56例特发性正常压力脑积水患者的临床和MRI特征分析

吴倩; 何文杰; 张协军; 夏军

doi:10.15953/j.ctta.2023.095

56例特发性正常压力脑积水患者的临床和MRI特征分析

doi: 10.15953/j.ctta.2023.095

吴倩^1,,
何文杰^{2, a},
张协军^{2, b},
夏军^{2, a, ,}

1.
广州医科大学研究生院, 广州511436
1.
医学影像科；深圳大学第一附属医院/深圳市第二人民医院
2.
神经外科，广东深圳518035 深圳大学第一附属医院/深圳市第二人民医院

基金项目: 国家自然科学基金（机器学习构建特发性正常压力脑积水分流术预后模型：基于大脑结构与连接的磁共振研究（82171913））。

详细信息

作者简介:
吴倩：女，广州医科大学放射影像学专业型硕士研究生，主要研究方向为头颈部及中枢神经系统影像诊断，E-mail：qianwu400@163.com

通讯作者:
男，深圳市第二人民医院放射科主任医师，主要研究方向为头颈部及中枢神经系统影像诊断，E-mail：xiajun2003sz@aliyun.com

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出版历程
- 收稿日期: 2023-04-19
- 修回日期: 2023-06-15
- 录用日期: 2023-06-26
- 网络出版日期: 2023-09-11

Clinical and MRI Characteristics of 56 Patients with Idiopathic Normal Pressure Hydrocephalus

WU Qian^1
,,
HE Wenjie^{2, a},
ZHANG Xiejun^{2, b},
XIA Jun^{2, a
, ,}

1.
Guangzhou Medical University, Guanghzou 511436, China
1.
Shenzhen Second People's Hospital, Shenzhen 518035, China Department of Radiology
2.
Shenzhen Second People's Hospital, Shenzhen 518035, China Department of Neurosurgery

摘要

摘要: 目的：对行手术确诊的特发性正常压力脑积水患者进行临床和MRI表现分析和总结，研究其临床、MRI特征以提高对该疾病的认识。方法：回顾性分析我院56例行分流术确诊的iNPH患者临床和术前MR（包括3DT1WI、T2WI、T2 FLAIR）资料，对iNPH常见MR影像征象进行评估和描述。结果：56例iNPH患者中，步态障碍、认知障碍及尿失禁的发生率分别为91.1％、60.7％及42.9％，经典三联征为23.2％；常见合并症依次为高血压（51.8％）、糖尿病（28.6％）及帕金森病（PD）（12.5％）。对56例iNPH患者MR图像进行分析，82.1％患者胼胝体角呈锐角，39.3％患者蛛网膜下腔不成比例扩大征象（DESH）阳性，DESH评分平均得分（5.24±1.27）。结论：iNPH确诊患者最常合并高血压、糖尿病和PD，经典三联征较少，且典型的MR征象阳性率不高，阴性患者的诊断和预后预测仍然存在挑战，应结合其他临床检查明确诊断和治疗。
- 特发性正常压力性脑积水 /
- 临床特征 /
- 磁共振成像
Abstract: Objective: To analyze and summarize the clinical and MRI manifestations of patients with idiopathic normal pressure hydrocephalus (iNPH) diagnosed via surgery in order to improve the understanding of this disease. Methods: We performed a retrospective analysis of the clinical and preoperative MR (including 3D T1WI, T2 WI, and T2 FLAIR) data of 56 patients with iNPH diagnosed via shunt surgery at our hospital to evaluate and describe MR linear parameters and common radiological features. Results: Among the 56 patients with iNPH, 91.1%, 60.7%, and 42.9% showed gait disturbance, cognitive impairment, and urinary disturbance, respectively; the classical triad accounted for 23.2%. The most common comorbidities were hypertension (51.8%), diabetes (28.6%), and PD (12.5%). In the analysis of the 56 patients’ MR images, 82.1% had acute callosal angle and 39.3%, positive disproportionately enlarged subarachnoid space signs (DESH), with a mean DESH score of 5.24±1.27. Conclusion: Patients with confirmed iNPH most often also have hypertension, diabetes mellitus, and PD. The classical triad is less frequent, and the positive rate of typical MR signs is not high. Thus, the accurate diagnosis and prognosis prediction of negative patients remains challenging and should be combined with other clinical examinations to clarify the diagnosis and treatment.
- idiopathic normal pressure hydrocephalus /
- clinical characteristics /
- magnetic resonance imaging

