导水管平面脑脊液流动磁共振成像研究
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摘要
目的：应用MR相位对比法分析正常对照组(对照组)、梗阻性脑积水组(脑积水组)与慢性紧张型头痛组(头痛组)导水管平面脑脊液流量、流速及流动曲线。
材料和方法：对照组26例,脑积水组10例,头痛组17例均应用3.0T磁共振扫描仪、CSF-QF CLEAR相位对比电影序列对导水管平面进行扫描,扫描数据输入电脑工作站应用脑脊液分析软件对脑脊液进行定性观察和定量测定。对比分析不同组别脑脊液流动曲线、流量、流速是否具有差别。
结果：对照组导水管平面脑脊液呈与心脏博动相关的双向节律性流动。对照组脑脊液流动曲线呈平滑“U”型26例,波浪型1例。脑积水组呈平滑“U”型1例,波浪型9例。头痛组呈平滑“U”型11例,波浪型6例。对照组、脑积水组与头痛组导水管平面头侧脑脊液平均流量分别为0.235±0.157ml/s、0.068±0.099 ml/s、0.133±0.106 ml/s;足侧脑脊液平均流量分别为-0.358±0.201ml/s、-0.127±0.144 ml/s、-0.190±0.141ml/s;头侧脑脊液平均流速分别为6.023±2.654cm/s、1.590±1.652cm/s、3.479±2.364cm/s;足侧脑脊液平均流速分别为-8.263±3.020cm/s、-2.791±3.062cm/s-4.788±2.862cm/s;三组头侧与足侧脑脊液平均流量、流速两两比较均具有统计学义(P<0.05)
结论：MR相位对比法能显示导水管平面脑脊液的流动节律,头侧、足侧方向的脑脊液流量与流速。对照组、脑积水组、头痛组导水管平面的脑脊液流动节律、头侧及足侧的脑脊液平均流量、流速均不同。
Objective:To analyze the rate, velocity and curve of flow of cerebrospinal fluid (CSF) in the cerebral aqueduct of three groups of normal volunteers (control group), chronic tension headache patients (headache group) and obstructive hydrocephalus patients (hydrocephalus group) with cine phase contrast (cine-PC) magnetic resonance imaging.
Materials and Methods:There were 26 of normal volunteers,17 of chronic tension headache and 10 of hydrocephalus who were scanned with CSF-QF CLEAR series of cine phase contrast on a Phillips Achieva 3.0T X-series MR unit. The data was transmitted to the computing workstation in order to analyze the rate, velocity and curve of flow of CSF in the cerebral aqueduct with software Extended MR Workspace R2.6.3. The groups were compared statistically.
Results:The maps showed that the CSF in the cerebral aqueduct flowed bidirectionally in cardiac rhythm in control group. There were two types of the flow curves which like "U" or wave. The control group had 25 of U-curve and 1 of wave-curve, and the hydrocephalus group had 1 and 9, and the headache group had 11 and 6. In control, hydrocephalus and headache groups, the mean craniocaudal rate of flow of the CSF in the cerebral aqueduct was 0.235±0.157ml/s,0.068±0.099 ml/s and 0.133±0.106 ml/s respectively, and the mean caudocranial one was-0.358±0.201ml/s,-0.127±0.144ml/s and -0.190±0.141 ml/s respectively. The mean craniocaudal velocity of the CSF in the cerebral aqueduct was 6.023±2.654cm/s,1.590±1.652cm/s and 3.479±2.364cm/s respectively, and the caudocranial one was -8.263±3.020cm/s,-2.791±3.062cm/s and-4.788±2.862cm/s respectively. The difference of rate, velocity of flow of CSF in the cerebral aqueduct in three groups has statistical significance.
Conclusion:Cine PC MRI is capable of demonstrating the rate, velocity and curve of flow of CSF in the cerebral aqueduct, which are different in control group, headache group and hydrocephalus group.
