Dinçer Alp, Özek M Memet
Department of Radiology, School of Medicine, Acibadem University, Inonu Cad. Okur Sok. No:21, Kozyatagı, Istanbul 34742, Turkey.
Childs Nerv Syst. 2011 Oct;27(10):1543-62. doi: 10.1007/s00381-011-1559-x. Epub 2011 Sep 17.
The aim of this review is to present the contemporary role of radiology in evaluating pediatric hydrocephalus. Although conventional brain imaging with ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) reveal the degree of ventricular enlargement and often the etiology of the hydrocephalus, the diagnosis and management of hydrocephalus present common problems in pediatric populations.
US, usually sufficient to assess and monitor ventricular size, is used most commonly in preterm infants who have germinal matrix hemorrhages and not able to tolerate transport to the radiology department. Although CT can demonstrate gross dilatation of ventricles, in most cases, it will be necessary to more closely define the nature of the obstruction, either functionally or anatomically. MRI is the best imaging modality to provide such functional and anatomic information. However, since identification of obstructive pathologic processes at any level through the cerebrospinal fluid (CSF) pathway in patients with hydrocephalus is of significant importance because it can change the treatment options, avoiding shunt insertion, a more sophisticated MRI approach is needed instead of obtaining a routine cranial MRI. Furthermore, the outcome after neuroendoscopic procedures is clearly related to patient selection under guidance of neuroimaging.
Therefore, the article focuses mainly on the effective usage of various MRI sequences in both diagnosis and follow-up of pediatric hydrocephalus, such as 3D CISS, cine PC, TSE, and GRE T2* sequences, to be able to investigate all possible obstructive pathology through the CSF pathway and to assess the efficiency of treatment in a standardized way.
本综述的目的是阐述放射学在评估小儿脑积水方面的当代作用。尽管传统的脑部超声（US）、计算机断层扫描（CT）和磁共振成像（MRI）能够揭示脑室扩大的程度以及脑积水的常见病因，但脑积水的诊断和管理在儿科人群中仍存在一些常见问题。
超声通常足以评估和监测脑室大小，最常用于患有生发基质出血且无法耐受转运至放射科的早产儿。虽然CT可以显示脑室的明显扩张，但在大多数情况下，有必要从功能或解剖学上更精确地确定梗阻的性质。MRI是提供此类功能和解剖信息的最佳成像方式。然而，由于确定脑积水患者脑脊液（CSF）通路任何水平的梗阻性病理过程对于改变治疗方案（避免分流置入）非常重要，因此需要一种更复杂的MRI检查方法，而不是常规的头颅MRI。此外，神经内镜手术后的结果显然与神经影像学引导下的患者选择有关。
因此，本文主要关注各种MRI序列在小儿脑积水诊断和随访中的有效应用，如3D CISS、电影相位对比（cine PC）序列、快速自旋回波（TSE）序列和梯度回波T2*序列，以便能够通过CSF通路研究所有可能的梗阻性病变，并以标准化方式评估治疗效果。
