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脑脊液由侧脑室的脉络丛不断产生,并通过脑室系统及蛛网膜下腔形成一个动态的、具有复杂的转运及吸收机制的循环过程。近年来,磁共振相衬成像(phase-contrast magnetic resonance imaging, PC-MRI)作为一项新兴非侵入性检查在脑脊液流动评价中有所应用,推动了脑脊液循环的病理生理学研究,并拓宽了对其流动机制的认识[1]。ChiariⅠ型畸形(Chiari malformation type Ⅰ, CMⅠ)是一组临床表现与枕骨大孔区脑脊液循环受阻严重程度密切相关的疾病,其中50%~70%病人合并脊髓空洞症[2]。后颅窝减压是其主要治疗方式,有研究[3]表明病人颅颈区脑脊液的双向流动与正常人对比具有较大差异,其术后临床症状的缓解与脑脊液循环的改善及枕大池扩大密切相关。本研究通过比较健康志愿者及CMⅠ伴脊髓空洞症病人手术前后脑脊液流动特点,并结合芝加哥Chiari畸形预后量表(Chicago Chiari outcome scale, CCOS)进一步分析PC-MRI技术在其临床诊断治疗和预后评估中的应用价值。现作报道。
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CMⅠ组病人中脑导水管中央段脑脊液净流量和冲程流量均明显低于对照组(P < 0.01),此处收缩期脑脊液流速到达最大值时间较对照组明显延迟(P < 0.01),三处脑脊液收缩期及舒张期峰值流速均高于对照组(P < 0.05~P < 0.01)(见表 1)。
分组 n 中脑导水管中央段 四脑室出口段 第二颈椎腹侧 净流量/μL 冲程流量/μL 收缩期峰流速/(cm/s) 时间比/% 舒张期峰流速/(cm/s) 收缩期峰流速/(cm/s) 舒张期峰流速/(cm/s) 收缩期峰流速(cm/s) 舒张期峰流速/(cm/s) CMⅠ组 17 2.24±0.75 55.71±12.28 5.69±0.79 34.44±5.49 6.83±0.69 1.79±0.24 1.93±0.33 4.30±1.19 8.98±2.16 对照组 16 9.06±2.02 74.38±12.64 5.05±0.89 29.19±3.78 6.07±0.61 1.48±0.34 1.48±0.36 3.43±1.16 6.73±2.08 t — 12.71* 4.30 2.19 3.18 3.34 3.04 3.75 2.12 3.04 P — < 0.01 < 0.01 < 0.05 < 0.01 < 0.01 < 0.01 < 0.01 < 0.05 < 0.01 *示t′值 表 1 CMⅠ组与对照组脑脊液流动参数比较(x±s)
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PC-MRI提示,CMⅠ病人术后中脑导水管处脑脊液净流量及冲程流量均较术前明显上升(P < 0.01),导水管处脑脊液到达处收缩期峰值时间明显缩短(P < 0.01),且各处脑脊液收缩期及舒张期最大流速较术前明显降低(P < 0.01)(见表 2)。
时间 n 中脑导水管中央段 四脑室出口段 第二颈椎腹侧 净流量/μL 冲程流量/μL 收缩期峰流速/(cm/s) 时间比/% 舒张期峰流速/(cm/s) 收缩期峰流速/(cm/s) 舒张期峰流速/(cm/s) 收缩期峰流速(cm/s) 舒张期峰流速/(cm/s) 术前 17 2.24±0.75 55.71±12.28 5.69±0.79 34.44±5.49 6.83±0.69 1.79±0.24 1.93±0.33 4.30±1.19 8.98±2.16 术后 17 6.94±2.33 80.41±14.92 4.60±0.82 30.28±5.97 5.52±0.62 1.26±0.22 1.41±0.30 3.00±1.00 6.63±1.68 t — 7.92* 5.27 3.95 2.11 5.82 6.71 4.81 3.45 3.54 P — < 0.01 < 0.01 < 0.01 < 0.05 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 *示t′值 表 2 CMⅠ病人手术前后脑脊液流动各项参数比较(x±s)
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根据CCOS评分对CMⅠ病人预后进行评估,以10分为分界点[4]将病人分为预后较好组(CCOS评分>10分)12例和预后较差组(CCOS≤10分)5例。预后较好病人中脑导水管中段脑脊液术后净流量及冲程流量较术前增加量均明显高于预后较差者(P < 0.01),此处脑脊液到达收缩期峰值时间也较预后较差者明显缩短(P < 0.01),中脑导水管中段、第二颈椎腹侧脑脊液收缩期及舒张期峰流速均明显低于预后较差者(P < 0.05~P < 0.01),而2组四脑室出口段脑脊液峰流速差异无统计学意义(P>0.05)(见表 3)。