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图 1 特发性正常压力脑积水。男，67岁，线性参数的测量方法示意图

（a）3D T1 WI横断面，侧脑室扩大指数的测量；（b）T2 FLAIR，侧脑室颞角直径测量；（c）3D T1 WI横断面，三脑室最大直径测量；（d）（e）3D T1 WI矢、冠状面，胼胝体角（CA）的测量，取经过后联合且垂直于前后联合连线的平面测量两侧侧脑室的夹角。

Figure 1. Idiopathic normal pressure hydrocephalus. Male, 67 years old, measurement of linear parameters

下载: 全尺寸图片幻灯片

图 2 特发性正常压力脑积水。男，71岁，脑白质MR信号改变及DESH征象评估

（a）T2 FLAIR横断面，脑深部白质高信号（DWMH）（粗箭头）；（b）T2 FLAIR横断面，脑室周围高信号（PVH）（粗箭头）；（c）T2 FLAIR冠状面，DESH征（蛛网膜下腔不成比例扩大），即大脑凸面挤压效应（粗箭头）同时合并双侧裂池扩大（细箭头）；（d）3D T1 WI横断面，大脑顶叶局部脑沟扩大（粗箭头）。

Figure 2. Idiopathic normal pressure hydrocephalus. Male, 71 years old, White matter MR signal changes and evaluation of DESH sign image

下载: 全尺寸图片幻灯片

表 1 56例iNPH患者的一般资料及临床表现

Table 1. General data and clinical manifestations of 56 patients with iNPH

指标		结果
年龄/（岁，x±s）		70.8±6.4
年龄段/例（％）	60～69	24（42.9）
	70～79	27（48.2）
	≧80	5（8.9）
性别（男）/例（％）		35（62.5）
病程（月，x±s）		26.8±3.5
临床症状/例（％）	步态障碍	51（91.1）
	认知障碍	34（60.7）
	排尿障碍	24（42.9）
	步态+认知障碍	29（51.8）
	步态+排尿障碍	21（37.5）
	认知+排尿障碍	16（28.6）
	三联征	13（23.2）
共病情况/例（％）	高血压	29（51.8）
	糖尿病	16（28.6）
	帕金森病	7（12.5）
	阿尔兹海默病	1（1.8）
	冠心病及其合并症	3（5.4）
	脑血管疾病及其合并症	4（7.2）
	其他	5（8.9）

下载: 导出CSV

表 2 56例iNPH患者的MR影像表现

Table 2. MR imaging manifestations of 56 patients with iNPH

指标		结果
EI（x±s）		0.35±0.03
第3脑室直径/（mm，x±s）		14.6±3.4
颞角直径/（mm，x±s）		9.6±4.5
CA（x±s）		72.2±14.6
分级/例（％）	<90°	46（82.1）
	90°≥，≤100°	5（8.9）
	>100°	5（8.9）
大脑凸面挤压效应/例（％）		23（41.1）
侧裂池扩大/例（％）		31（55.4）
局部脑沟扩大/例（％）		36（64.3）
DWMH（x±s）		1.9±0.3
PVH（x±s）		1.5±0.5
DESH征/例（％）		22（39.3）
DESH评分（x±s）		5.24±1.27
DESH评分分级/例（％）	3分	4（7.1）
	4分	15（26.8）
	5分	10（17.9）
	6分	19（33.9）
	7分	6（10.7）
	8分	2（3.6）
注：CA为胼胝体角；DWMH为深部白质高信号；PVH为脑室周围高信号；DESH征为蛛网膜下腔不成比例扩大的脑积水征象。

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