磁共振三维稳态进动快速成像序列在内镜下第三脑室底造瘘术后早期疗效评估中的应用

Application of three-dimensional fast imaging employing steady-state acquisition in prognostic evaluation in the early stage after endoscopic third ventriculostomy

摘要:

目的 探讨磁共振三维稳态进动快速成像（3D FIESTA）序列在脑积水内镜下第三脑室底造瘘术后早期疗效评估的应用价值。方法 分析陕西省核工业二一五医院2020年1月至2023年12月收治的内镜下第三脑室底造瘘术17例症状性脑积水患者临床资料，术前及术后早期（1个月内）常规行磁共振平扫（T1WI、T2WI、T2 Flair序列）及3D FIESTA序列检查，分别根据手术前后脑室系统大小变化（Evans指数）、脑室周围间质水肿程度及第三脑室底部和终板结构移位等指标将病例分为治疗有效组和治疗无效组。结果 早期磁共振平扫显示脑积水脑治疗有效组7例（41.2%）、治疗无效组10例（58.8%）；3D FIESTA序列扫描显示治疗有效组15例（88.2%），治疗无效组2例（11.8%），两者在梗阻性脑积水行第三脑室底造瘘术后早期评估方面有统计学差异（P=0.010）。结论 磁共振3D FIESTA序列检查可以为梗阻性脑积水的第三脑室底造瘘术后早期疗效评估提供客观精准影像指导。

Abstract:

Objective To investigate the application value of three-dimensional fast imaging employing steady-state acquisition （3D FIESTA） in prognostic evaluation in the early stage after endoscopic third ventriculostomy for hydrocephalus.Methods A retrospective analysis was performed for the clinical data of 17 patients with symptomatic hydrocephalus who underwent endoscopic third ventriculostomy in No. 215 Hospital of Shaanxi Nuclear Industry from January 2020 to December 2023. Routine magnetic resonance （MR） imaging （T1WI， T2WI， and T2 Flair sequences） and 3D FIESTA were performed before surgery and in the early stage after surgery （within 1 month）， and the patients were divided into response group and non-response group according to the change in the size of the cerebral ventricular system after surgery （Evans index）， the degree of periventricular interstitial edema， and the displacement of the base and lamina terminalis of the third ventricle.Results Routine MR imaging showed that there were 7 patients （41.2%） in the response group and 10 patients （58.8%） in the non-response group； 3D FIESTA sequence showed 15 patients （88.2%） in the response group and 2 patients （11.8%） in the non-response group， and there were significant differences between routine MR imaging and 3D FIEATS in prognostic evaluation in the early stage after endoscopic third ventriculostomy for obstructive hydrocephalus （P = 0.010）.Conclusions Perioperative MR imaging and 3D FIESTA sequence can provide objective and accurate imaging guidance for prognostic evaluation in the early stage after endoscopic third ventriculostomy for obstructive hydrocephalus.