成人可逆性胼胝体压部病变综合征临床分析

目的总结成人可逆性胼胝体压部病变综合征的临床特征,并探讨可逆性细胞毒性水肿形成机制。方法与结果纳入2017年1月至2019年5月南昌大学第一附属医院诊断与治疗的23例可逆性胼胝体压部病变综合征患者,临床主要表现为头痛头晕、发热、抽搐、意识障碍等,均存在血清白蛋白水平降低。头部MRI共同特点为可逆性胼胝体压部孤立性病灶,呈边界清楚的类圆形,T1WI呈低信号、T2WI呈高信号、DWI呈高信号、ADC呈低信号,且于发病第14天病灶逐渐或完全消失。结论可逆性胼胝体压部病变综合征病因及临床表现复杂,MRI表现为胼胝体压部可逆性类圆形病灶。影像学病灶通常早于临床症状消失。血清白蛋白水平降低可能是其细胞毒性水肿的危险因素。     

可逆性胼胝体压部病变综合征一例

目的探讨可逆性胼胝体压部病变综合征的临床特点、磁共振(MRI)影像学特征、治疗方法及预后。方法分析1例可逆性胼胝体压部病变综合征临床资料并结合相关资料对此例胼胝体压部局灶性孤立病变进行分析。结果患者胼胝体压部椭圆形长T1、长T2信号,Flair及DWI高信号影,经抗病毒及对症处理后发病第14天病灶消失。结论可逆性胼胝体压部病变综合征临床特征以MRI发现胼胝体压部孤立病灶为特点,病因、发病机制尚不明确,有一定自愈性。     

可逆性胼胝体压部病变综合征1例并文献复习

目的探讨可逆性胼胝体压部病变综合征患者的临床表现及影像学特点、诊断与治疗要点。方法分析我院诊断为可逆性胼胝体压部病变综合征1例患者的临床资料与影像学资料,并结合相关资料对此例胼胝体压部局灶性孤立病变进行分析。结果患者在前驱感染后出现间断视物不清、头晕,头MRI平扫及增强扫描示:胼胝体压部类圆形、边界清楚的稍长T_1、长T_2信号,弥散加权高信号,病变周围无明显水肿,无明显占位效应,增强扫描未见强化。患者治疗1个月后复查头MRI结果显示胼胝体压部病灶消失。结论可逆性胼胝体压部病变综合征是一种单病程脑炎,临床表现多种多样,其特异的影像学特点为胼胝体压部可逆的类圆形病灶,预后良好。     

可逆性胼胝体压部病变综合征临床分析

目的探讨可逆性胼胝体压部病变综合征(reversible splenial lesion syndrome,RESLES)的病因、临床表现、影像学特征、治疗及预后。方法回顾4例确诊为RESLES患者的临床资料,结合相关文献进行分析。结果 4例患者中男1例,女3例,呈急性病程,病因均为感染,临床表现各异,4例患者均行腰穿检查,除1例患者脑脊液(cerebrospinal fluid,CSF)白细胞12×10~6个/L,其余3例CSF相关检测均正常。头颅MRI表现为胼胝体压部(splenium of corpus callosum,SCC)的类圆形或条索状病灶,其中2例同时累及双侧脑白质,病灶呈T_1等或稍长信号、T_2稍长信号,DWI高信号,增强扫描后病灶无强化。临床表现多样且无特异性,针对原发病及对症治疗后头颅MRI病灶消失,预后较好。结论本组4例患者的临床症状及颅内病灶分布罕见,对进一步探讨RESLES的诊断及治疗提供相关的参考依据。     

可逆性胼胝体压部病变综合征四例分析

目的总结可逆性胼胝体压部病变综合征的临床表现和影像学特点,探讨其病因和发病机制。方法回顾分析4例可逆性胼胝体压部病变综合征患者的临床表现、影像学特点和病因。结果4例患者中2例(例1和例2)有颅脑创伤史,1例(例3)于饮酒后出现发作性双眼视物模糊,1例(例4)于感冒后出现头痛、晕厥,伴间断性视物模糊和慢性肾功能衰竭;MRI表现为胼胝体压部孤立性圆形或类圆形、边界清晰的病变,呈T_1WI等或稍低信号,T_2WI、扩散加权成像和FLAIR成像高信号,表观扩散系数低信号,无明显水肿和占位效应,1例(例2)除胼胝体压部病变外,磁敏感加权成像可见额叶出血。均经对因和对症支持治疗后症状完全缓解,病程8~15 d。复查MRI,3例胼胝体异常信号消失,1例(例2)病变信号范围和强度较前明显好转,均未遗留神经功能障碍。结论可逆性胼胝体压部病变综合征是一种临床影像学综合征,病因多样,癫及其相关疾病是最常见病因,颅脑创伤也可以引起可逆性胼胝体压部病变综合征,临床表现无特异性,经对因治疗后预后良好。     

