of lateral ventricle, 2 cases with cyst of fourth ventricle,2 cases with space-occupying lesion in foramen ofmonro,2 cases with foramen ofmonro atresia, 4 cases with craniopharyngioma,36 cases with communicating hydrocephalus.There were 112 hydrocephalus cases （73.7%） were treated with ETV, without shunt catheter insertion in follow-up study from 1 to 18 months （average （14 ±9） months）.Conclusions For obstructive hydrocephalus, MRI 3D-SPACE s

关 键 词：脑积水 磁共振成像 脑室腹膜分流术 脑室造口术 

分 类 号：R651.1[医药卫生—外科学]