Hydrocephalus Resulting from Late-Onset Aqueductal Membranous Occlusion: A Case Report and Review of the Literature.
- 作者列表："Terada Y","Yamamoto M","Motoie R","Matsui Y","Katsuki T","Mori N","Hashimoto K
BACKGROUND:Late-onset aqueductal membranous occlusion (LAMO) is 1 of the few causes of noncommunicating hydrocephalus. Here, we report a case of LAMO and review the associated literature. CASE DESCRIPTION:A 36-year-old man had complained of headache and loss of consciousness. Conventional magnetic resonance imaging (MRI) showed dilatation of the lateral and third ventricles but not of the fourth ventricle. Phase-contrast cine MRI confirmed cessation of cerebrospinal fluid (CSF) flow in the aqueduct of Sylvius. Sagittal and coronal turbo spin echo T2-weighted imaging with 3-dimensional driven equilibrium pulse (3D-DRIVE) revealed a membranous occlusion at the aqueduct of Sylvius and LAMO was diagnosed. The patient underwent endoscopic third ventriculostomy. Occlusion of the aqueduct of Sylvius by a thin membrane was observed and endoscopic aqueductoplasty was also conducted. The patient's symptoms were ameliorated shortly after the operation. Postoperative phase-contrast cine and 3D-DRIVE MRI showed restored CSF flow in the aqueduct of Sylvius and at the bottom of the third ventricle. CONCLUSIONS:We treated a case of LAMO, which usually presents with headache as an initial symptom. 3D-DRIVE MRI is useful for detecting membranous occlusions and for evaluating pre- and postoperative CSF flow. LAMO can be cured by endoscopic third ventriculostomy and/or endoscopic aqueductoplasty.
背景: 迟发性导水管膜性闭塞 (LAMO) 是非交通性脑积水的少数原因之一。在此，我们报告一例LAMO病例并复习相关文献。 病例描述: 一名36岁的男性主诉头痛和意识丧失。常规磁共振成像 (MRI) 显示侧脑室和第三脑室扩张，但第四脑室不扩张。相位对比电影MRI证实Sylvius导水管中的脑脊液 (CSF) 流动停止。采用三维驱动平衡脉冲 (3D-DRIVE) 的矢状和冠状涡轮自旋回波T2-weighted成像显示Sylvius导水管处的膜性闭塞，并诊断为LAMO。患者行内镜下第三脑室底造瘘术。观察到薄膜阻塞了Sylvius导水管，并进行了内窥镜导水管成形术。患者的症状在手术后不久得到改善。术后相位对比电影和3D-DRIVE MRI显示Sylvius导水管和第三脑室底部的CSF流恢复。 结论: 我们治疗了1例以头痛为首发症状的LAMO。3D-DRIVE MRI可用于检测膜性闭塞以及评估术前和术后CSF流量。可以通过内窥镜第三脑室造瘘术和/或内窥镜导水管成形术治愈LAMO。
METHODS:OBJECTIVES:The aim was to evaluate the image quality and sensitivity to artifacts of compressed sensing (CS) acceleration technique, applied to 3D or breath-hold sequences in different clinical applications from brain to knee. METHODS:CS with an acceleration from 30 to 60% and conventional MRI sequences were performed in 10 different applications in 107 patients, leading to 120 comparisons. Readers were blinded to the technique for quantitative (contrast-to-noise ratio or functional measurements for cardiac cine) and qualitative (image quality, artifacts, diagnostic findings, and preference) image analyses. RESULTS:No statistically significant difference in image quality or artifacts was found for each sequence except for the cardiac cine CS for one of both readers and for the wrist 3D proton density (PD)-weighted CS sequence which showed less motion artifacts due to the reduced acquisition time. The contrast-to-noise ratio was lower for the elbow CS sequence but not statistically different in all other applications. Diagnostic findings were similar between conventional and CS sequence for all the comparisons except for four cases where motion artifacts corrupted either the conventional or the CS sequence. CONCLUSIONS:The evaluated CS sequences are ready to be used in clinical daily practice except for the elbow application which requires a lower acceleration. The CS factor should be tuned for each organ and sequence to obtain good image quality. It leads to 30% to 60% acceleration in the applications evaluated in this study which has a significant impact on clinical workflow. KEY POINTS:• Clinical implementation of compressed sensing (CS) reduced scan times of at least 30% with only minor penalty in image quality and no change in diagnostic findings. • The CS acceleration factor has to be tuned separately for each organ and sequence to guarantee similar image quality than conventional acquisition. • At least 30% and up to 60% acceleration is feasible in specific sequences in clinical routine.
METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.
METHODS:OBJECTIVE:The primary purpose of this study was to evaluate the effectiveness of a three-dimensional (3D) software tool (smart planes) for displaying fetal brain planes, and the secondary purpose was to evaluate its accuracy in performing automatic measurements. MATERIAL AND METHODS:This prospective study included singleton fetuses with a gestational age (GA) greater than 18 weeks. Transabdominal two-dimensional ultrasound (2DUS) and 3D smart planes images were respectively used to obtain the basic planes of the fetal brain, with five parameters measured. The images, by either two-dimensional (2D) manual or 3D automatic operation, were reviewed by two experienced sonographers. The agreements between two measurements were analyzed. RESULTS:A total of 226 cases were included. The rates of successful detection by automatic display were as high as 80%. There was substantial agreement between the measurements of the biparietal diameter, head circumference and transcerebellar diameter, but poor agreement between the measurements of cisterna magna and lateral ventricle width. CONCLUSIONS:Smart Planes might be valuable for the rapid evaluation of fetal brain, because it simplifies the evaluation process. However, the technology requires improvement. In addition, this technology cannot replace the conventional manual US scans; it can only be used as an additional approach.