| Objective:To explore the application value of PC cine MRI combined with three-dimentional pulsed continuous ASL(3D-pCASL)technique in the obstructive hydrocephalus of aqueduct.and preliminarily explore the correlation between the degree of obstructive hydrocephalus obstruction and cerebral tissue perfusion.Materials and Methods:26 cases of patients with aqueduct obstructive hydrocephalus in the middle brain(hydrocephalus group),and 30 cases of normal volunteers(control group)all were examined with 3.0T magnetic resonance scanner.Firstly,all cases received cranial routine sequences of magnetic resonance and 3D-TOF-MRA(Three-dimensional time of flight MR angiography)scan,preliminary understanding the intracranial basic situation of the subjects.Then,the kinetics of aqueduct plane cerebrospinal fluid was quantitatively measured and qualitatively observed by PC cine sequence,The dynamic parameters of cerebrospinal fluid circulation(average flow rate,mean flow velocity,peak flow velocity of systolic phase and peak flow velocity of diastolic phase)and fluxion curve diagram were obtained within one cardiac cycle at the aqueduct level in the hydrocephalus preoperative group,postoperative group and control group.Finally,the whole brain3D-pCASL scan was performed with the same labeling delay time(PLD)(T=1525 ms)to obtain the cerebral tissue perfusion value(cerebral blood flow,CBF)of each brain regions(the anterior and outer watershed,the posterior and outer watershed,the basal ganglia area,the half oval center)of the hydrocephalus preoperative group,postoperative group and control group.Each dynamic parameters of the cerebrospinal fluid circulation in the aqueduct plane and the CBF in each brain regions between the hydrocephalus preoperative group,the hydrocephalus postoperative group and the control group were compared usingone-way ANOVA(one-way ANOVA),The two groups were compared using LSD-t test,The CBF in each brain regions of the preoperative low and high obstruction hydrocephalus group was compared by the independent samples t-test.the above statistical results showed that the difference were statistically significant at P<0.05.Chi square test was used to compare the types of cerebrospinal fluid flow in aqueduct plane between the hydrocephalus preoperative group,multiple comparison between multiple sample rates in Chi square test,the hydrocephalus postoperative group and the control group,the statistical results showed that the difference was statistically significant at P<0.0125.Analysis of receiver operating characteristic(ROC)curve of the CBF in each brain regions of the preoperative low and high obstruction hydrocephalus group,the area under curve(area under curve,AUC),sensitivity,specificity,and optimal threshold were obtained.Results:1.Qualitative analysis of cerebrospinal fluid dynamics:Comparison of the types of cerebrospinal fluid flow in aqueduct plane between the hydrocephalus preoperative group,the hydrocephalus postoperative group and the control group: the difference between the control group and the hydrocephalus preoperative group,the hydrocephalus preoperative group and the hydrocephalus postoperative group were all statistically significance,the difference between the control group and the hydrocephalus postoperative group was not statistically significant.2.Quantitative analysis of cerebrospinal fluid dynamics:The difference of each dynamic parameters of the cerebrospinal fluid circulation in the aqueduct plane between the control group and the hydrocephalus preoperative group,the hydrocephalus preoperative group and the hydrocephalus postoperative group were all statistically significance,the difference of each dynamic parameters of the cerebrospinal fluid circulation in the aqueduct plane between the control group and the hydrocephalus postoperative group was not statistically significant.3.The CBF comparison of each brain regions between the hydrocephalus preopera-tive group,the hydrocephalus postoperative group and the control group:The difference of the CBF of the anterior and outer watershed and the basal ganglia area between the control group and the hydrocephalus preoperative group,the hydrocephalus preoperative group and the hydrocephalus postoperative group were all statistically significance;the difference of the CBF of the posterior and outer watershed and the half oval center was not statistically significant.the difference of the CBF of the anterior and outer watershed,the posterior and outer watershed,the basal ganglia area and the half oval center between the control group and the hydrocephalus postoperative group were not all statistically significant.4.Comparative analysis of the CBF in each brain regions of the preoperative low and high obstruction hydrocephalus group:The difference of the CBF of the anterior and outer watershed and the basal ganglia area between the preoperative low and high obstruction hydrocephalus group were statistically significance;the difference of the CBF of the posterior and outer watershed and the half oval center were not statistically significant.5.Analysis of receiver operating characteristic(ROC)curve of the CBF in each brain regions of the preoperative low and high obstruction hydrocephalus group:The area under the ROC curve of the CBF of the anterior and outer watershed and the basal ganglia area diagnosis the preoperative low and high obstruction hydrocephalus was 0.815 and 0.78,respectively,and the diagnostic accuracy was relatively good.The optimal thresholds of the CBF in the anterior and outer watershed and basal ganglia area for the preoperative diagnosis of low and high obstruction hydrocephalus were 21.769ml/(100 g×min)and 41.878 ml/(100 g×min),respectively.the sensitivity of the CBF of the posterior and outer watershed with 27.296ml/(100g×min)as the optimal threshold was used to diagnose preoperative low and high obstruction hydrocephalus was 0.5,the specificity was 0.929,and the area under the curve was 0.679.the sensitivity of the CBF of the posterior and outer watershed with 25.565ml/(100g×min)as the optimal threshold was used to diagnose preoperative low and high obstruction hydrocephalus was 0.583,thespecificity was 0.786,and the area under the curve was 0.696,and the diagnostic accuracy was low.Conclusion:1.PC cine MRI combined with 3D-pCASL technology can diagnose aqueduct obstruction hydrocephalus and evaluate the postoperative effect from the two aspects of cerebrospinal fluid circulation dynamics in the aqueduct plane and cerebral tissue hemodynamics.It provides a more comprehensive and reliable method for the clinical diagnosis and treatment of aqueduct obstructive hydrocephalus,and provides a further evaluation index for future prospective study of obstructive hydrocephalus.2.There is an abnormal cerebral perfusion in patients with aqueduct obstructive hydrocephalus.The CBF of the anterior and outer watershed and the basal ganglia area is lower than that of the corresponding brain region of the normal person.The degree of hydrocephalus obstruction is negatively correlated with cerebral tissue perfusion in the anterior and outer watershed and the basal ganglia area,that is,the more severe the obstruction,the lower the CBF value of the above brain regions in patients with hydrocephalus.the CBF in the anterior and outer watershed and the basal ganglia area with 21.769ml/(100g×min)and 41.878ml/(100g×min)as the optimal threshold in the preoperative hydrocephalus group were used to evaluate the progress of the degree of hydrocephalus obstruction,which could provide more effective and timely information for clinical decision-making. |
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