Clinical and MRI Characteristics of 56 Patients with Idiopathic Normal Pressure Hydrocephalus
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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。
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关键词:
- 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. -
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
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) 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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