特发性正常压力脑积水新型影像学标志的诊断效能及其与临床症状的相关性  

Diagnostic efficacy of novel imaging markers and its correlation with clinical symptoms for idiopathic normal pressure hydrocephalus

作　　者：黄文君 方旭昊 李仕红[1] 毛仁玲 叶春涛[1] 刘伟[1] 林光武[1] HUANG Wenjun;FANG Xuhao;LI Shihong;MAO Renling;YE Chuntao;LIU Wei;LIN Guangwu(Department of Medical Imaging,Huadong Hospital affiliated to Fudan University,Shanghai 200040,China;Neurosurgery department,Huadong Hospital affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华东医院医学影像科,上海200040 [2]复旦大学附属华东医院神经外科,上海200040

出　　处：《磁共振成像》2021年第12期12-17,23,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金面上项目(编号:81771816);上海市卫生和计划生育委员会面上项目(编号:201740003)。

摘　　要：目的评价各平面影像学标志(包括线性、角度、体积及相关比值)在特发性正常压力脑积水(idiopathic normal pressure hydrocephalus,i NPH)诊断中的效能及其与临床症状的关系。材料与方法回顾性分析22名iNPH确诊患者和26名正常老年受试者通过结构相磁共振成像得出的各新型影像学标志,包括额角径、颅骨内径、胼胝体角、额角垂直径、侧脑室中央部、幕上最大颅内径、脑室上组织、胼胝体侧脑室距离(callosal ventricular distance,CVD)、胼胝体-连合距离、颞角径、胼胝体高度及Evans指数、z-Evans指数、脑实质与侧脑室比值。通过受试者工作特征(receiver operator characteristic,ROC)曲线分析、t检验和Logistic回归模型分析各影像学标志的诊断效能。分析i NPH确诊患者临床症状(包括步态、认知及排尿功能)与各影像学指标的相关性。结果各新型影像学标志中,Evans指数、侧脑室中央部、胼胝体-连合距离、颞角径、额角垂直直径及CVD、z-Evans指数、胼胝体高度均显示出较高的特异度(P<0.001),其中侧脑室中央部是最佳指标(AUC=0.985),Evans指数其次(AUC=0.981),颞角径第三(AUC=0.946)。侧脑室中央部及颞角径在区分i NPH组与正常老年组时差异具有最显著的统计学意义(OR_(1)=0.562,95%CI_(1):0.400~0.789;OR_(2)=0.376,95%CI_(2):0.218-0.646)。z-Evans指数、额角垂直直径和胼胝体高度与术前特发性正常压力脑积水临床系统评分(idiopathic normal pressure hydrocephalus grade scale,i NPHGS)排尿部分呈一定相关性(P_(1)=0.034,P_(2)=0.029,P_(3)=0.018)。结论本研究涉及的各新型影像学标志中,Evans指数、侧脑室中央部、胼胝体-连合距离及颞角径表现出突出的诊断能力,由此推断侧脑室扩张更多表现在Z轴方向。z-Evans指数、额角垂直直径、胼胝体高度与患者术前排尿情况呈一定相关性。Objective:To evaluate the diagnosis efficacy of imaging markers (including linearity,angle,volume and the ratio) of idiopathic normal pressure hydrocephalus (i NPH) and their relationship with clinical symptoms.Materials and Methods:The novel imaging markers,frontal horn diameter (FHD),inner skull diameter (ISD),cella media width (CMW),maximum supratentorial intracranial diameter (MSID),supraventricular width (SVW),callosal-ventricular distance (CVD),callosal-commissural distance (CCD),temporal horn width (THW),callosal height (CH),Evans index (EI),z-Evans index (ZEI),frontal horn vertical diameter (FHVD),brain-to-ventricle ratio (BVR),obtained from 3.0 T brain magnetic resonance imaging in twenty-two patients with idiopathic normal pressure hydrocephalus and twenty-six healthy elders.Diagnostic performance of imaging markers was studied by using receiver operating characteristic (ROC) analysis,t-statistic and Logistic regression models.To analyze the correlation between the clinical symptoms (including gait,cognition and urination function) of the patients diagnosed with INPH and the imaging indexes.Results:EI,CMW,CCD,FHVD,CVD,THW and CH,ZEI showed high specificity (P<0.001).CMW showed the highest discriminatory power between i NPH and healthy control group (AUC=0.985),followed by EI (AUC=0.981) and THW (AUC=0.946).CMW and THW had the most statistically significant difference between the i NPH group and the normal age group.ZEI,FHVD and CH were correlated with preoperative idiopathic normal pressure hydrocephalus grade scale (i NPHGS) micturition score.Conclusion:The best diagnostic performance among these new imaging markers is EI,CMW,CCD and THW.Thus it can be inferred that lateral ventricular dilatation is more in the Z-axis direction.ZEI,FHVD and CH were correlated with preoperative urination.

关 键 词：特发性正常压力脑积水 磁共振成像 痴呆 影像学标志 诊断效能 

分 类 号：R445.2[医药卫生—影像医学与核医学] R742.7[医药卫生—诊断学]