CCOS评分/分 n 中脑导水管中央段 四脑室出口段 第二颈椎腹侧 净流量/μL 冲程流量/μL 收缩期峰流速/(cm/s) 时间比/% 舒张期峰流速/(cm/s) 收缩期峰流速/(cm/s) 舒张期峰流速/(cm/s) 收缩期峰流速(cm/s) 舒张期峰流速/(cm/s) >10 12 6.00±0.95 32.17±7.71 4.23±0.65 26.72±2.12 5.22±0.45 1.20±0.22 1.36±0.31 2.66±0.89 5.97±1.28 ≤10 5 1.60±1.14 6.80±3.96 5.48±0.41 38.83±0.94 6.24±0.31 1.41±0.15 1.54±0.28 3.83±0.82 8.22±1.52 t — 8.23 6.90 3.94 12.11 4.59 1.94 1.12 2.52 3.14 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 >0.05 >0.05 < 0.05 < 0.01 表 3 不同预后病人脑脊液流动各项参数比较(x±s)
应用磁共振相衬技术对ChiariⅠ型畸形合并脊髓空洞症的脑脊液动力学研究
Study on the applicaton value of the PC-MRI on the cerebrospinal fluid dynamics in Chiari malformation type Ⅰ complicated with syringomyelia
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摘要:
目的应用磁共振相衬技术评估脑脊液动力学改变对ChiariⅠ型畸形脑脊液动力学的影响。 方法选取ChiariⅠ型畸形合并脊髓空洞症病人17例(CMⅠ组)和同期健康志愿者16名(对照组)为研究对象,病人均行后颅窝减压术,并于术前及术后12个月分别针对颅颈交界区行磁共振相衬技术检查,志愿者仅检查一次,分析中脑导水管中央段、第四脑室出口段及第二颈椎水平脑脊液流速、流量等参数的改变。 结果与对照组比较,CMⅠ组病人各被检处脑脊液峰流速均增快(P < 0.05~P < 0.01),且总体流量减少(P < 0.01)。病人术后各处流速较术前明显变缓(P < 0.01),流量增加(P < 0.01)。不同预后病人的中脑导水管中段脑脊液流量、流速和第二颈椎腹侧脑脊液流速差异均有统计学意义(P < 0.05~P < 0.01)。 结论Chiari畸形Ⅰ型伴脊髓空洞症病人存在脑脊动力学变化,表现为脑脊液流动受阻,而脑脊液动力学的改善与病人预后具有相关性,应用磁共振相衬技术监测脑脊液动力学变化有助于评估病人预后。 -
关键词:
- Chiari畸形Ⅰ型 /
- 脊髓空洞症 /
- 磁共振相衬技术 /
- 脑脊液动力学
Abstract:ObjectiveTo explore the effects of the cine phase-contrast magnetic resonance imaging(PC-MRI) in evaluating the change of dynamics of cerebrospinal fluid(CSF) on the CSF dynamics in patients with Chiari malformation type Ⅰ(CMⅠ). MethodsSixteen healthy volunteers and 17 CMⅠ and syringomyelia patients were divided into the control goup and CMⅠgroup, respectively.The region between canium and neck of CMⅠ group was detected using PC-MRI scans before and after 12 months of operation, and the control group was checked only once.The changes of CSF velocity and flow at the central segment of midbrain aqueduct, exit segment of the fourth ventricle and second cervical spine level were analyzed. ResultsCompared with the control group, the peak flow velocity of CSF in each examined site in CMⅠ group increased(P < 0.05 to P < 0.01), and the overall