材料和方法：对照组26例,脑积水组10例,头痛组17例均应用3.0T磁共振扫描仪、CSF-QF CLEAR相位对比电影序列对导水管平面进行扫描,扫描数据输入电脑工作站应用脑脊液分析软件对脑脊液进行定性观察和定量测定。对比分析不同组别脑脊液流动曲线、流量、流速是否具有差别。
结果：对照组导水管平面脑脊液呈与心脏博动相关的双向节律性流动。对照组脑脊液流动曲线呈平滑“U”型26例,波浪型1例。脑积水组呈平滑“U”型1例,波浪型9例。头痛组呈平滑“U”型11例,波浪型6例。对照组、脑积水组与头痛组导水管平面头侧脑脊液平均流量分别为0.235±0.157ml/s、0.068±0.099 ml/s、0.133±0.106 ml/s;足侧脑脊液平均流量分别为-0.358±0.201ml/s、-0.127±0.144 ml/s、-0.190±0.141ml/s;头侧脑脊液平均流速分别为6.023±2.654cm/s、1.590±1.652cm/s、3.479±2.364cm/s;足侧脑脊液平均流速分别为-8.263±3.020cm/s、-2.791±3.062cm/s-4.788±2.862cm/s;三组头侧与足侧脑脊液平均流量、流速两两比较均具有统计学义(P<0.05)
结论：MR相位对比法能显示导水管平面脑脊液的流动节律,头侧、足侧方向的脑脊液流量与流速。对照组、脑积水组、头痛组导水管平面的脑脊液流动节律、头侧及足侧的脑脊液平均流量、流速均不同。
Objective:To analyze the rate, velocity and curve of flow of cerebrospinal fluid (CSF) in the cerebral aqueduct of three groups of normal volunteers (control group), chronic tension headache patients (headache group) and obstructive hydrocephalus patients (hydrocephalus group) with cine phase contrast (cine-PC) magnetic resonance imaging.
Materials and Methods:There were 26 of normal volunteers,17 of chronic tension headache and 10 of hydrocephalus who were scanned with CSF-QF CLEAR series of cine phase contrast on a Phillips Achieva 3.0T X-series MR unit. The data was transmitted to the computing workstation in order to analyze the rate, velocity and curve of flow of CSF in the cerebral aqueduct with software Extended MR Workspace R2.6.3. The groups were compared statistically.
Results:The maps showed that the CSF in the cerebral aqueduct flowed bidirectionally in cardiac rhythm in control group. There were two types of the flow curves which like "U" or wave. The control group had 25 of U-curve and 1 of wave-curve, and the hydrocephalus group had 1 and 9, and the headache group had 11 and 6. In control, hydrocephalus and headache groups, the mean craniocaudal rate of flow of the CSF in the cerebral aqueduct was 0.235±0.157ml/s,0.068±0.099 ml/s and 0.133±0.106 ml/s respectively, and the mean caudocranial one was-0.358±0.201ml/s,-0.127±0.144ml/s and -0.190±0.141 ml/s respectively. The mean craniocaudal velocity of the CSF in the cerebral aqueduct was 6.023±2.654cm/s,1.590±1.652cm/s and 3.479±2.364cm/s respectively, and the caudocranial one was -8.263±3.020cm/s,-2.791±3.062cm/s and-4.788±2.862cm/s respectively. The difference of rate, velocity of flow of CSF in the cerebral aqueduct in three groups has statistical significance.
Conclusion:Cine PC MRI is capable of demonstrating the rate, velocity and curve of flow of CSF in the cerebral aqueduct, which are different in control group, headache group and hydrocephalus group.
引文
[1]Dandy WE,Blackfan K.D.Tntenal hydrocephalus.An experimental,clinical and pathological study.Am.J.Dis.Child,1914,8:406.
[2]Welch K,Friedman V:The cerebrospinal fluid valves.Brain,1960,83:454-469.
[3]Di Chino G.Observations on the circulation of the cerebrospinal fluid[J].Acta Radiol Diagn(Stockh),1966,5:988-1002.
[4]Di Chiro G.Movement of cerebrospinal fluid in human beings.Nature[J].1964, 204:290-291.
[5]Di Chiro G,Larsson SM,Harrington T,et al.Descent of cerebrospinal fluid to spinal subarachnoid space[J].Aeta Radiol Diagn(Stockh),1973,14(4):3 79—384.
[6]O'Connell JEA.The vascular factor in intracranial pressure and the maintenance of the cerebrospinal fluid circulation[J].Brain,1943,66:204-208.
[7]Wallace GB.,Brodie B.B.On the source of cerebrospinal fluid:The distribution of bromide and iodide throughout the central nervous system.J. Pharmacol, 1940,70:418.
[8]Beering EA JA.Choroids plexus and arterial pulsation of cerebrospinal fluid;demonstration of the choroid plexuses as a cerebrospinal fluid pump. Arch Neurol Psychiatry,1955,73:165-172.
[9]Du boulay GH. Pulsatile movements in the CSF pathways.BR J Radiol, 1966,39:255～262.
[10]Lane B, Kricheff Ⅱ..Cerebrospinal fluid pulsations at myelography:a videodensitometric study. Radiology,1974,110:579-587.
[11]Greitz D.Cerebrospinal fluid circulation and associated intracranial dynamics.A radiologic investigation using MR imaging and radionuclide cisternography.Acta Radiol,1993,34:1—23.
