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Idiopathischer Normaldruckhydrozephalus

Liquorflussmessung mittels Phasenkontrast-MRT und ihre diagnostische Bedeutung

Idiopathic normal-pressure hydrocephalus

Flow measurement of cerebrospinal fluid using phase contrast MRI and its diagnosic importance

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Zusammenfassung

Zielsetzung

Die Messung des Liquorflusses im Aquaeductus cerebri zur Diagnostizierung des idiopathischen Normaldruckhydrozephalus (iNPH) ist durch die Entwicklung nichtinvasiver Messmethoden mittels Magnetresonanztomographie (MRT) in den Mittelpunkt des Interesses gerückt. Ziel unserer Arbeit ist es, herauszufinden, ob dieses diagnostische Verfahren die bisher unvermeidbaren invasiven Methoden in der Diagnostik des iNPH ersetzen kann.

Methoden

Zwischen Januar 2003 und April 2005 untersuchten wir 61 Patienten, die unter den klinischen Symptomen der Hakim-Trias litten und eine Erweiterung des Ventrikelsystems zeigten mittels lumbalem Infusionstest, Zerebrospinal-Tap-Test und einer Liquorflussmessung mit einer kardial getriggerten 2D-Phasenkontrast-Sequenz. Die anschließend mit einem ventrikuloperitonealen Shunt therapierten Patienten wurden nach 12 Monaten nachuntersucht. Die Dokumentation der Symptomatik erfolgte anhand des Kiefer-Scores; das Outcome der Patienten wurde mit der NPH-Recovery-Rate nach Meier gemessen.

Ergebnisse

Entsprechend des Studienprotokolls diagnostizierten wir bei 41 Patienten einen iNPH und bei 20 Patienten eine Hirnatrophie. 39 der 41 iNPH-Patienten therapierten wir mittels Implantation eines ventrikuloperitonealen Shunts, 2 Patienten lehnten eine Operation ab. Im Anschluss an den Eingriff ergab sich eine signifikante Besserung der mit dem Kiefer-Score gemessenen klinischen Symptomatik. In der anschließenden Analyse der MR-Messdaten, gewonnen mittels quantitativer 2D-Phasenkontrast-Technik konnte nachgewiesen werden, dass eine Liquorflussrate von mehr als 24,5 ml/min mit einer Spezifität von 95% mit einem iNPH korreliert ist.

Schlussfolgerungen

Die Messung des Liquorflusses mittels Phasenkontrasttechnik eignet sich als hochselektive nichtinvasive Voruntersuchung in der Diagnostik des iNPH.

Summary

Aim

The measurement of CSF flow in the aqueduct has been a focus of interest since the development of MR imaging (MRI) techniques for this purpose in diagnosing idiopathic normal-pressure hydrocephalus (iNPH). The purpose of this prospective study was to determine the ability of this diagnostic tool to replace invasive methods in establishing the diagnosis of iNPH.

Patients and Methods

Between January 2003 and April 2005, 61 patients with the Hakim triad of clinical symptoms and dilated ventricular systems underwent the intrathecal infusion test, cerebrospinal tap test, and phase-contrast MRI to measure CSF flow rate in the aqueduct. Shunted patients were controlled 12 months postperatively. Pre- and postoperative clinical symptoms were evaluated with the Kiefer score. Outcome was calculated according to the NPH recovery rate.

Results

According to these criteria the patients were classified into groups of 41 with iNPH and 20 with brain atrophy. Of the iNPH patients, 39 were shunted and two did not agree to surgery. The mean Kiefer score of the shunted patients was statistically significantly lower after surgery. The aqueductal CSF flow rate of these patients was statistically analyzed and showed that a flow rate of more than 24.5 ml/min is 95% specific to iNPH.

Conclusion

Measurement of the CSF flow rate in the aqueduct using phase-contrast MRI is a highly specific preselective method for diagnosing iNPH

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Authors and Affiliations

  1. Klinik für Neurochirurgie, Unfallkrankenhaus, Warener Straße 7, 12683 , Berlin, Deutschland

    F.T. Al-Zain,  J. Lemcke &  U. Meier

  2. Institut für Radiologie, Unfallkrankenhaus Berlin, Berlin, Deutschland

    G. Rademacher &  S. Mutze

Authors
  1. F.T. Al-Zain
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  2. G. Rademacher
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  3. J. Lemcke
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  4. S. Mutze
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  5. U. Meier
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Correspondence to U. Meier.

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Al-Zain, F., Rademacher, G., Lemcke, J. et al. Idiopathischer Normaldruckhydrozephalus. Nervenarzt 78, 181–187 (2007). https://doi.org/10.1007/s00115-006-2231-7

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  • DOI: https://doi.org/10.1007/s00115-006-2231-7

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