Al-Zain F T, Rademacher G, Lemcke J, Mutze J, Meier U
Klinik für Neurochirurgie, Unfallkrankenhaus Berlin.
Nervenarzt. 2007 Feb;78(2):181-7. doi: 10.1007/s00115-006-2231-7.
The measurement of CSF flow in the aqueduct has been a focus of interest since the development of MR imaging (MRI) techniques for this purpose in diagnosing idiopathic normal-pressure hydrocephalus (iNPH).The purpose of this prospective study was to determine the ability of this diagnostic tool to replace invasive methods in establishing the diagnosis of iNPH.
Between January 2003 and April 2005, 61 patients with the Hakim triad of clinical symptoms and dilated ventricular systems underwent the intrathecal infusion test, cerebrospinal tap test, and phase-contrast MRI to measure CSF flow rate in the aqueduct. Shunted patients were controlled 12 months postoperatively. Pre- and postoperative clinical symptoms were evaluated with the Kiefer score. Outcome was calculated according to the NPH recovery rate.
According to these criteria the patients were classified into groups of 41 with iNPH and 20 with brain atrophy. Of the iNPH patients, 39 were shunted and two did not agree to surgery. The mean Kiefer score of the shunted patients was statistically significantly lower after surgery. The aqueductal CSF flow rate of these patients was statistically analyzed and showed that a flow rate of more than 24.5 ml/min is 95% specific to iNPH.
Measurement of the CSF flow rate in the aqueduct using phase-contrast MRI is a highly specific preselective method for diagnosing iNPH.
自从用于诊断特发性正常压力脑积水(iNPH)的磁共振成像(MRI)技术发展以来,中脑导水管脑脊液流动的测量一直是人们关注的焦点。这项前瞻性研究的目的是确定这种诊断工具在确立iNPH诊断方面替代侵入性方法的能力。
在2003年1月至2005年4月期间,61例有哈基姆三联征临床症状且脑室系统扩张的患者接受了鞘内注射试验、脑脊液穿刺试验以及相位对比MRI以测量中脑导水管的脑脊液流速。分流手术患者在术后12个月进行对照。术前和术后临床症状用基弗评分进行评估。结果根据NPH恢复率进行计算。
根据这些标准,患者被分为41例iNPH组和20例脑萎缩组。在iNPH患者中,39例行分流手术,2例不同意手术。分流患者术后的平均基弗评分在统计学上显著降低。对这些患者的中脑导水管脑脊液流速进行统计分析,结果显示流速超过24.5毫升/分钟对iNPH具有95%的特异性。
使用相位对比MRI测量中脑导水管脑脊液流速是诊断iNPH的一种高度特异性的预选方法。