Kahlon Babar, Annertz Mårten, Ståhlberg Freddy, Rehncrona Stig
Department of Neurosurgery, University Hospital, Lund, Sweden.
Neurosurgery. 2007 Jan;60(1):124-9; discussion 129-30. doi: 10.1227/01.NEU.0000249208.04344.A3.
To evaluate clinical usefulness of cerebrospinal fluid stroke volume (SV) assessed in the cerebral aqueduct, via cine phase-contrast magnetic resonance imaging, for predicting outcome after shunt surgery in suspected normal pressure hydrocephalus.
Thirty-eight patients with suspected normal pressure hydrocephalus were included. SV was assessed using cine phase-contrast magnetic resonance imaging, and the results were kept blinded until postoperative follow-up after 7 +/- 5.8 months (mean +/- standard deviation). Selection to surgery was based on a positive lumbar infusion test or cerebrospinal fluid tap test, and outcome was evaluated with objective tests.
Six patients were excluded from SV measurements because of technical difficulties. Eight patients were not operated (negative lumbar infusion test and cerebrospinal fluid tap test). SV in the not operated patients (mean, 66 +/- 53 microl) did not differ from the operated patients (95 +/- 78 microl; P = 0.335). Operated patients showed statistically significant improvements in walk (P = 0.020), reaction time (P = 0.006), and memory (P = 0.001) tests. Patients were divided into three groups according to SV range: low (0-50 microl), middle (51-100 microl), and high (>100 microl). No statistically significant (P > 0.05) improvements in any of the objective tests were found in any of the SV ranges. The numbers of individually improved patients were similar in the different SV ranges: six out of seven in the low, nine out of nine in the middle, and five out of eight in the high range. Weak correlations were found between SV and the initial pulse amplitude (Rs = 0.043; P = 0.014) as well as the plateau pulse amplitude (Rs = 0.043; P = 0.014) as measured with the lumbar infusion test.
The data from this study show no evidence that cine phase-contrast magnetic resonance imaging measurements of SV in the cerebral aqueduct are useful for selecting patients with normal pressure hydrocephalus symptoms to shunt surgery.
通过电影相位对比磁共振成像评估中脑导水管脑脊液每搏量（SV）对预测疑似正常压力脑积水患者分流手术后结局的临床实用性。
纳入38例疑似正常压力脑积水患者。使用电影相位对比磁共振成像评估SV，结果在术后7±5.8个月（均值±标准差）随访前保持盲态。手术选择基于阳性腰椎灌注试验或脑脊液穿刺试验，结局通过客观测试进行评估。
6例患者因技术困难被排除在SV测量之外。8例患者未接受手术（腰椎灌注试验和脑脊液穿刺试验为阴性）。未接受手术患者的SV（均值，66±53微升）与接受手术患者（95±78微升；P = 0.335）无差异。接受手术患者在步行（P = 0.020）、反应时间（P = 0.006）和记忆（P = 0.001）测试中显示出统计学上的显著改善。根据SV范围将患者分为三组：低（0 - 50微升）、中（51 - 100微升）和高（>100微升）。在任何SV范围内，任何客观测试均未发现统计学上的显著改善（P > 0.05）。不同SV范围内个体改善患者的数量相似：低范围7例中有6例，中范围9例中有9例，高范围8例中有5例。在腰椎灌注试验中测量的SV与初始脉搏振幅（Rs = 0.043；P = 0.014）以及平台期脉搏振幅（Rs = 0.043；P = 0.014）之间发现弱相关性。
本研究数据表明，没有证据显示电影相位对比磁共振成像测量中脑导水管SV对选择有正常压力脑积水症状的患者进行分流手术有用。
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