The Clinical Study Of The Diagnostic Value On The Dynamic CT Cisternography For CSF Dynamics Disorder Diseases

Part OneThe Quantitative Study of the Diagnostic Value on the Dynamic CT Cisternography for Subdural EffusionObjective The aim of this in vivo study was to study the characteristics and laws of CSF dynamics in diagnosing subdural effusion by quantitative analysis, presume the major causes and pathogenesis of subdural effusion, and to suggest a classification for the disease in order to guide the clinical therapies.Method We set a patient group and a control group to study the laws of dynamic CT cisternography by case-control method. Dynamic CT cisternography with Omnipaque through lumbar puncture was the main parameter, which gave us CT values of every ventricle, cerebral cisternae in subarachnoid and subdural cavity at 0, 1, 6, 12, 24 and 48 hour. We drew the flexuous curves with CT values to reflect the CSF dynamics and make independent-samples T test to look for the difference of developing or expurgating speed between patient and control group.Results Peak time of Omnipaque in cerebral cisternae of patients delayed about 6 hours compared with that of control group. The developing level of Omnipaque was lower and the clearance was significantly slower after independent-samples T test in all the patients. It did not expurgate at 24h until 48h in cisternae of patients while it had expurgated at 24h in control. Significantly, the "asymmetric developing" was frequently found in many cisternae in patients, which manifested that only partial or unilateral cisternae had been developed. Part of the forth ventricles showed the countercurrent of Omnipaque both in patient and control group, while part of the other ventricles showed only in patient group. The fact of peak time existing and no expurgating at 24h in ventricles was similar with that of in cisternae. From the flexuous curves and T test, two models of Omnipaque circulation had been found in subdural effusion: filling quickly or slowly. Meanwhile, protein and RBC concentration in effusion were highly increased compared with normal CSF.Conclusion The quantitative analysis of dynamic CT cisternography can reflect the characteristics and laws of CSF dynamics in subdural effusion. The disorders of CSF circulation and absorption were presented in the patient group, which, together with the valve mechanism and osmosis mechanism, leading to the subdural effusion, and the valve hypothesis was proved by the cisternography. Subdural effusion, together with the hydrocephalus, had the same characteristics and laws of dynamic CT cisternography. Two types of effusion developing were found as filling quickly or slowly with the significant difference at first 6 hours, which could evaluate the tears size and valve degree, and even be helpful for classification. According to our analysis from curve, the subdural effusion could be classified into two groups: the pure type and the hydrocephalus type. Cisternography could be helpful for the classification and guidance for the clinical therapies of subdural effusion. Part TwoThe Quantitative Study of the Diagnostic Value on the Dynamic CT Cisternography for Arachnoid CystObjective The aim of this in vivo study was to study the characteristics and laws of CSF dynamics in diagnosing arachnoid cyst by quantitative analysis, and to suggest a new classification for arachnoid cyst in order to set up the clinical pathways.Method We set a patient group and a control group to study the laws of dynamic CT cisternography by case-control method. Dynamic CT cisternography with Omnipaque through lumbar puncture was the main parameter, which supplied us the CT values of every ventricle, cerebral cisternae and the cyst at 0, 1, 6, 12, 24 and 48 hour. The characteristics between the patient group and the control group were compared separately.Results Peak time of Omnipaque in cerebral cisternae of 4 patients were at the 6th hour, without the developing of contrast medium in the cyst. It did not expurgate at the 24^th hour with the remarkable countercurrent to the forth ventricle. It was observed that the contrast medium developed in the cyst until at the 24^th hour and delayed to 48^th hour to be diminished. In the latter seven cases, the developing level of Omnipaque, the peak time and the diminished interval for the contrast medium were in similar with the normal group, and it was difficult to distinguish the cyst in the cistern magna.Conclusion The quantitative analysis of dynamic CT cisternography was useful in distinguish the arachnoid cyst from the variant cistern magna with the advantages of objective, clear and accurate. According to the characteristics and laws of dynamic CT cisternography in arachnoid cyst, three types of cyst could be identified by clinical application: the complete arachnoid cyst, the incomplete arachnoid cyst and the variant cisternae. As for the former two types arachnoid cyst,procedure should be considered, while not for the variant cisternae.Part ThreeThe Diagnostic Value and the Clinical Application of the Dynamic CT Cisternography for CSF Dynamics DisorderDiseasesThrough the quantitative study of the diagnostic value on the dynamic CT cisternography for subdural effusion, arachnoid cyst and hydrocephalus, the following conclusions could be drawn as a summarization of this dissertation:i. The dynamic CT cisternography may take the place of isotope cisternography in diagnosis and differential diagnosis of CSF dynamics disorder diseases, especially for subdural effusion, arachnoid cyst and hydrocephalus;ii. According to the characteristics and laws of the dynamic CT cisternography for different kinds of CSF dynamics disorder diseases, it may help us to understand the pathogenesis and the correlation among all kinds of CSF dynamics disorder diseases, which could improve the clinical efficacy;iii. Subdural effusion and hydrocephalus have the coherence consistency inthe pathogenesis and should share the same therapy principle.