Wang Junlu,Zhang Li,Liu Jiangang,et al.Application value of transcraniocerebral vascular Doppler ultrasonography in the diagnoses and postoperative evaluations of Chiari type Ⅰ malformation in children[J].Journal of Clinical Pediatric Surgery,,():140-146.[doi:10.3760/cma.j.cn101785-202212039-008]
Application value of transcraniocerebral vascular Doppler ultrasonography in the diagnoses and postoperative evaluations of Chiari type Ⅰ malformation in children
- Keywords:
- Chiari Malformation; Ultrasonography; Doppler; Transcranial; Cranial Fossa; Posterior; Cerebrovascular Circulation; Treatment Outcome; Treatment Outcome; Child
- Abstract:
- Objective To explore the application value of transcranialcerebral vessel Doppler (TVD) ultrasonography in the diagnoses and postoperative evaluations of type Ⅰ Chiari malformation in children.Methods From March 2018 to December 2021,the relevant clinical data were retrospectively reviewed for 27 children with type Ⅰ Chiari malformation.Based upon age,they were assigned into two groups of preschool (aged 1-6 year,n=15) and school-age (aged 7-16 year,n=12).TVD was detected at pre-operation,24 h post-operation and 1 month post-operation.Posterior cerebral artery (PCA),bilateral vertebral artery (VA) and basilar artery (BA) in posterior cranial fossa were selected as target vessels.Peak systolic velocity (PSV),end-diastolic velocity (EVD) and pulsative index (PI) of the corresponding target vessels were monitored.Hemodynamic profiles of posterior cranial fossa were compared in different age groups at pre-operation versus post-operation.The accuracy of diagnosis was compared with magnetic resonance imaging (MRI) at pre-operation and the consistency of efficacy compared with Tator evaluation post-operation.Results PSV of bilateral PCA post-operation spiked in preschool group as compared with that pre-operation ［left (44.25±13.06) vs. (66.76±14.45) cm/s,t=5.148,P=0.023; right (45.12±13.41) cm/s vs. (65.33±10.12) cm/s,t=5.389,P=0.021) and PI declined ［left (1.18±0.42) vs. (0.91±0.18),t=4.545,P=0.033; right (1.24±0.48) vs. (0.92±0.13),t=4.776,P=0.028),bilateral VA PSV ［left (43.50±11.99) vs. (70.94±7.56) cm/s,t=7.042,P=0.008; right (44.56±8.45) vs. (68.82±9.02) cm/s,t=6.833,P=0.009］,preoperative EVD rose ［left (19.01±9.22) vs. (27.18±8.53) cm/s,t=4.587,P=0.032; right (18.28±5.77) vs. (28.32±7.26) cm/s,t=4.683,P=0.030］and preoperative bilateral PI dropped ［left (1.12±0.45) vs. (0.86±0.19),t=4.712,P=0.029; right (1.31±0.46) vs. (0.84±0.31) cm/s,t=5.277,P=0.022］,BA PSV ［(48.75±16.57) vs. (69.17±11.86) cm/s,t=5.413,P=0.019］,preoperative EVD increased ［(27.73±7.34) vs. (27.18±8.53) cm/s,t=4.738,P=0.027) and preoperative PI decreased ［(1.13±0.55) vs. (0.90±0.28),t=4.721,P=0.030］; PSV of bilateral VA after surgery in school-age group was higher than that pre-operation ［left (48.16±18.47) vs. (53.77±24.73)cm/s,t=4.187,P=0.045; right ［(45.72±18.53) vs. (56.31±19.82) cm/s,t=3.872,P=0.036)］,BA PSV ［(48.50±11.44) vs. (58.17±18.86) cm/s,t=5.108,P=0.024］,preoperative EVD increased ［(18.63±9.91) vs. (23.19±10.63) cm/s,t=4.763,P=0.029］and preoperative PI declined ［(1.06±0.42) vs. (0.92±0.25),t=4.572,P=0.032］.Preoperative TVD detection rate of 27 cases was lower than that of MRI (χ2=5.511,P=0.019).At 1 month after Tator efficacy evaluation,there were improvements (n=19,70.4%) and non-improvements (n=8,29.6%).TVD ultrasonic monitoring parameters improved (n=22,81.5%) and stagnated (n=5,18.5%).There was consistency between TVD ultrasound and Tator efficacy evaluation ［χ2=0.911,P=0.340］.Conclusions MRI is a gold diagnostic standard for Chiari type Ⅰ malformation in children.However,TVD ultrasound has some accuracy and auxiliary effects.It can effectively depict the hemodynamic changes of posterior fossa artery and indirectly and non-invasively assess intracranial pressures.Thus it enables clinicians to make a timely diagnosis,offer a proper treatment and make an accurate assessment of outcomes.
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Memo
收稿日期:2023-9-15。
基金项目:上海市科学技术委员会上海市2020年度科技创新行动计划医学创新研究专项项目(20Y11905800)
通讯作者:张立,Email:zhangl1@shchildren.com.cn