Hong Jae Taek, Son Byung Chul, Sung Jae Hoon, Kim Il Sub, Yang Seung Ho, Lee Sang Won, Park Chun Kun
Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, South Korea.
Clin Neurol Neurosurg. 2008 Feb;110(2):137-44. doi: 10.1016/j.clineuro.2007.09.019. Epub 2007 Nov 19.
The aim of this study is to assess the significance of an apparent diffusion coefficient (ADC) modality for the diagnosis and follow-up evaluation of ventriculitis.
Twelve patients with ventriculitis were enrolled in this study. Diffusion-weighted (DW) magnetic resonance images (MRI) and ADC maps of the periventricular white matter, intraventricular collections detected in the third or lateral ventricles and normal cerebrospinal fluid (CSF) were obtained. The images and ADC data from each lesion were correlated and then compared amongst the different lesions. CSF studies were performed via external ventricular drain (EVD) catheters or lumbar punctures performed on the same day as ADC mapping. Linear regression was used to analyze relationships among pleocytosis, glucose, chloride, protein content of pus, and ADC counting.
A total of 24 ADC values for intraventricular pus and CSF findings were obtained from 12 patients and analyzed. The DW MRI showed marked hyperintensity in purulent lesions, and the corresponding ADC maps revealed prominent hypointensity and decreased ADC values in dependent CSF compared with non-dependent CSF and normal white matter. Dependent CSF is defined as the CSF which is mixed with purulent discharge which is located at the lower portion of the ventricle by gravity. The correlations between ADC counting and pleocytosis, and also protein content were strong: r(2)=-0.84, r(2)=-0.62, respectively (p<0.001).
A decreased ADC value and increased signal intensity of dependent intraventricular fluid by DW MRI suggests the presence of material with restricted water diffusion in the ventricular space. This is seen in pyogenic ventriculitis when water diffusion is restricted in suppurative fluid. ADC counting is negatively correlated with pleocytosis and the protein content of CSF. Therefore, the ADC value might be a useful non-invasive method for the follow-up evaluation of ventriculitis as well as the diagnosis of it.
本研究旨在评估表观扩散系数（ADC）模式在脑室炎诊断及随访评估中的意义。
本研究纳入12例脑室炎患者。获取了脑室周围白质、第三脑室或侧脑室内发现的脑室内积液以及正常脑脊液（CSF）的扩散加权（DW）磁共振成像（MRI）和ADC图。将每个病变的图像和ADC数据进行关联，然后在不同病变之间进行比较。通过外部脑室引流（EVD）导管或在与ADC测绘同一天进行的腰椎穿刺进行脑脊液研究。采用线性回归分析脑脊液细胞增多、葡萄糖、氯化物、脓液蛋白含量与ADC计数之间的关系。
从12例患者中获取并分析了总共24个脑室内脓液和脑脊液检查结果的ADC值。DW MRI显示脓性病变呈明显高信号，相应的ADC图显示与非下垂部位脑脊液和正常白质相比，下垂部位脑脊液有明显低信号和ADC值降低。下垂部位脑脊液定义为因重力作用位于脑室下部且与脓性分泌物混合的脑脊液。ADC计数与脑脊液细胞增多以及蛋白含量之间的相关性很强：r(2)分别为-0.84和-0.62（p<0.001）。
DW MRI显示下垂部位脑室内液体的ADC值降低且信号强度增加，提示脑室空间存在水扩散受限的物质。这在化脓性脑室炎中可见，此时化脓性液体中水扩散受限。ADC计数与脑脊液细胞增多和脑脊液蛋白含量呈负相关。因此，ADC值可能是一种用于脑室炎随访评估及诊断的有用非侵入性方法。
