相位对比电影-磁共振成像技术对Chiari畸形Ⅰ型脑脊液流体力学的分析研究
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摘要
目的:应用相位对比电影-磁共振成像(Cine PC-MRI)技术辅助Arnold-Chiari畸形Ⅰ型患者手术策略选择,分析对照手术前后脑脊液流体力学的特点。方法:选择19例Arnold-Chiari畸形Ⅰ型患者,应用Cine PC-MRI技术明确脑脊液循环障碍部位,选择后颅窝重建术或枕大池重建术;定量分析感兴趣区(ROI)的平均流量(MF)、每搏输出量(SV)、反流分数(RF)及最大峰值流速(V_(max))[分为头向最大峰值流速(V_(umax))和足向最大峰值流速(V_(dmax))];预后评估应用芝加哥Chiari结果量表(CCOS)评分。结果:Cine PC-MRI提示术后ROI脑脊液MF、SV增加,V_(umax)和V_(dmax)减小,与术前比较差异有统计学意义(F=2.792,F=3.561,F=3.305,F=2.362;P<0.05);术后CCOS评分均高于11分,平均得分13分,最低评分12分,满分16分,无患者需二次手术。结论:Cine PC-MRI技术可在Arnold-Chiari畸形Ⅰ型诊疗中予以辅助指导手术策略,可定量及定性分析脑脊液流体力学。
Objective: To apply cine phase contrast-MRI(Cine PC-MRI) to assist the selection of surgical strategies for patients with Arnold-Chiari malformation type Ⅰ, and to analyze and contrast the characteristics of hydrodynamics of cerebrospinal fluid before and after surgery. Methods: 19 patients with Arnold-Chiari malformation type Ⅰ were enrolled in the research. Cine PC-MRI was used to confirm the location of circulatory disturbance of cerebrospinal fluid, and posterior fossa reconstruction or cisterna magna reconstruction were selected and applied. And the mean flow(MF), stroke volume(SV), regurgitant fraction(RF) and maximum peak velocity(V_(max))(which were divided into V_(umax) and V_(dmax)) of region of interesting(ROI) were quantitatively analyzed. And the prognosis evaluation was achieved by using Chicago Chiari Outcome Scale(CCOS). Results: Cine PC-MRI showed that MF and SV of cerebrospinal fluid of ROI post operation increased, and V_(umax) and V_(dmax) of that decreased, which were significantly different from preoperative values(F=2.792, F=3.561, F=3.305, F=2.362, P<0.05), respectively. And postoperative CCOS scores of these patients were higher than 11 points, and average score of them was 13 points, and the lowest score in them was 12 points, and the full score in them was 16 points, and no patient required a second surgery. Conclusion: The Cine PC-MRI technique can contribute to guide the surgical strategy in the diagnosis and treatment of Arnold-Chiari malformation type Ⅰ, and it can quantitatively and qualitatively analyze the hydromechanics of cerebrospinal fluid.
Objective: To apply cine phase contrast-MRI(Cine PC-MRI) to assist the selection of surgical strategies for patients with Arnold-Chiari malformation type Ⅰ, and to analyze and contrast the characteristics of hydrodynamics of cerebrospinal fluid before and after surgery. Methods: 19 patients with Arnold-Chiari malformation type Ⅰ were enrolled in the research. Cine PC-MRI was used to confirm the location of circulatory disturbance of cerebrospinal fluid, and posterior fossa reconstruction or cisterna magna reconstruction were selected and applied. And the mean flow(MF), stroke volume(SV), regurgitant fraction(RF) and maximum peak velocity(V_(max))(which were divided into V_(umax) and V_(dmax)) of region of interesting(ROI) were quantitatively analyzed. And the prognosis evaluation was achieved by using Chicago Chiari Outcome Scale(CCOS). Results: Cine PC-MRI showed that MF and SV of cerebrospinal fluid of ROI post operation increased, and V_(umax) and V_(dmax) of that decreased, which were significantly different from preoperative values(F=2.792, F=3.561, F=3.305, F=2.362, P<0.05), respectively. And postoperative CCOS scores of these patients were higher than 11 points, and average score of them was 13 points, and the lowest score in them was 12 points, and the full score in them was 16 points, and no patient required a second surgery. Conclusion: The Cine PC-MRI technique can contribute to guide the surgical strategy in the diagnosis and treatment of Arnold-Chiari malformation type Ⅰ, and it can quantitatively and qualitatively analyze the hydromechanics of cerebrospinal fluid.