西藏地区可逆性胼胝体压部病变综合征8例临床特点分析

目的探讨西藏地区可逆性胼胝体压部病变综合征患者的临床和影像学特点。方法回顾性分析8例可逆性胼胝体压部病变综合征患者的临床资料和影像学资料的特点。结果 8例患者的平均发病年龄为27.5岁,其中男6例,女2例;汉族4例,藏族4例;部分患者发病前存在上呼吸道感染、癫痫持续状态、入藏史以及阿托品治疗窦性心动过缓等诱因,以头晕、头痛、视物模糊或抽搐为主要临床表现。所有患者治疗前头颅MRI平扫均表现为胼胝体压部接近中央部位类圆形或条状边界清楚的等或稍长T_1、长T_2信号,弥散加权像(diffusion weighted image,DWI)高信号,表观扩散系数(apparent diffusion coefficient,ADC)值减低,病变周围无明显水肿及明显占位效应。予对症支持治疗后症状缓解,胼胝体压部异常信号消失或减低。结论可逆性胼胝体压部病变综合征一般临床症状轻微、临床表现多种多样,具有特异的影像学特征,预后良好,西藏独特的高原环境对该病的发病可能有一定的影响。     

产后可逆性胼胝体压部病变综合征(附1例报告及文献复习)

目的提高对可逆性胼胝体压部病变综合征的认识。方法报告1例产后以精神症状为主要临床表现的可逆性胼胝体压部病变综合征患者的临床表现及治疗情况,结合文献复习予以分析讨论。结果患者为青年女性,急性起病,主要表现为发热、精神行为异常。磁共振成像(MRI)检查提示胼胝体压部信号异常,经治疗后MRI检查结果正常,精神症状明显好转。结论产后发生可逆性胼胝体压部病变综合征临床少见,患者出现突发的神经系统症状时除外多发病和常见病,应考虑可逆性胼胝体压部病变综合征等少见病的可能。     

可逆性胼胝体压部病变综合征:二例报告并文献复习

目的报告2例临床罕见的可逆性胼胝体压部病变综合征病例,初步总结其诊断与治疗要点。方法与结果回顾分析2例患者之病因、临床表现、影像学特征和临床转归,并复习相关文献。例1主要表现为头晕,例2则以精神障碍、发热、肌强直、震颤、外周血白细胞计数增加、血清肌酸激酶水平升高为主。临床表现均无特异性且无胼胝体离断综合征之证据,发病初期主要表现为上呼吸道感染症状,呈急性病程,经糖皮质激素等药物治疗14和21 d后症状与体征明显好转。头部MRI共同特点为胼胝体压部孤立性病灶,呈类圆形,增强扫描病灶无强化;原发病缓解后胼胝体压部病灶完全消失。结论可逆性胼胝体压部病变综合征是一种具有多种病因、独特的临床影像综合征,除骤然停用抗癫药物和感染等因素外,恶性综合征亦可能是诱因之一。本组2例患者的诊断与治疗结果支持最近文献提出的其预后取决于导致该综合征的原发病而非胼胝体压部病变的观点。     

可逆性胼胝体压部病变综合征的影像表现

目的：探讨可逆性胼胝体压部病变综合征的临床及影像特点。方法对我院收治的9例可逆性胼胝体压部病变综合征患者的临床及影像资料进行回顾性分析。结果9例患者中婴幼儿3例,儿童1例,成人5例;2例婴幼儿及1例儿童有发热等感染病史伴神经症状,1例婴幼儿以缺血缺氧性脑病入院,成人以头痛、发热、昏迷、意识障碍等为主入院,其中伴有癫痫病史2例。头颅MRI显示胼胝体压部类圆形（婴幼儿累及全胼胝体压部）稍长T1稍长T2信号,FLAIR序列呈高或稍高信号,DWI呈高信号;其中3例增强扫描未见强化;头颅CT显示欠佳。经对症治疗后,症状缓解,MRI复查示胼胝体压部异常信号消失。结论可逆性胼胝体压部病变综合征的临床无特异性,而M RI表现有一定特征性,可为临床的诊疗及预后提供指导。     

