不同颅内压状态下乙状窦沟骨板缺损性耳鸣的脑脊液流场及体积变化特征  

Cerebrospinal fluid flow dynamics and volume changes in sigmoid sinus wall dehiscence-pulsatile tinnitus patients with different intracranial pressure

作　　者：陈澜月 李薇 马晓博 曲晓霞 郑丹丹 刘兆会[1] CHEN Lanyue;LI Wei;MA Xiaobo;QU Xiaoxia;ZHENG Dandan;LIU Zhaohui(Department of Radiology,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China;Department of Radiology,Chongqing General Hospital,Chongqing,400080,China;Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China;Department of Clinical and Technical Support,Philips(China)Investment Co.,Ltd.Beijing Branch,Beijing,100600,China)

机构地区：[1]首都医科大学附属北京同仁医院放射科,北京100730 [2]重钢总医院放射科,重庆400080 [3]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730 [4]飞利浦(中国)投资有限公司北京分公司临床与技术支持部,北京100600

出　　处：《中国耳鼻咽喉头颈外科》2025年第2期94-99,共6页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：国家自然科学基金(82071882);北京市自然科学基金(7222029)。

摘　　要：目的基于MRI探讨不同颅内压状态下乙状窦沟骨板缺损性耳鸣(SSWD-PT)患者的脑脊液流场和体积变化特征。方法前瞻性收集2019年10月~2023年9月就诊于首都医科大学附属北京同仁医院的颅内压增高状态SSWD-PT患者35例、正常颅内压状态SSWD-PT患者25例,以及年龄、性别匹配的正常对照组35名。记录人口统计学特征。通过横窦狭窄指数(ITSS)和形态学评估颅内压。基于磁共振相位对比成像(PC-MRI)对中脑导水管水平脑脊液流场进行分析。基于T1加权3D梯度场回波序列(T1-TFE)通过ITK-SNAP软件分割脑脊液并计算体积。比较三组间各指标差异。结果三组间的平均流量、反流分数有统计学差异(P<0.05),其中颅内压增高组的平均流量明显低于对照组(P<0.017),而反流分数明显高于对照组(P<0.017)。正常颅内压组的平均流量、反流分数与颅内压增高组、对照组比较无统计学差异(P>0.017)。三组间年龄、性别、体重指数及正向流量、反向流量、平均流速、峰值流速、每搏输出量、脑脊液体积均无统计学差异(P>0.05)。结论SSWD-PT患者存在脑脊液异常改变,并且伴有颅内压增高的患者更明显。这些改变可能与乙状窦内血流动力学异常以及耳鸣的发生有关。OBJECTIVE To evaluate cerebrospinal fluid(CSF)flow dynamics and volume changes of pulsatile tinnitus(PT)patients caused by sigmoid sinus wall dehiscence(SSWD)with different intracranial pressure via MRI.METHODS Prospective enrolled 35 SSWD-PT patients with intracranial hypertension,25 SSWD-PT patients with normal intracranial pressure and 35 age-,sex-matched healthy controls.Demographic characteristics were recorded.Intracranial pressure was assessed by the index of transverse sinus stenosis(ITSS)and morphology changes.CSF flow dynamics were evaluated via phase-contrast magnetic resonance imaging(PC-MRI)and CSF volume were evaluated via three-dimensional T1-weighted turbo field echo(3D T1-TFE)sequence and ITK-SNAP software.Compared the differences of each index between three groups.RESULTS The mean flux and regurgitant fraction were significantly different among the three groups(P<0.05).The intracranial hypertension group presented significantly decreased mean flux(MF)and significantly increased regurgitant fraction(RF)compared to controls(P<0.017).There were no significant differences in MF and RF of normal intracranial pressure group compared with intracranial hypertension group and control group(P>0.017).There were no statistical differences in age,sex,body mass index,forward flow volume,backward flow volume,mean velocity,peak velocity,stroke volume and CSF volume(P>0.05).CONCLUSION SSWD-PT patients have abnormal changes in CSF,and those with increased intracranial pressure are more obvious.These changes may be associated with abnormal hemodynamics in the sigmoid sinus and the occurrence of PT.

关 键 词：耳鸣 颅内压 磁共振成像 搏动性耳鸣 乙状窦沟骨板缺损 脑脊液 磁共振相位对比成像 

分 类 号：R764.45[医药卫生—耳鼻咽喉科]