在健康老年人和脑外伤病例中比较有创与 MRI 衍生颅内压测量：一项初步研究。
Comparing invasive with MRI-derived intracranial pressure measurements in healthy elderly and brain trauma cases: A pilot study.
机构信息
University of Miami, Biomedical Engineering Department, Coral Gables, Florida, USA.
University of Miami, Department of Neurological Surgery, Florida, USA.
出版信息
J Magn Reson Imaging. 2019 Sep;50(3):975-981. doi: 10.1002/jmri.26695. Epub 2019 Feb 22.
BACKGROUND
Intracranial pressure (ICP) is an important physiological parameter in several neurological disorders. Considerable effort has been made to measure ICP noninvasively. MR-based ICP (MR-ICP) is a nonempirical method based on principles of cerebrospinal fluid (CSF) physiology, where ICP is obtained from measurements of blood and CSF flows to and from the cranium during the cardiac cycle.
PURPOSE
To compare MR-ICP with invasive ICP measurements obtained using lumbar puncture (LP) or external ventricular drainage (EVD).
STUDY TYPE
Prospective, cross-sectional, observational study.
SUBJECTS
Ten cognitively healthy elderly subjects (age 69.6 ± 6.6 years; seven females) and six brain trauma patients (age 36.8 ± 19.7 years; two females).
FIELD STRENGTH
Velocity encoding cine phase-contrast at 1.5 T and 3 T.
ASSESSMENT
MR-ICP and craniospinal compliance distribution were estimated from arterial inflow and venous outflow to and from cranium, and craniospinal CSF flow at the upper cervical region, measured using cine phase contrast MRI. LP (done 177 ± 163 days after scan) and EVD measurements (at the time of scan) were performed in lateral recumbent and supine positions, respectively.
STATISTICAL TESTS
Linear regression was used to assess the relationships of MR-ICP with invasive ICP, and the dependency of these measurements on age, weight, height, and BMI. A Shapiro-Wilks test and Bland-Altman plot were respectively used to evaluate the normality and agreement between these two pressure distributions. Student's t-test was used throughout the analysis to compare differences between the EVD and LP cohorts.
RESULTS
In the combined cohort, MR-ICP and invasive ICP were positively correlated (r = 0.95, P < 0.001), with invasive ICP being higher than MR-ICP by 2.2 mmHg on average. In the healthy cohort, the cranial contribution to total craniospinal compliance was negatively correlated with MR-ICP (r = -0.90, P < 0.001).
DATA CONCLUSION
MR-ICP provides a reliable estimate of ICP, with 14 out of 16 datapoints within the clinically acceptable error. Craniospinal compliance distribution plays a role in modulating ICP in supine position.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:975-981.
背景
颅内压（ICP）是几种神经疾病中的一个重要生理参数。人们已经做出了相当大的努力来无创地测量 ICP。基于磁共振的 ICP（MR-ICP）是一种基于脑脊液（CSF）生理学原理的非经验性方法，其中 ICP 是通过在心脏周期期间从颅骨的血液和 CSF 流入和流出测量来获得的。
目的
比较 MR-ICP 与通过腰椎穿刺（LP）或外部脑室引流（EVD）获得的有创 ICP 测量值。
研究类型
前瞻性、横断面、观察性研究。
受试者
十名认知健康的老年受试者（年龄 69.6±6.6 岁；七名女性）和六名脑外伤患者（年龄 36.8±19.7 岁；两名女性）。
磁场强度
1.5T 和 3T 时速度编码电影相位对比。
评估
从动脉流入和静脉流出到颅骨，以及从颅骨到上颈区的 CSF 流动，使用电影相位对比 MRI 来估计 MR-ICP 和颅脊顺应性分布。LP（在扫描后 177±163 天进行）和 EVD 测量（在扫描时）分别在侧卧位和仰卧位进行。
统计检验
线性回归用于评估 MR-ICP 与有创 ICP 的关系，以及这些测量值与年龄、体重、身高和 BMI 的依赖性。Shapiro-Wilks 检验和 Bland-Altman 图分别用于评估这两种压力分布的正态性和一致性。在整个分析过程中，学生 t 检验用于比较 EVD 和 LP 队列之间的差异。
结果
在合并队列中，MR-ICP 和有创 ICP 呈正相关（r=0.95，P<0.001），平均有创 ICP 比 MR-ICP 高 2.2mmHg。在健康队列中，颅脊总顺应性的颅骨贡献与 MR-ICP 呈负相关（r=-0.90，P<0.001）。
数据结论
MR-ICP 提供了 ICP 的可靠估计，16 个数据点中有 14 个在临床可接受的误差范围内。颅脊顺应性分布在仰卧位时调节 ICP 方面起着作用。
证据水平
3 级 技术功效：2 级 J. Magn. Reson. Imaging 2019；50：975-981。
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