Department for Neurosurgery, University Hospital Tübingen, 72076, Tübingen, Germany.
Department for Neuroradiology, University Hospital Tübingen, Tübingen, Germany.
Acta Neurochir (Wien). 2020 Jan;162(1):23-30. doi: 10.1007/s00701-019-04143-5. Epub 2019 Nov 25.
In childhood hydrocephalus, both the amount of cerebrospinal fluid and the brain volume are relevant for the prognosis of the development and for therapy monitoring. Since classical planar measurements of ventricular size are subject to strong limitations, imprecise and neglect brain volume, 3D volumetry is most desirable. We used and evaluated the robust segmentation algorithms of the freely available FSL-toolbox in paediatric hydrocephalus patients before and after specific therapy.
Retrospectively 76 pre- and postoperative high-resolution T2-weighted MRI sequences (true FISP, 1 mm isovoxel) were analyzed in 38 patients with paediatric hydrocephalus (mean 4.4 ± 5.1 years) who underwent surgical treatment (ventriculo-peritoneal (VP) shunt n = 22, endoscopic third ventriculostomy (ETV) n = 16). After preprocessing, the 3D-datasets were skull stripped to estimate the inner skull surface. Following, a 2 class segmentation into different tissue types (brain matter and CSF) was performed. The volumes of CSF and brain were calculated.
The method could be implemented in an automated fashion in all 76 MRIs. In the VP shunt cohort, the amount of CSF (p < 0.001) decreased. Consecutively brain volume increased significantly (p < 0.001). Following ETV, CSF volume (p = 0.019) decreased significantly (p = 0.012) although the reduction was less pronounced than after shunt implantation. Brain volume expanded (p = 0.02).
A reliable automated segmentation of CSF and brain could be performed with the implemented algorithm. The method was able to track changes after therapy and detected significant differences in CSF and brain volumes after shunting and after ETV.
在儿童脑积水中，脑脊液的量和脑体积都与发育预后和治疗监测相关。由于经典的脑室大小平面测量方法受到很大限制，不够精确且忽略了脑体积，因此最理想的是 3D 容积测量。我们在特定治疗前后使用并评估了免费的 FSL 工具箱中稳健的分割算法，对儿科脑积水患者进行了分析。
回顾性分析了 38 例接受手术治疗（脑室-腹腔分流术（VP）分流术 22 例，内镜第三脑室造口术（ETV）16 例）的儿科脑积水患者的 76 例术前和术后高分辨率 T2 加权 MRI 序列（真实 FISP，1mm 等体素）。预处理后，对 3D 数据集进行颅骨剥离，以估计内颅骨表面。随后，对不同组织类型（脑实质和 CSF）进行 2 类分割。计算 CSF 和脑的体积。
该方法可以在所有 76 例 MRI 中以自动化方式实现。VP 分流组中，CSF 量（p<0.001）减少。随后，脑体积显著增加（p<0.001）。在 ETV 后，CSF 体积（p=0.019）显著减少（p=0.012），尽管减少程度不如分流植入后明显。脑体积扩大（p=0.02）。
该算法能够可靠地自动分割 CSF 和脑。该方法能够追踪治疗后的变化，并在分流和 ETV 后检测到 CSF 和脑体积的显著差异。
