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Brain and Nerve No to Shinkei Volume 30, Issue 9 （September 1978）

Brain and Nerve 脳と神経 30巻9号（1978年9月発行）

Japanese English

原著

Metrizamide CT Cisternographyによる脳脊髄液循環動態の検討 EVALUATION OF CSF DYNAMICS WITH METRIZAMIDE CT CISTERNOGRAPHY 平塚秀雄 ¹ , 露無松平 ¹ , 岡田洽大 ¹ , 藤原敬吾 ¹ , 山口武兼 ¹ , 大家一夫 ¹ , 高里良男 ¹ , 稲葉穰 ¹ Hideo Hiratsuka ¹ , Matsutaira Tsuyumu ¹ , Kodai Okada ¹ , Keigo Fujiwara ¹ , Takekane Yamaguchi ¹ , Kazuo Oie ¹ , Yoshio Takasato ¹ , Yutaka Inaba ¹ ¹東京医科歯科大学医学部脳神経外科 ¹Department of Neurosurgery, School of Medicine, Tokyo Medical and Dental University pp.1015-1023

発行日 1978年9月1日 Published Date 1978/9/1

DOI https://doi.org/10.11477/mf.1406204308

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Abstract 文献概要
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I．はじめに

　1974年　Greitz　＆　Hindmarsh^4）によつて，はじめて報告された水溶性造影剤Metrizamide^14）によるComputed　Tomography （CT） Cisternographyは，従来のCTスキャンではみられなかつた脳脊髄液循環動態（CSF dy—namics）の検索を可能にした。すなわち造影剤による"CSF enhancement"を行ない，脳室，脳槽等の詳細な形態および　CSF dynamicsを経時的に描出するものである。その後本法によるCSF dynamicsに関する報告は，Drayerら^3）によるもののみである。われわれは，1977年4月以後本法を施行し，その診断的価値についてはすでに報告したが^10），さらに症例を追加し，CSF dy—namics,CSFの吸収について検討し，興味ある知見をえたので報告する。

We have studied alterations in the cerebrospinal fluid circulation in 52 patients with several neuro-surgical diseases by CT cisternography using a watersoluble contrast medium, metrizamide. Six to 10ml of metrizamide solution with a concentration of 170mg I/ml was injected routinely through lumbar intrathecal route. Computed tomography with EMI scanner (CT 1010) was taken 1, 3, 6, 24, 48, and sometimes 72 hours after the injection. Results of cisternogram were classified into 3 groups and 5 subgroups: Group I; persistent ventricular filling (ventricular stasis) (21%) A) no convexity flow (8%), B) partial convexity flow (13%), Group II; transient ventricular filling (12%), Group III ; no ventricular filling (67%) A) delayed convexity flow (13%), B) normal convexity flow (54%).

Out of 11 patients who showed ventricular reflux of metrizamide, periventricular low density areawas observed in 5 cases. Time course of the density which is represented as Hounsfield Unit was analy-sed. In some cases, the density at periventricular low density zone increased with statistical signifi-cance at 6 and 24 hours after metrizamide injection compared with plain CT. This strongly suggests the transependymal resorption of metrizamide into periventricular white matter. In the case who had had ventriculoperitoneal shunt for normal pressure hydrocephalus, periventricular low density area was not observed and the density was not increased in this area, although ventricular reflux was present. In cases who showed transient ventricular reflux had no periventricular low density area and showed no or minimal increase in density. The presence of periventricular low density area with increase of the density after ventricular reflux of metriza-mide would be an important criteria for CSF shunt-ing operation in normal pressure hydrocephalus or communicating hydrocephalus.

In cases with normal or delayed convexity flow, diffuse increase in density in the brain substance contiguous with subarachnoid spaces at 24 or 48 hours was observed, which suggests CSF resorption from cortical surface.

Serial metrizamide CT cisternography shows normal and abnormal CSF circulation with accurate morphologic definition. The mathematical analysis of the density at the region of interest gives ob-jective and quantitative data for the visual im-pression of images regarding CSF dynamics.