以可逆性皮层盲为主要表现的可逆性后部白质脑病综合征三例临床和影像学分析

目的探讨主要表现为皮层盲的可逆性后部白质脑病综合征的临床与影像学表现、早期诊断和治疗。方法回顾性分析主要表现为可逆性皮层盲的慢性肾功能衰竭患者1例、先兆子痫和子痫患者各1例的临床、腰椎穿刺和影像学资料。结果3例患者均出现急性双侧完全性皮层盲,伴有高血压、头痛,1例伴有癫痫发作。腰椎穿刺示轻度颅内压增高。头颅MRI示双侧枕叶皮层或皮层下对称性异常信号,T2WI、FLAIR为高信号,DWI为低或等信号,ADC为高信号,提示血管源性水肿。3例患者均诊断为可逆性后部白质脑病综合征,经控制血压、脱水降颅压等治疗,皮层盲在2天内均完全好转,2周后复查头MRI病灶完全消失。结论可逆性皮层盲是可逆性后部白质脑病综合征最为特征性的症状之一,是由于双侧枕叶皮层或皮层下血管源性水肿所致。     

Spatial distribution of perfusion abnormality in acute MCA occlusion is associated with likelihood of later recanalization

The aim of this study is to investigate whether different spatial perfusion-deficit patterns, which indicate differing compensatory mechanisms, can be recognized and used to predict recanalization success of intravenous fibrinolytic therapy in acute stroke patients. Twenty-seven acute stroke data sets acquired within 6 hours from symptom onset including diffusion- (DWI) and perfusion-weighted magnetic resonance (MR) imaging (PWI) were analyzed and dichotomized regarding recanalization outcome using time-of-flight follow-up data sets. The DWI data sets were used for calculation of apparent diffusion coefficient (ADC) maps and subsequent infarct core segmentation. A patient-individual three-dimensional (3D) shell model was generated based on the segmentation and used for spatial analysis of the ADC as well as cerebral blood volume (CBV), cerebral blood flow, time to peak (TTP), and mean transit time (MTT) parameters derived from PWI. Skewness, kurtosis, area under the curve, and slope were calculated for each parameter curve and used for classification (recanalized/nonrecanalized) using a LogitBoost Alternating Decision Tree (LAD Tree). The LAD tree optimization revealed that only ADC skewness, CBV kurtosis, and MTT kurtosis are required for best possible prediction of recanalization success with a precision of 85%. Our results suggest that the propensity for macrovascular recanalization after intravenous fibrinolytic therapy depends not only on clot properties but also on distal microvascular bed perfusion. The 3D approach for characterization of perfusion parameters seems promising for further research.     

磁共振弥散张量成像在诊断中枢神经系统疾病的初步应用

目的 探讨磁共振(MRI)弥散张量成像(DTI)对中枢神经系统疾病的脑白质改变的诊断价值。方法 对10名健康志愿者和64例神经系统疾病患者(脑血管病31例，脱髓鞘疾病7例，炎症7例，肿瘤10例，变性病和先天性发育不良各2例，脑萎缩3例，其他2例)进行MRI检查，包括常规T1WI,T2WI,T2Flair,EWI以及ETI序列。并分别测量FA值。结果 本组59例(92．1％)可见病变区脑白质纤维束消融，FA值减低；12例(20．3％)可见边界清楚的侵蚀状改变，肿瘤病例均可见病变区域旁的白质纤维束推压和移位。结论 DTI可早期发现白质内的病变。与传统MRI相比，DTI能更好地显示脑白质纤维束的受损和移位。     

Noninvasive high-speed photoacoustic tomography of cerebral hemodynamics in awake-moving rats