[12]Greitz D,Greitz T,Hindmarsh TV. A new view on the CSF-circulation with the potential for pharmacological treatment of childhood hydrocephalus.Acta Paediatr,1997,86:125-132.
[13]Greitz D,Greitz T:The pathogenesis and hemodynamics of hydrocephalus. A proposal for a new understanding.Int J Neuroradiol,1997,3:367-375.
[14]Greitz D.:A proposed model of cerebrospinal fluid circulation:observations with radionuclide cisternography.AJNR,17:431-438.
[15]Feinberg DA,Mark AS.Human brain motion and cerebrospinal fluid circulation demonstrated with MR velocity imaging.Radiology,1987,163:793-799.
[16]Enzmann DR,Ross MR,Marks MP,el al.Blood flow in major cerebral arteries measured by phase-contrast cine MR[J]. AJNR Am J Neuroradiol,1994, 15(1):123—129.
[17]Florez YN,Moratal D,Fomer J, et al.Semiautomatic analysis of the phase contrast magnetic resonance imaging of cerebrospinal fluid low through the squeduct of Sylvius [J].MAGMA,2006,19(2):78-87.
[18]朱晓黎,沈天真,陈星荣.正常中脑导水管脑脊液流动磁共振定量研究[J].医学影像学杂志,2004,,14(11)：875-878.
[19]姚伟武,陈星荣,沈天真等.正常脑脊液循环的MRI定量研究[J].中国医学计算机成像杂志,2001,7(5)：289-294.
[20]朱晓黎,沈天真,陈星荣.MR流体定量技术在脑脊液循环障碍疾病诊断中的应用[J].中国医学计算机成像杂志,2003,9(2)：97-98.
[21]何滨,韩博,李金柱等.正常中脑导水管脑脊液MR流速流量研究[J].实用放射学杂志,2007,23(11)：1529-1532.
[22]周良辅.现代神经外科学[M],上海：上海复旦大学出版社,2001,944.
[23]黄斌,李剑波.外伤后脑积水15例诊断与治疗[J].医学临床研究,2004,12(21)：1460-1461.
[24]蒲传强.中国现代神经疾病杂志,2005,5(4)：222-224.
[25]徐炜,余新光,杜长生,唐虹,李钟铭,封耀辉(武警总医院神经外科,北京10039；解放军总医院神经外科,北京100853).脑脊液正常流动的MRI研究.武警医学,2008,19(4)：309-312.
[26]Teng-Yi Huang, Hsiao-Wen Chung, Ming-Yen Chen, et al.Supratentorial Cerebrospinal Fluid Production Rate in Healthy Adults:Quantification with Two-dimensional Cine Phase-Contrast MR Imaging with High Temporal and Spatial Resolution Radiology 2004,233:603-608.
[27]朱晓黎,沈天真,陈星荣.MR流体定量技术在脑脊液循环障碍疾病诊断中的应用.中国医学计算机成像杂志,2003,9(2)：73-78.
[28]姚伟武,陈星荣,沈天真.交通性脑积水脑室分流前后的脑脊液MRI定量研究.中国医学计算机成像杂志,2003,9(1)：12-16.
[29]Wendy D Jones, Makarand Kulkarni, K Ravishankar,et al. Intracranial hypotension secondary to spinal arachnoid cyst rupture presenting with acute severe headache:a case report. J Med Case Reports.2010; 4:406.
[1]Dandy WE,Blackfan K.D.Tntenal hydrocephalus.An experimental,clinical and pathological study.Am.J.Dis.Child,1914,8:406.
[2]Welch K,Friedman V:The cerebrospinal fluid valves.Brain,1960,83:454-469.
[3]Di Chino G.Observations on the circulation of the cerebrospinal fluid[J].Acta Radiol Diagn(Stockh),1966,5:988-1002.
[4]Di Chiro G.Movement of cerebrospinal fluid in human beings.Nature[J].1964, 204:290-291.
[5]Di Chiro G,Larsson SM,Harrington T,et al.Descent of cerebrospinal fluid to spinal subarachnoid space[J].Aeta Radiol Diagn(Stockh),1973,14(4):379—384.
[6]O'Connell JEA.The vascular factor in intracranial pressure and the maintenance of the cerebrospinal fluid circulation[J].Brain,1943,66:204-208.
[7]Wallace GB.,Brodie B.B.On the source of cerebrospinal fluid:The distribution of bromide and iodide throughout the central nervous system. J.Pharmacol,1940,70:418.
