利用弥散张量成像技术评估继发性正常压力性脑积水分流手术的效果  

Evaluation of ventriculoperitoneal shunt in patients with secondary normal pressure hydrocephalus by diffusion tensor imaging

作　　者：娄云霄 曹付强 王本瀚 扶宇 姚安会 唐斌 李经纶 LOU Yunxiao;CAO Fuqiang;WANG Benhan;FU Yu;YAO Anhui;TANG Bin;LI Jinglun(Department of Neurosurgery,No.988 Hospital of PLA Joint Logistics Support Force,Zhengzhou,Henan Province,450042,China)

机构地区：[1]中国人民解放军联勤保障部队第九八八医院神经外科,郑州450042

出　　处：《陆军军医大学学报》2022年第10期1048-1053,共6页Journal of Army Medical University

基　　金：联勤保障部队面上项目(CJN16J004)。

摘　　要：目的应用弥散张量成像(diffusion tensor imaging,DTI)及纤维束成像(diffusion tensor imaging tracking,DTT)技术评估继发性正常压力脑积水患者分流手术的效果。方法分析2018年1月至2020年1月本院收治的22例行脑室腹腔分流术的继发性正常压力性脑积水患者术前和术后1个月的DTI、DTT变化,测量患者脑室旁内囊位置各项异性分数(fractional anisotropy,FA)值及平均弥散率(mean diffusivity,MD)值,根据纤维束重建技术记录患者脑室旁纤维束数量及形态变化情况。结果所有患者术后脑室旁FA值、MD值较术前显著下降(P<0.01),纤维束数量较术前有明显增加(P<0.01),术后纤维束形态明显受压率较术前有显著降低(P<0.01)。术后恢复不良组患者的脑室旁FA值、MD值较术前显著下降(P<0.01),纤维束明显受压率与术前相比差异无统计学意义,纤维束数量有明显增加(P<0.01)。术后恢复良好组患者的dFA值(手术前后FA差值)显著高于恢复不良组(P<0.01)。结论弥散张量成像和纤维束成像技术在预测继发性正常压力性脑积水患者分流手术效果中优势明显,具有一定的临床意义。Objective To evaluate the efficacy of ventriculoperitoneal shunt in patients with secondary normal pressure hydrocephalus by using the diffusion tensor imaging(DTI)and diffusion tensor tractography(DTT).Methods 3.0 T MRI was performed on 22 patients before and 1 month after their ventriculoperitoneal shunts,DTI and DTT imaging were performed simultaneously.We recorded the values of fractional anisotropy(FA)and mean diffusivity(MD)around the ventricle,the number of white matter fiber tracts around the lateral ventricle,and the orientation and distribution of neural fiber tracts.Results After ventriculoperitoneal shunts were performed,the values of FA and MD were decreased significantly(P<0.01),the number of white matter fiber tracts around the lateral ventricle were obviously increased(P<0.01),and the compression rate of fiber tracts was reduced(P<0.01).Among the poor rehabilitative patients,the values of FA and MD around the ventricle were decreased significantly(P<0.01).We calculated the differences of FA value(dFA)and MD value(dMD)and the number of fiber tracts before and after operation,the results suggested that the dFA was higher in the patients of better rehabilitation than those of poor rehabilitative outcomes.The dMD were higher and the number of fiber tracts was increased in the better rehabilitative patients(P<0.01).Conclusion The relevant items of DTI and DTT are significantly improved in the poor effective patients with normal pressure hydrocephalus after ventriculoperitoneal shunt.The changes of FA value around the lateral ventricle can predict the efficacy of the surgery.DTI and DTT techniques provide certain and valuable guidance for the organic improvement after ventriculoperitoneal shunt.

关 键 词：继发性正常压力性脑积水 脑室腹腔分流 弥散张量成像 纤维束成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R651.11[医药卫生—诊断学]