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首页> 外文期刊>American Journal of Neuroradiology >Normal Pressure Hydrocephalus: Vascular White Matter Changes on MR Images Must Not Exclude Patients from Shunt Surgery
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Normal Pressure Hydrocephalus: Vascular White Matter Changes on MR Images Must Not Exclude Patients from Shunt Surgery

机译：常压性脑积水：MR图像上的血管白质变化不能排除分流手术的患者

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BACKGROUND AND PURPOSE: White matter changes such as periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH) are associated with both periventricular edema and ischemic white matter degeneration. Their diagnostic and predictive value in normal pressure hydrocephalus (NPH) is unclear. To identify prognostically important changes, we classified PVH and DWMH at MR imaging in a large series of patients with NPH, before and after ventriculoperitoneal shunt surgery. METHODS: Axial proton density– and T2-weighted turbo spin-echo sequences and coronal T1-weighted sequences were performed on a 0.5-T imager in 34 patients with NPH, before and 3 months after shunt surgery. PVH at the anterior, central, and posterior thirds of the lateral ventricles was assessed on transaxial images with a semiquantitative five-step scale describing the extension (in mm) and shape of the PVH. DWMH was quantified with a four-step scale. The number of cortical and subcortical lacunar infarctions, the flow void sign, and the width of the third and lateral ventricles were registered. Gait ability, need for sleep, urinary incontinence, living conditions, and psychometric test performance were assessed pre- and postoperatively. RESULTS: After shunt surgery, 25 patients improved and nine did not. PVH, DWMH, and other MR imaging variables before shunting did not differ between groups, and no MR imaging variable could predict the clinical effect of shunt surgery. Postoperatively, the width of PVH was reduced in the improved patients, and clinical improvement correlated with reduction in PVH. Only the irregular type of PVH located at the frontal horns was reduced postoperatively. The presence of risk factors or MR imaging changes normally associated with cerebrovascular disease had no negative influence on the outcome of shunt surgery. CONCLUSION: The presence of DWMH or subcortical lacunar infarctions in NPH did not predict a poor outcome from shunt surgery and should not be used as exclusion criteria for shunting. No MR imaging findings could predict outcome of shunt surgery in patients with NPH. Clinical improvement after surgery is associated with reduction in the irregular type of PVH located around the frontal horns.
机译：背景与目的：脑室周围水肿和缺血性 >白质变性。它们在常压性脑积水（NPH）中的诊断和预测价值 尚不清楚。为了确定 在预后上的重要变化，我们对大量NPH患者， 之前和之后的室性腹膜分流手术后MR成像中的PVH和DWMH 进行了分类。 方法：轴向质子密度和T2加权涡轮自旋回波 序列以及冠状T1加权序列在 0.5-T上进行在分流手术前后3个月内对34例NPH患者进行成像。在侧脑室的前，中和后三分之二的PVH在经轴心图像上进行评估，并采用半定量五步标尺描述 延伸（以毫米为单位）和PVH的形状。 DWMH采用四步法进行量化 。记录皮层和皮层下 腔梗死的数目，流空征以及 第三和侧脑室的宽度。术前和术后评估步态能力， 睡眠，尿失禁，生活条件和 心理测验的表现。 结果：分流手术后，有25例患者好转，有9例 没有。分流前的PVH，DWMH和其他MR影像变量在各组之间没有差异，并且没有MR影像变量可以预测分流手术的临床效果。术后， 患者的PVH宽度减小，而临床 患者的改善与PVH的降低相关。术后仅减少了位于额角的不规则PVH 型。 危险因素或MR影像的存在通常与脑血管疾病有关 结论：分流手术的结局没有负面影响。结论：NPH中存在DWMH或皮质腔隙性脑梗死 不能预示不良结局。来自分流手术的资料， 不应用作分流的排除标准。没有MR 影像学发现可预测NPH患者 的分流手术结局。手术后的临床改善与 额叶周围不规则类型的PVH减少有关。

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  • 来源
    《American Journal of Neuroradiology》 |2001年第9期|1665-1673|共9页
  • 作者

    Mats Tullberg; Christer Jensen; Sven Ekholm; Carsten Wikkels?;

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    From the Institute of Clinical Neuroscience (M.T., C.W.) and Department of Radiology (C.J., S.E.), Sahlgrenska University Hospital, G?teborg University, G?teborg, Sweden.;

    From the Institute of Clinical Neuroscience (M.T., C.W.) and Department of Radiology (C.J., S.E.), Sahlgrenska University Hospital, G?teborg University, G?teborg, Sweden.;

    From the Institute of Clinical Neuroscience (M.T., C.W.) and Department of Radiology (C.J., S.E.), Sahlgrenska University Hospital, G?teborg University, G?teborg, Sweden.;

    From the Institute of Clinical Neuroscience (M.T., C.W.) and Department of Radiology (C.J., S.E.), Sahlgrenska University Hospital, G?teborg University, G?teborg, Sweden.;

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