flow decreased(P < 0.01).After operation, the peak velocity of CSF in CMⅠ group slowed significantly down(P < 0.01), and the flow increased(P < 0.01).The differences of the peak flow velocity and flow of CSF between the central segment of midbrain aqueduct and second cervical spine level among different prognosis patients were statistically significant(P < 0.05 to P < 0.01). ConclusionsThe improvement of CSF dynamics is related to the prognosis of patients.The application of PC-MRI in monitoring the dynamics of CSF is helpful to evaluate the prognosis of patients with CMⅠ complicated with syringomyelia. -
表 1 CMⅠ组与对照组脑脊液流动参数比较(x±s)
分组 n 中脑导水管中央段 四脑室出口段 第二颈椎腹侧 净流量/μL 冲程流量/μL 收缩期峰流速/(cm/s) 时间比/% 舒张期峰流速/(cm/s) 收缩期峰流速/(cm/s) 舒张期峰流速/(cm/s) 收缩期峰流速(cm/s) 舒张期峰流速/(cm/s) CMⅠ组 17 2.24±0.75 55.71±12.28 5.69±0.79 34.44±5.49 6.83±0.69 1.79±0.24 1.93±0.33 4.30±1.19 8.98±2.16 对照组 16 9.06±2.02 74.38±12.64 5.05±0.89 29.19±3.78 6.07±0.61 1.48±0.34 1.48±0.36 3.43±1.16 6.73±2.08 t — 12.71* 4.30 2.19 3.18 3.34 3.04 3.75 2.12 3.04 P — < 0.01 < 0.01 < 0.05 < 0.01 < 0.01 < 0.01 < 0.01 < 0.05 < 0.01 *示t′值 表 2 CMⅠ病人手术前后脑脊液流动各项参数比较(x±s)
时间 n 中脑导水管中央段 四脑室出口段 第二颈椎腹侧 净流量/μL 冲程流量/μL 收缩期峰流速/(cm/s) 时间比/% 舒张期峰流速/(cm/s) 收缩期峰流速/(cm/s) 舒张期峰流速/(cm/s) 收缩期峰流速(cm/s) 舒张期峰流速/(cm/s) 术前 17 2.24±0.75 55.71±12.28 5.69±0.79 34.44±5.49 6.83±0.69 1.79±0.24 1.93±0.33 4.30±1.19 8.98±2.16 术后 17 6.94±2.33 80.41±14.92 4.60±0.82 30.28±5.97 5.52±0.62 1.26±0.22 1.41±0.30 3.00±1.00 6.63±1.68 t — 7.92* 5.27 3.95 2.11 5.82 6.71 4.81 3.45 3.54 P — < 0.01 < 0.01 < 0.01 < 0.05 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 *示t′值 表 3 不同预后病人脑脊液流动各项参数比较(x±s)
CCOS评分/分 n 中脑导水管中央段 四脑室出口段 第二颈椎腹侧 净流量/μL 冲程流量/μL 收缩期峰流速/(cm/s) 时间比/% 舒张期峰流速/(cm/s) 收缩期峰流速/(cm/s) 舒张期峰流速/(cm/s) 收缩期峰流速(cm/s) 舒张期峰流速/(cm/s) >10 12 6.00±0.95 32.17±7.71 4.23±0.65 26.72±2.12 5.22±0.45 1.20±0.22 1.36±0.31 2.66±0.89 5.97±1.28 ≤10 5 1.60±1.14 6.80±3.96 5.48±0.41 38.83±0.94 6.24±0.31 1.41±0.15 1.54±0.28 3.83±0.82 8.22±1.52 t — 8.23 6.90 3.94 12.11 4.59 1.94 1.12 2.52 3.14 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 >0.05 >0.05 < 0.05 < 0.01 -
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