ISSN 1004-4140
CN 11-3017/P

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

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

吴倩, 何文杰, 张协军, 等. 56例特发性正常压力脑积水患者的临床和MRI特征分析[J]. CT理论与应用研究, xxxx, x(x): 1-8. DOI: 10.15953/j.ctta.2023.095
引用本文: 吴倩, 何文杰, 张协军, 等. 56例特发性正常压力脑积水患者的临床和MRI特征分析[J]. CT理论与应用研究, xxxx, x(x): 1-8. DOI: 10.15953/j.ctta.2023.095
WU Q, HE W J, ZHANG X J, et al. Clinical and MRI Characteristics of 56 Patients with Idiopathic Normal Pressure Hydrocephalus[J]. CT Theory and Applications, xxxx, x(x): 1-8. DOI: 10.15953/j.ctta.2023.095. (in Chinese)
Citation: WU Q, HE W J, ZHANG X J, et al. Clinical and MRI Characteristics of 56 Patients with Idiopathic Normal Pressure Hydrocephalus[J]. CT Theory and Applications, xxxx, x(x): 1-8. DOI: 10.15953/j.ctta.2023.095. (in Chinese)

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
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

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

  • 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。

     

  • 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

    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(%)       60~6924(42.9)
           70~7927(48.2)
           ≧805(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。
    下载: 导出CSV
  • [1] NAKAJIMA M, YAMADA S, MIYAJIMA M, et al. Guidelines for management of idiopathic normal pressure hydrocephalus (Third Edition): Endorsed by the japanese society of normal pressure hydrocephalus[J]. Neurologia Medico-chirurgica, 2021, 61(2): 63−97. DOI: 10.2176/nmc.st.2020-0292.
    [2] MISKIN N, PATEL H, FRANCESCHI A M, et al. Diagnosis of normal-pressure hydrocephalus: Use of traditional measures in the era of volumetric MR imaging[J]. Radiology, 2017, 285(1). DOI:10.1148/radiol. 2017161216.
    [3] KITAGAKI H, MORI E, ISHII K, et al. CSF spaces in idiopathic normal pressure hydrocephalus: Morphology and volumetry[J]. American Journal of Neuroradiology, 1998, 19(7): 1277−1284.
    [4] 王长春, 王作伟, 袁庆国, 等. 老年特发性正常压力脑积水患者的手术治疗及中期随访[J]. 中华老年医学杂志, 2011,30(8): 664−666. DOI: 10.3760/cma.j.issn.0254-9026.2011.08.014.

    WANG C C, WANG Z W, YUAN Q G, et al. The surgical treatment of elderly patients with idiopathic normal pressure hydrocephalus and medium-term follow-up[J]. Journal of the Chinese elderly Medical Journal, 2011, 30(8): 664−666. DOI: 10.3760/cma.j.issn.0254-9026.2011.08.014. (in Chinese).
    [5] TOMA A K, HOLL E, KITCHEN N D, et al. Evans' index revisited: the need for an alternative in normal pressure hydrocephalus[J]. Neurosurgery, 2011, 68(4): 939−944. DOI: 10.1227/NEU.0b013e318208f5e0.
    [6] ISHII K, KANDA T, HARADA A, et al. Clinical impact of the callosal angle in the diagnosis of idiopathic normal pressure hydrocephalus[J]. European Radiology, 2008, 18(11): 2678−2683. DOI: 10.1007/s00330-008-1044-4.
    [7] FAZEKAS F, CHAWLUK J B, ALAVI A, et al. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging[J]. American Journal of Neuroradiology, 1987, 149(2): 351−356. DOI: 10.2214/ajr.149.2.351.
    [8] MIYAZAKI K, ISHII K, HANAOKA K, et al. The tight medial and high convexity subarachnoid spaces is the first finding of idiopathic normal pressure hydrocephalus at the preclinical stage[J]. Neurologia Medico-chirurgica (Tokyo), 2019, 59(11): 436−443. DOI: 10.2176/nmc.oa.2019-0133.
    [9] SASAKI M, HONDA S, YUASA T, et al. Narrow CSF space at high convexity and high midline areas in idiopathic normal pressure hydrocephalus detected by axial and coronal MRI[J]. Neuroradiology, 2008, 50(2): 117−122. DOI: 10.1007/s00234-007-0318-x.
    [10] VIRHAMMAR J, LAURELL K, CESARINI K G, et al. Preoperative prognostic value of MRI findings in 108 patients with idiopathic normal pressure hydrocephalus[J]. American Journal of Neuroradiology, 2014, 35(12): 2311−2318. DOI: 10.3174/ajnr.A4046.
    [11] HOLODNY A I, GEORGE A E, DE-LEON M J, et al. Focal dilation and paradoxical collapse of cortical fissures and sulci in patients with normal-pressure hydrocephalus[J]. Journal of Neurosurgery, 1998, 89(5): 742−747. DOI: 10.3171/jns.1998.89.5.0742.
    [12] SHINODA N, HIRAI O, HORI S, et al. Utility of MRI-based disproportionately enlarged subarachnoid space hydrocephalus scoring for predicting prognosis after surgery for idiopathic normal pressure hydrocephalus: Clinical research[J]. Journal of Neurosurgery, 2017, 127(6): 1436−1442. DOI: 10.3171/2016.9.JNS161080.
    [13] 中华医学会神经外科学分会, 中华医学会神经病学分会, 中国神经外科重症管理协作组. 中国特发性正常压力脑积水诊治专家共识(2016)[J]. 中华医学杂志, 2016,96(21): 1635−1638. DOI: 10.3760/cma.j.issn.0376-2491.2016.021.003.