引文
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[4]Fan T,Zhao H,Zhao X,et al.Surgical management of Chiari I malformation based on different cerebrospinal fluid flow patterns at the cranial-vertebral junction[J].Neurosurgical Review,2017,40(4):663-670.
[5]李鹏超,刘勇,菅凤增,等.Chiari畸形外科治疗回顾与进展[J].中国现代神经疾病杂志,2012,12(4):389-393.
[6]Bapuraj JR,Londy FJ,Delavari N,et al.Cerebrospinal fluid velocity amplitudes within the cerebral aqueduct in healthy children and patients with Chiari I malformation[J].Magn Reson Imaging,2016,44(2):463-470.
[7]Battal B,Kocaoglu M,Bulakbasi N,et al.Cerebrospinal fluid flow imaging by using phase-contrast MRtechnique[J].Br J Radiol,2011,84(1004):758-765.
[8]Urbizu A1,Poca MA,Vidal X,et al.MRI-based morphometric analysis of posterior cranial fossa in the diagnosis of chiari malformation type I[J].Neuroimaging,2014,24(3):250-256.
[9]Tubbs RS.Definitions and Anatomic Considerations in Chiari I Malformation and Associated Syringomyelia[J].Neurosurg Clin N Am,2015,26(4):487-493.
[10]Smith BW,Strahle J,Bapuraj JR,et al.Distribution of cerebellar tonsil position:implications for understanding Chiari malformation[J].Neurosurg,2013,119(3):812-819.
[11]Strahle J,Muraszko KM,Kapurch J,et al.Chiari malformation Type I and syrinx in children undergoing magnetic resonance imaging[J].Neurosurg Pediatr,2011,8(2):205-213.
[12]Zhao JL,Li MH,Wang CL,et al.A Systematic review of Chiari I malformation:techniques and outcomes[J].World Neurosurg,2016,88:7-14.
[2]金延方,郭劲松,岳云龙.MR相位对比脑脊液电影成像的临床应用[J].中国医刊,2010,45(1):12-14.
[3]陈明生.枕大池成形术对Chiari畸形Ⅰ型伴脊髓空洞症患者脑脊液流体力学的影响[D].泸州:西南医科大学,2015.
[4]Fan T,Zhao H,Zhao X,et al.Surgical management of Chiari I malformation based on different cerebrospinal fluid flow patterns at the cranial-vertebral junction[J].Neurosurgical Review,2017,40(4):663-670.
[5]李鹏超,刘勇,菅凤增,等.Chiari畸形外科治疗回顾与进展[J].中国现代神经疾病杂志,2012,12(4):389-393.
[6]Bapuraj JR,Londy FJ,Delavari N,et al.Cerebrospinal fluid velocity amplitudes within the cerebral aqueduct in healthy children and patients with Chiari I malformation[J].Magn Reson Imaging,2016,44(2):463-470.
[7]Battal B,Kocaoglu M,Bulakbasi N,et al.Cerebrospinal fluid flow imaging by using phase-contrast MRtechnique[J].Br J Radiol,2011,84(1004):758-765.
[8]Urbizu A1,Poca MA,Vidal X,et al.MRI-based morphometric analysis of posterior cranial fossa in the diagnosis of chiari malformation type I[J].Neuroimaging,2014,24(3):250-256.
[9]Tubbs RS.Definitions and Anatomic Considerations in Chiari I Malformation and Associated Syringomyelia[J].Neurosurg Clin N Am,2015,26(4):487-493.
[10]Smith BW,Strahle J,Bapuraj JR,et al.Distribution of cerebellar tonsil position:implications for understanding Chiari malformation[J].Neurosurg,2013,119(3):812-819.
[11]Strahle J,Muraszko KM,Kapurch J,et al.Chiari malformation Type I and syrinx in children undergoing magnetic resonance imaging[J].Neurosurg Pediatr,2011,8(2):205-213.
[12]Zhao JL,Li MH,Wang CL,et al.A Systematic review of Chiari I malformation:techniques and outcomes[J].World Neurosurg,2016,88:7-14.