We present a noninvasive method of photoacoustic tomography (PAT) for imaging cerebral hemodynamics in awake-moving rats. The wearable PAT (wPAT) system has a size of 15 mm in height and 33 mm in diameter, and a weight of ~8 g (excluding cabling). The wPAT achieved an imaging rate of 3.33 frames/s with a lateral resolution of 243 μm. Animal experiments were designed to show wPAT feasibility for imaging cerebral hemodynamics on awake-moving animals. Results showed that the cerebral oxy-hemoglobin and deoxy-hemoglobin changed significantly in response to hyperoxia; and, after the injection of pentylenetetrazol (PTZ), cerebral blood volume changed faster over time and larger in amplitude for rats in awake-moving state compared with rats under anesthesia. By providing a light-weight, high-resolution technology for in vivo monitoring of cerebral hemodynamics in awake-behaving animals, it will be possible to develop a comprehensive understanding on how activity alters hemodynamics in normal and diseased states.     

Diffusion tensor and dynamic susceptibility contrast MRI in glioblastoma

Objective

We prospectively investigated the correlation between diffusion tensor (DTI), dynamic susceptibility contrast (DSC) perfusion MRI metrics and Ki-67 labelling index in glioblastomas.

Methods

We studied seventeen patients who were operated on for glioblastoma. DTI and DSC MRI were performed within a week prior to surgical excision. Lesion/normal ratios were calculated for the apparent diffusion coefficient (ADC), fractional anisotropy (FA), relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF) and relative mean transit time (rMTT) ratio. In the excised tumour specimens Ki-67 antigen expression was evaluated by the MIB-1 immunostaining method.

Results

A significant correlation was observed between Ki-67 index and ADC ratio (r = −0.528, p = 0.029) and FA ratio (r = 0.589, p = 0.012). rCBV and rMTT presented a trend towards significant correlation with Ki-67 index (r = 0.628, p = 0.07 and r = 0.644, p = 0.06 respectively). There was a trend towards better survival for patients with gross total tumour excision and FA values lower than 0.48 (p = 0.1 and p = 0.09 respectively). No significant correlation was found between ADC ratio, rCBV, rCBF, rMTT and overall survival.

Conclusion

ADC ratio, FA ratio, rCBV and rMTT tumour/normal tissue ratios may represent indicators of glioma proliferation. FA values may hold promise for predicting survival in patients with glioblastoma.     

低血糖脑病的影像学特征

目的探讨低血糖脑病的影像学特征。方法回顾性分析7例低血糖脑病患者的核磁共振资料。结果低血糖脑损害有高度的区域选择性,可不对称。主要累及大脑皮层、海马、基底节和胼胝体压部,甚至皮层下白质;MRI表现为等或稍长T1、长T2信号,DWI呈高信号,伴ADC值降低,部分病变可逆;MRS示病变区乳酸峰无明显变化。结论低血糖脑损害有很强的区域选择性、可不对称;DWI对病变更敏感;大脑皮层和基底节区受累者预后不佳,侵犯胼胝体压部者预后好。     

Evolution of the diffusion-weighted signal and the apparent diffusion coefficient in the late phase after minor stroke

Introduction Diffusion-weighted imaging (DWI) is mainly used in acute stroke, and signal evolution in the acute phase has been studied extensively. However, patients with a minor stroke frequently present late. Recent studies suggest that DWI may be helpful at this stage, but only very few published data exist on the evolution of the DW-signal in the weeks and months after a stroke. We performed a follow-up study of DWI in the late stages after a minor stroke. Methods 28 patients who presented 48 hours to 14 days after a minor stroke underwent serial MRI at baseline, 4 weeks, 8 weeks, 12 weeks, 6 months and ≥9 months after their event. Signal intensity within the lesion was determined on T2-weighted images, DW-images and the Apparent Diffusion Coefficient (ADC) map at each time-point, and ratios were calculated with contralateral normal values (T2_r, DWI_r, ADC_r). Results T2_r was increased in all patients from the beginning, and showed no clear temporal evolution. ADC_r normalized within 8 weeks in 83% of patients, but still continued to increase for up to 6 months after the event. The DW-signal decreased over time, but was still elevated in 6 patients after ≥6 months. The evolution of ADC_r and DWI_r showed statistically highly significant inter-individual variation (p < 0.0001), which was not accounted for by age, sex, infarct size or infarct location. Conclusion The ADC and the DW-signal may continue to evolve for several months after a minor ischaemic stroke. Signal evolution is highly variable between individuals. Further studies are required to determine which factors influence the evolution of the ADC and the DW-signal. Received in revised form: 14 April 2006