    Chinese Society of Neurosurgery, Chinese Society of Neurology, Chinese Collaborative Group of Neurosurgery Intensive Care Management. China expert consensus of diagnosis and treatment of idiopathic normal pressure hydrocephalus (2016)[J]. Chinese Journal of Medicine, 2016, 96(21): 1635−1638. DOI: 10.3760/cma.j.issn.0376-2491.2016.021.003. (in Chinese).
    [14] ARUGA S, KUWANA N, SHIROKI Y, et al. Effect of cerebrospinal fluid shunt surgery on lower urinary tract dysfunction in idiopathic normal pressure hydrocephalus[J]. Neurourology and Urodynamics, 2018, 37(3): 1053−1059. DOI: 10.1002/nau.23399.
    [15] 李勇, 方旭昊, 毛仁玲, 等. 老年正常压力脑积水患者与脑卒中患者三维步态参数的差异性研究[J]. 老年医学与保健, 2017,23(4): 324−327. doi: 10.3969/j.issn.1008-8296.2017.04.024

    LI Y, FANG X H, MAO R L, et al. Difference of 3-dimensional gait parameters between the elderly patients with normal pressure hydrocephalus and the patients with hemiplegia after stroke[J]. Geriatrics and Health Care, 2017, 23(4): 324−327. (in Chinese). doi: 10.3969/j.issn.1008-8296.2017.04.024
    [16] 方旭昊, 舒卫权, 高幸, 等. 急诊跌倒老年人群特发性正常压力脑积水诊治的初步探索[J]. 老年医学与保健, 2018,24(1): 8−11,21. doi: 10.3969/j.issn.1008-8296.2018.01.004

    FANG X H, SHU W Q, GAO X, et al. Preliminary exploration of the diagnosis and treatment of iNPH in emergency elderly patients with falls[J]. Geriatrics and Health Care, 2018, 24(1): 8−11,21. (in Chinese). doi: 10.3969/j.issn.1008-8296.2018.01.004
    [17] KURIYAMA N, MIYAJIMA M, NAKAJIMA M, et al. Nationwide hospital-based survey of idiopathic normal pressure hydrocephalus in Japan: Epidemiological and clinical characteristics[J]. Brain and behavior, 2017, 7(3): e635. DOI: 10.1002/brb3.635.
    [18] KAMOHARA C, NAKAJIMA M, KAWAMURA K, et al. Neuropsychological tests are useful for predicting comorbidities of idiopathic normal pressure hydrocephalus[J]. Acta Neurologica Scandinavica, 2020, 142(6): 623−631. DOI: 10.1111/ane.13306.
    [19] HUDSON M, NOWAK C, GARLING R J, et al. Comorbidity of diabetes mellitus in idiopathic normal pressure hydrocephalus: A systematic literature review[J]. Fluids and Barriers of the CNS, 2019, 16(1). DOI: 10.1186/s12987-019-0125-x.
    [20] ANDREN K, WIKKELSO C, SUNDSTROM N, et al. Long-term effects of complications and vascular comorbidity in idiopathic normal pressure hydrocephalus: A quality registry study[J]. Journal of Neurology, 2018, 265(1): 178−186. DOI: 10.1007/s00415-017-8680-z.
    [21] WILLIAMS M A, RELKIN N R. Diagnosis and management of idiopathic normal pressure hydrocephalus[J]. Neurology Clinical Practice, 2013, 3(5): 375−385. doi: 10.1212/CPJ.0b013e3182a78f6b
    [22] ALLALI G, GARIBOTTO V, ASSAL F. Parkinsonism differentiates idiopathic normal pressure hydrocephalus from its mimics[J]. Journal of Alzheimer's Disease, 2016, 54(1): 123−127. DOI: 10.3233/JAD-160428.
    [23] LEMAY M, NEW P F. Radiological diagnosis of occult normal-pressure hydrocephalus[J]. Radiology, 1970, 96(2): 347−358. DOI: 10.1148/96.2.347.
    [24] 方旭昊, 舒卫权, 何文杰, 等. DESH评分预测特发性正常压力脑积水脑脊液放液试验的效果[J]. 老年医学与保健, 2020,26(4): 583−586,601. DOI: 10.3969/j.issn.1008-8296.2020.04.019.

    FANG X H, SHU W Q, HE W J, et al. Effect of DESH score on prediction of cerebrospinal fluid drainage test of idiopathic normal Pressure hydrocephalus[J]. Geriatrics and Health Care, 2020, 26(4): 583−586,601. DOI: 10.3969/j.issn.1008-8296.2020.04.019. (in Chinese).
  • 加载中
图(2) / 表(2)
计量
  • 文章访问数:  16
  • HTML全文浏览量:  9
  • PDF下载量:  5
  • 被引次数: 0
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

目录

    /

    返回文章
    返回