[8]Beering EA JA.Choroids plexus and arterial pulsation of cerebrospinal fluid;demonstration of the choroid plexuses as a cerebrospinal fluid pump. Arch Neurol Psychiatry,1955,73:165-172.
[9]Du boulay GH. Pulsatile movements in the CSF pathways.BR J Radiol, 1966,39:255～262.
[10]Greitz D.Cerebrospinal fluid circulation and associated intracranial dynamics. A radiologic investigation using MR imaging and radionuclide cisternography. Acta Radiol,1993,34:1—23.
[11]Greitz D,Greitz T,Hindmarsh TV. A new view on the CSF-circulation with the potential for pharmacological treatment of childhood hydrocephalus.Acta Paediatr,1997,86:125-132.
[12]Greitz D,Greitz T:The pathogenesis and hemodynamics of hydrocephalus. A proposal for a new understanding.Int J Neuroradiol,1997,3:367-375.
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[17]Lane B,Kricheff Ⅱ..Cerebrospinal fluid pulsations at myelography:a videodensitometric study.Radiology,1974,110:579-587.
[18]Feinberg DA,Mark AS.Human brain motion and cerebrospinal fluid circulation demonstrated with MR velocity imaging. Radiology,1987, 163:793-799.
[19]Greitz D.:A proposed model of cerebrospinal fluid circulation:observations with radionuclide cisternography.AJNR,17:431-438.
[20]Enzmann DR,Ross MR,Marks MP,el al. Blood flow in major cerebral arteries measured by phase-contrast cine MR[J]. AJNR Am J Neuroradiol,1994,15 (1):123—129.
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[25]姚伟武,陈星荣,沈天真等.正常脑脊液循环的MRI定量研究[J].中国医学计算机成像杂志,2001,7(5)：289-294.
[26]姚长义,梁传声,王运杰.脑脊液相位对比动力学MRI研究[J].神经疾病与精神卫生,2002,2(1)：72—75.
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[28]Jeong Hyun Lee,Ho Kyu Lee,Jae Kyun Kim, et al. CSF Flow Quantification of the Cerebral Aqueduct in Normal Volunteers Using Phase Contrast Cine MR Imaging.Korean J Radiol 5(2),June 2004:81-86.
[29]Teng-Yi Huang, Hsiao-Wen Chung, Ming-Yen Chen, et al.Supratentorial Cerebrospinal Fluid Production Rate in Healthy Adults:Quantification with Two-dimensional Cine Phase-Contrast MR Imaging with High Temporal and Spatial Resolution Radiology 2004,233:603-608.
[30]Nitz RG,Bradeley WG Watanable AS,et al.Flow dynamics of cerebrospinal fluid:assessment with phase-contrast velocity MR imaging performed with retrospective cardiac gating.Radiology,1992,183:395-405.
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[2]Welch K,Friedman V:The cerebrospinal fluid valves.Brain,1960,83:454-469.
[3]Di Chino G.Observations on the circulation of the cerebrospinal fluid[J].Acta Radiol Diagn(Stockh),1966,5:988-1002.
[4]Di Chiro G.Movement of cerebrospinal fluid in human beings.Nature[J].1964, 204:290-291.
[5]Di Chiro G,Larsson SM,Harrington T,et al.Descent of cerebrospinal fluid to spinal subarachnoid space[J].Aeta Radiol Diagn(Stockh),1973,14(4):3 79—384.
[6]O'Connell JEA.The vascular factor in intracranial pressure and the maintenance of the cerebrospinal fluid circulation[J].Brain,1943,66:204-208.
[7]Wallace GB.,Brodie B.B.On the source of cerebrospinal fluid:The distribution of bromide and iodide throughout the central nervous system.J. Pharmacol, 1940,70:418.
[8]Beering EA JA.Choroids plexus and arterial pulsation of cerebrospinal fluid;demonstration of the choroid plexuses as a cerebrospinal fluid pump. Arch Neurol Psychiatry,1955,73:165-172.
[9]Du boulay GH. Pulsatile movements in the CSF pathways.BR J Radiol, 1966,39:255～262.
[10]Lane B, Kricheff Ⅱ..Cerebrospinal fluid pulsations at myelography:a videodensitometric study. Radiology,1974,110:579-587.
[11]Greitz D.Cerebrospinal fluid circulation and associated intracranial dynamics.A radiologic investigation using MR imaging and radionuclide cisternography.Acta Radiol,1993,34:1—23.
[12]Greitz D,Greitz T,Hindmarsh TV. A new view on the CSF-circulation with the potential for pharmacological treatment of childhood hydrocephalus.Acta Paediatr,1997,86:125-132.
