特发性正常压力脑积水患者脑脊液引流前后脑在心动周期中表观扩散系数（ADC）的变化

Changes in Apparent Diffusion Coefficient (ADC) during Cardiac Cycle of the Brain in Idiopathic Normal Pressure Hydrocephalus Before and After Cerebrospinal Fluid Drainage.

作者信息

Osawa Tomoshi, Ohno Naoki, Mase Mitsuhito, Miyati Tosiaki, Omasa Ryoko, Ishida Shota, Kan Hirohito, Arai Nobuyuki, Kasai Harumasa, Shibamoto Yuta, Kobayashi Satoshi, Gabata Toshifumi

机构信息

Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.

出版信息

J Magn Reson Imaging. 2021 Apr;53(4):1200-1207. doi: 10.1002/jmri.27412. Epub 2020 Oct 28.

DOI:10.1002/jmri.27412

PMID:33112007

Abstract

BACKGROUND

The causative mechanisms of idiopathic normal-pressure hydrocephalus (iNPH) symptoms are currently unknown.

PURPOSE

To assess the dynamic changes in the apparent diffusion coefficient (ADC) during the cardiac cycle (ΔADC) of the brain before and after the lumbar tap and shunt surgery for the purpose of determining changes in hydrodynamic and biomechanical properties in the brain after cerebrospinal fluid (CSF) drainage for iNPH.

STUDY TYPE

Retrospective.

SUBJECTS

Overall, 22 patients suspected to have iNPH were examined before and after the lumbar tap and were divided into patients who showed symptomatic improvements (positive group, n = 17) and those without improvement (negative group, n = 5) after the lumbar tap. Seven patients in the positive group were examined after the shunt surgery.

FIELD STRENGTH/SEQUENCE: 1.5T, electrocardiographically synchronized single-shot diffusion echo-planar imaging.

ASSESSMENT

The frontal white matter ΔADC and mean ADC (ADC ) were compared between before and 24 hours after lumbar tap and from 1 week to 1 month after the shunt surgery.

STATISTICAL TESTS

Wilcoxon signed-rank test was used. P < 0.05 was considered statistically significant.

RESULTS

The ΔADC after the lumbar tap in the positive group was significantly lower than that before (P < 0.05), whereas no significant difference was found in the negative group (P = 0.23). After the lumbar tap, ΔADC decreased in 16 of 17 patients in the positive group, whereas ADC did not significantly change (P = 0.96). After the shunt surgery, ΔADC decreased in all seven patients (P < 0.05), whereas ADC did not significantly change (P = 0.87).

DATA CONCLUSION

The frontal white matter ΔADC in iNPH decreased after the lumbar tap and shunt surgery. ΔADC analysis may provide detailed information regarding changes in the hydrodynamic and biomechanical properties through CSF drainage.

LEVEL OF EVIDENCE

TECHNICAL EFFICACY STAGE

摘要

背景

特发性正常压力脑积水（iNPH）症状的致病机制目前尚不清楚。

目的

评估腰椎穿刺和分流手术前后大脑在心动周期中的表观扩散系数（ADC）动态变化（ΔADC），以确定iNPH脑脊液（CSF）引流后大脑流体动力学和生物力学特性的变化。

研究类型

回顾性研究。

研究对象

总共22例疑似iNPH的患者在腰椎穿刺前后接受检查，并分为腰椎穿刺后症状改善的患者（阳性组，n = 17）和无改善的患者（阴性组，n = 5）。阳性组中的7例患者在分流手术后接受检查。

场强/序列：1.5T，心电图同步单次激发扩散加权回波平面成像。

评估

比较腰椎穿刺前和穿刺后24小时以及分流手术后1周~1个月之间额叶白质的ΔADC和平均ADC（ADC）。

统计检验

采用Wilcoxon符号秩检验。P < 0.05被认为具有统计学意义。

结果

阳性组腰椎穿刺后的ΔADC显著低于穿刺前（P < 0.05），而阴性组未发现显著差异（P = 0.23）。腰椎穿刺后，阳性组17例患者中有16例ΔADC降低，而ADC无显著变化（P = 0.96）。分流手术后，所有7例患者的ΔADC均降低（P < 0.05），而ADC无显著变化（P = 0.87）。