Preliminary Value Of 3D-pCASL In Differential Diagnosis Of Ventricular Enlargement Caused By Hydrocephalus And Atrophy

Obj ectiveTo explore the application value of three dimensional pseudo-continuous arterial spin labeling(3D-pCASL)in the differential diagnosis of hydrocephalus and brain atrophy and the relationship between Evans' index and cerebral blood flow(CBF)in patients with hydrocephalus.Materials and MethodsFrom December 2017 to November 2018,40 patients with ventricular enlargement in Qianfoshan Hospital of Shandong Province were collected.Among them,20 cases were hydrocephalus(11 males and 9 females,age 63±13 years old,11 obstructive hydrocephalus and 9 communicating hydrocephalus),20 age-and sex-matched patients with asymptomatic brain atrophy were included in the criteria:1.El>0.3;2.According to Wu En-hui 's diagnostic criteria of brain atrophy,two experienced imaging physicians have a common diagnosis of brain atrophy;3.No history of ischemia and hypoxia,no history of brain trauma,and no diabetes.20 age-and sex-matched normal people were selected.All the subjects showed normal cerebral MRA,no history of neurological or mental illness,and all of them were right-handedness.On the day of examination,they drank no caffeine,functional drinks,and had no strenuous exercise on the same day.All the subjects were approved by the Hospital Ethics Committee and were informed of the purpose,contents and informed consent of the study before scanning.Images were obtained by using GE Discovery 750 3.0T MR equipment with 32 channel phased array head coil.All the subjects were examined by routine brain sequence(T1WI,T2WI,T2-FLAIR,DWI),3-D MRA,3D-pCASL and 3D-T1BRAVO.All the original ASL data were processed by GE ADW 4.6 workstation to obtain ASL pseudo-color map,and then fused them with 3D-T1 BRAVO sequences to obtain the fusion map of ASL pseudo-color map and 3D-T1BRAVO.Eight areas in each the basal ganglia level and the semi-oval center level accompanied by the disappearing of lateral ventricles were selected as the regions of interest,and numbered as ROI 1-8.The corresponding CBF value of ROI was obtained.The bilateral periventricular ROI was obtained symmetrically by the mirror image method.Several ROI regions were selected at the left and right semi-oval center respectively.The mean value of CBF in the left and right semi-oval center were regard as ROI 9,10.Each ROI size ranged between 50-100mm2,and the selection of the region of interest avoided the ischemic infarct softening focus,the cerebral fissure and large blood vessels.El(the ratio of the transverse diameter of the anterior horns of the lateral ventricles to the greatest internal diameter of the skull)was measured on the axial T2-FLAIR sequence by two imaging physicians with more than 3 years' working experience.The data were analyzed by SPSS 19.0 software.The CBF values and El values of the three groups were in accordance with normal distribution.The difference of CBF among the three groups was analyzed by one-way ANOVA,and Pearson correlation analysis was used between El and CBF.Results1.Comparison of CBF value between hydrocephalus group and cerebral atrophy group:the CBF value of ROI1-8 in hydrocephalus group was lower than that of brain atrophy group,in which the CBF value in ROI 1,ROI 2,ROI 5,ROI 6 and ROI 8 of hydrocephalus group showed statistically significant decrease(P<0.05).2.Comparison of CBF value between hydrocephalus group and normal group:the CBF value of ROI1-8 in hydrocephalus group was lower than that in normal group,and showed statistically significant decrease(P<0.05).3.Comparison of CBF value between brain atrophy group and normal group:the CBF value in bilateral caudate nucleus head(ROI 3,4)and corpus callosum(ROI 7?8)of brain atrophy group was lower than of normal group,but there is no statistically significant difference between normal group and brain atrophy group(P>0 05).4.The correlation between CBF value and El:The El in the hydrocephalus group had significant negative correlation with the CBF value in ROI 1,ROI 2,ROI 6,ROI 9,ROI 10(P=0.049,r=-0.445;P=0.008,r=-0.575;P=0.030,r=-0.485;P=0.017,r=-0.526;P=0.001,r=-0.703),and there was no significant correlation in other ROI.Conclusions1.3D-pCASL techniquea has certain application value in the differential diagnosis of hydrocephalus and brain atrophy.2.3D-pCASL can be used to quantify the cerebral blood flow in patients and nornal persons,and to find abnormal changes of cerebral parenchyma perfusion caused by ventricular dilatation and deformation.