[13]Greitz D,Greitz T:The pathogenesis and hemodynamics of hydrocephalus. A proposal for a new understanding.Int J Neuroradiol,1997,3:367-375.
[14]Greitz D.:A proposed model of cerebrospinal fluid circulation:observations with radionuclide cisternography.AJNR,17:431-438.
[15]Feinberg DA,Mark AS.Human brain motion and cerebrospinal fluid circulation demonstrated with MR velocity imaging.Radiology,1987,163:793-799.
[16]Enzmann DR,Ross MR,Marks MP,el al.Blood flow in major cerebral arteries measured by phase-contrast cine MR[J]. AJNR Am J Neuroradiol,1994, 15(1):123—129.
[17]Florez YN,Moratal D,Fomer J, et al.Semiautomatic analysis of the phase contrast magnetic resonance imaging of cerebrospinal fluid low through the squeduct of Sylvius [J].MAGMA,2006,19(2):78-87.
[18]朱晓黎,沈天真,陈星荣.正常中脑导水管脑脊液流动磁共振定量研究[J].医学影像学杂志,2004,,14(11)：875-878.
[19]姚伟武,陈星荣,沈天真等.正常脑脊液循环的MRI定量研究[J].中国医学计算机成像杂志,2001,7(5)：289-294.
[20]朱晓黎,沈天真,陈星荣.MR流体定量技术在脑脊液循环障碍疾病诊断中的应用[J].中国医学计算机成像杂志,2003,9(2)：97-98.
[21]何滨,韩博,李金柱等.正常中脑导水管脑脊液MR流速流量研究[J].实用放射学杂志,2007,23(11)：1529-1532.
[22]周良辅.现代神经外科学[M],上海：上海复旦大学出版社,2001,944.
[23]黄斌,李剑波.外伤后脑积水15例诊断与治疗[J].医学临床研究,2004,12(21)：1460-1461.
[24]蒲传强.中国现代神经疾病杂志,2005,5(4)：222-224.
[25]徐炜,余新光,杜长生,唐虹,李钟铭,封耀辉(武警总医院神经外科,北京10039；解放军总医院神经外科,北京100853).脑脊液正常流动的MRI研究.武警医学,2008,19(4)：309-312.
[26]Teng-Yi Huang, Hsiao-Wen Chung, Ming-Yen Chen, et al.Supratentorial Cerebrospinal Fluid Production Rate in Healthy Adults:Quantification with Two-dimensional Cine Phase-Contrast MR Imaging with High Temporal and Spatial Resolution Radiology 2004,233:603-608.
[27]朱晓黎,沈天真,陈星荣.MR流体定量技术在脑脊液循环障碍疾病诊断中的应用.中国医学计算机成像杂志,2003,9(2)：73-78.
[28]姚伟武,陈星荣,沈天真.交通性脑积水脑室分流前后的脑脊液MRI定量研究.中国医学计算机成像杂志,2003,9(1)：12-16.
[29]Wendy D Jones, Makarand Kulkarni, K Ravishankar,et al. Intracranial hypotension secondary to spinal arachnoid cyst rupture presenting with acute severe headache:a case report. J Med Case Reports.2010; 4:406.
[1]Dandy WE,Blackfan K.D.Tntenal hydrocephalus.An experimental,clinical and pathological study.Am.J.Dis.Child,1914,8:406.
[2]Welch K,Friedman V:The cerebrospinal fluid valves.Brain,1960,83:454-469.
[3]Di Chino G.Observations on the circulation of the cerebrospinal fluid[J].Acta Radiol Diagn(Stockh),1966,5:988-1002.
[4]Di Chiro G.Movement of cerebrospinal fluid in human beings.Nature[J].1964, 204:290-291.
[5]Di Chiro G,Larsson SM,Harrington T,et al.Descent of cerebrospinal fluid to spinal subarachnoid space[J].Aeta Radiol Diagn(Stockh),1973,14(4):379—384.
[6]O'Connell JEA.The vascular factor in intracranial pressure and the maintenance of the cerebrospinal fluid circulation[J].Brain,1943,66:204-208.
[7]Wallace GB.,Brodie B.B.On the source of cerebrospinal fluid:The distribution of bromide and iodide throughout the central nervous system. J.Pharmacol,1940,70:418.
[8]Beering EA JA.Choroids plexus and arterial pulsation of cerebrospinal fluid;demonstration of the choroid plexuses as a cerebrospinal fluid pump. Arch Neurol Psychiatry,1955,73:165-172.
[9]Du boulay GH. Pulsatile movements in the CSF pathways.BR J Radiol, 1966,39:255～262.
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