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,2024,(02):140-146.[doi:10.3760/cma.j.cn101785-202212039-008]
经颅脑血管多普勒超声在小儿Ⅰ型Chiari畸形诊断及疗效评估中的应用研究
- Title:
- 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
- 摘要:
- 目的 研究经颅脑血管多普勒(transcraniocerebral vessel Doppler,TVD)超声技术在I型Chiari畸形患儿诊断以及术后疗效评估中的应用价值。方法 回顾性分析2018年3月至2021年12月上海交通大学医学院附属儿童医院神经外科收治的27例Ⅰ型Chiari畸形患儿临床资料。按年龄分为两组,学龄前组(1~6岁)15 例,学龄后组(7~16岁)12例。两组患儿均于术前、术后24 h及术后1个月行TVD超声探测,以后颅窝内双侧大脑后动脉(posterior cerebral artery,PCA)、椎动脉(vertebral artery,VA)及基底动脉(basilar artery,BA)为靶血管,收集相应靶血管的收缩期峰流速(peak systolic velocity,PSV)、舒张末期流速(end-diastolic velocity,EVD)及搏动指数(pulsative index,PI)等监测指标。分别比较两组患儿手术前后后颅窝动脉血流动力学差异;比较27例患儿术前TVD与MRI诊断结果的一致性,以及术后TVD检查结果与Tator疗效评估结果的一致性。结果 学龄前组患儿手术后双侧PCA的PSV较术前增加［左侧:(44.25±13.06)cm/s比(66.76±14.45)cm/s,t=5.148,P=0.023;右侧:(45.12±13.41)cm/s比(65.33±10.12)cm/s,t=5.389,P=0.021］、PI较术前降低［左侧:(1.18±0.42)比(0.91±0.18),t=4.545,P=0.033;右侧:(1.24±0.48)比(0.92±0.13),t=4.776,P=0.028］;双侧VA的PSV［左侧:(43.50±11.99)cm/s比(70.94±7.56)cm/s,t=7.042,P=0.008;右侧:(44.56±8.45)cm/s比(68.82±9.02) cm/s,t=6.833,P=0.009］、EVD［左侧:(19.01±9.22)cm/s比(27.18±8.53)cm/s,t=4.587,P=0.032;右侧:(18.28±5.77)cm/s比(28.32±7.26) cm/s,t=4.683,P=0.030］较术前增加,双侧PI较术前降低［左侧:(1.12±0.45)比(0.86±0.19),t=4.712,P=0.029;右侧:(1.31±0.46)比(0.84±0.31)cm/s,t=5.277,P=0.022］;BA的PSV［(48.75±16.57)cm/s比(69.17±11.86)cm/s,t=5.413,P=0.019］、EVD［(27.73±7.34)cm/s比(27.18±8.53)cm/s,t=4.738,P=0.027］较术前增加、PI较术前降低［(1.13±0.55)比(0.90±0.28),t=4.721,P=0.030］。学龄后组患儿手术后双侧VA的PSV较术前增加［左侧:(48.16±18.47)cm/s比(53.77±24.73)cm/s,t=4.187,P=0.045;右侧:(45.72±18.53)cm/s比(56.31±19.82)cm/s,t=3.872,P=0.036］,BA的PSV［(48.50±11.44)cm/s比(58.17±18.86)cm/s,t=5.108,P=0.024］、EVD［(18.63±9.91)cm/s比(23.19±10.63)cm/s,t=4.763,P=0.029］较术前增加、 PI较术前降低［(1.06±0.42)比(0.92±0.25),t=4.572,P=0.032］。27例术前TVD超声检出率低于MRI(χ2=5.511,P=0.019);术后1个月Tator疗效评估症状改善19例(19/27,70.4%)、无改善8例(8/27,29.6%);TVD超声监测指标改善22例(22/27,81.5%)、无改善5例(5/27,18.5%),TVD超声检查与Tator疗效评估结果具有较高的一致性(χ2=0.911,P=0.340)。结论 小儿Ⅰ型Chiari畸形的诊断应以MRI检查结果为金标准,但本研究中TVD超声具有一定的准确性和辅助性,可有效显示Ⅰ型Chiari畸形患儿后颅窝动脉的血流动力学变化,间接、无创地评估颅内压,不仅可以帮助医师及时诊断、给予治疗,同时TVD超声对于Ⅰ型Chiari畸形术后疗效评估也有良好的应用价值。
- 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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备注/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