Tierradentro-Garcia Luis Octavio, Onyango Levy, Dennis Rebecca, Freeman Colbey W, Haddad Sophie, Kozak Brandi, Hwang Misun
Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
Children (Basel). 2023 Jan 30;10(2):245. doi: 10.3390/children10020245.
Microvascular imaging ultrasound (MVI) can detect slow blood flow in small-caliber cerebral vessels. This technology may help assess flow in other intracranial structures, such as the ventricular system. In this study, we describe the use of MVI for characterizing intraventricular cerebrospinal fluid (CSF) flow dynamics in infants.
We included infants with brain ultrasound that had MVI B-Flow cine clips in the sagittal plane. Two blinded reviewers examined the images, dictated a diagnostic impression, and identified the third ventricle, cerebral aqueduct, fourth ventricle, and CSF flow direction. A third reviewer evaluated the discrepancies. We evaluated the association of visualization of CSF flow as detectable with MVI, with the diagnostic impressions. We also assessed the inter-rater reliability (IRR) for detecting CSF flow.
We evaluated 101 infants, mean age 40 ± 53 days. Based on brain MVI B-Flow, a total of 49 patients had normal brain US scans, 40 had hydrocephalus, 26 had intraventricular hemorrhage (IVH), and 14 had hydrocephalus+IVH. Using spatially moving MVI signal in the third ventricle, cerebral aqueduct, and fourth ventricle as the criteria for CSF flow, CSF flow was identified in 10.9% (n = 11), 15.8% (n = 16), and 16.8% (n = 17) of cases, respectively. Flow direction was detected in 19.8% (n = 20) of cases; 70% (n = 14) was caudocranial, 15% (n = 3) was craniocaudal, and 15% (n = 3) bidirectional, with IRR = 0.662, < 0.001. Visualization of CSF flow was significantly associated with the presence of IVH alone (OR 9.7 [3.3-29.0], < 0.001) and IVH+hydrocephalus (OR 12.4 [3.5-440], < 0.001), but not with hydrocephalus alone ( = 0.116).
This study demonstrates that MVI can detect CSF flow dynamics in infants with a history of post-hemorrhagic hydrocephalus with a high IRR.
微血管成像超声（MVI）能够检测小口径脑血管中的缓慢血流。这项技术可能有助于评估其他颅内结构（如脑室系统）中的血流情况。在本研究中，我们描述了使用MVI来表征婴儿脑室内脑脊液（CSF）的流动动力学。
我们纳入了接受过脑超声检查且矢状面有MVI B-Flow动态 cine 剪辑图像的婴儿。两名盲法审阅者检查图像，口述诊断印象，并识别第三脑室、中脑导水管、第四脑室以及脑脊液流动方向。第三名审阅者评估差异。我们评估了MVI可检测到的脑脊液流动可视化与诊断印象之间的关联。我们还评估了检测脑脊液流动的评分者间可靠性（IRR）。
我们评估了101名婴儿，平均年龄40±53天。基于脑部MVI B-Flow，共有49例患者脑部超声扫描正常，40例患有脑积水，26例患有脑室内出血（IVH），14例患有脑积水合并IVH。以第三脑室、中脑导水管和第四脑室中空间移动的MVI信号作为脑脊液流动的标准，分别在10.9%（n = 11）、15.8%（n = 16）和16.8%（n = 17）的病例中识别出脑脊液流动。在19.8%（n = 20）的病例中检测到流动方向；70%（n = 14）为尾颅向，15%（n = 3）为颅尾向，15%（n = 3）为双向，IRR = 0.662，P < 0.001。脑脊液流动的可视化与单独存在IVH（OR 9.7 [3.3 - 29.0]，P < 0.001）以及IVH + 脑积水（OR 12.4 [3.5 - 44.0]，P < 0.001）显著相关，但与单独的脑积水无关（P = 0.116）。
本研究表明，MVI能够以较高的IRR检测出血后脑积水婴儿的脑脊液流动动力学。
