肺癌脑转移的临床表现和其MRI诊断价值

目的 :观察肺癌脑转移的临床表现及评估其MRI的诊断价值。方法 :观察 1995年 6月～ 2 0 0 2年 2月收治肺癌脑转移患者共 2 5例的临床表现和总结分析其MRI脑扫描的资料。结果 :肺癌脑转移的患者多以脑卒中为首发症状 ,同时可见MRI对肺癌脑转移的影像诊断具有重要价值。结论 :肺癌脑转移的患者多以脑卒中为首发症状 ,因此临床上易误诊为急性脑血管病 ;而MRI对其诊断、治疗方法的选择及预后的评估有重要价值 ,可助早期诊断与制定合理的治疗方案。     

基于脑网络连接的实时功能磁共振成像神经反馈技术研究进展EI北大核心CSCD

实时功能磁共振成像(rt-f MRI)技术的发展为基于脑血液动力学水平的神经反馈技术提供了基础,并为认知神经科学的研究带来新的机遇与挑战。随着大脑高级神经机制研究的深入,基于rt-f MRI的神经反馈技术正从早期单一脑区的调节向更符合人脑功能活动的脑网络连接的调节发展,并有望成为rt-f MRI神经反馈的发展趋势。文中首先对基于rt-f MRI的神经反馈技术的基本原理和发展情况进行了介绍,然后重点讨论了基于脑网络连接的rt-f MRI神经反馈技术的研究现状,包括研究思路、实验方法和研究结论等,最后对该领域发展存在的问题进行了讨论和展望。     

磁共振联合磁敏感加权成像评估急性脑梗死的临床价值

目的:探讨磁共振成像（MRI）联合磁敏感加权成像（SWI）评估急性脑梗死预后的临床价值。方法:采用随机数字表法将100例急性脑梗死患者分为观察组（n=50）和对照组（n=50）。对照组行MRI检查,观察组行MRI联合SWI检查。比较两组患者的疾病检出率、脑微出血检出情况。结果:观察组疾病检出率显著高于对照组（96.0% vs 78.0%, P<0.05）;观察组脑微出血检出率显著高于对照组（64.0% vs 12.0%, P<0.05）;观察组的出血检出面积为（972.83±110.54） mm2,显著高于对照组的（532.71±110.53） mm2（P<0.05）。观察组脑梗死面积诊断评分显著小于对照组（P<0.05）。入院15 d后,观察组神经功能缺损程度评分明显低于对照组（P<0.05）;观察组神经功能缺损程度稳定率及好转率显著高于对照组（P<0.05）。结论:MRI联合SWI检查对急性脑梗死疾病的检出率明显较高,能够准确预测脑微出血,有助于制定正确的临床治疗方案,改善急性脑梗死患者的预后。     

脑后部可逆性脑病综合征的CT磁共振成像影像特征分析

目的探讨脑后部可逆性脑病综合征的CT及磁共振成像影像特征。方法指定同一名具有专业知识及丰富经验的医学影像检查医师完成20例脑后部可逆性脑病综合征患者CT及MRI检查工作，记录两种影像检查结果，给予统计学分析后得出结论。结果CT及MRI检查脑后部可逆性脑病综合征患者呈现出不同的病变区域及复查结果，经MRI扫描所得病灶位置、形态及范围均显著优于CT扫描。结论应用磁共振更有利于准确判断脑后部可逆性脑病综合征疾病，利用DWI及ADC检查可准确预测患者预后效果，可为临床医生提供可靠的诊断及治疗依据，保障患者疗效及预后。     

老化与帕金森病基底核的磁共振成像研究进展

随着神经成像技术的不断进步，人们对正常老化和帕金森病(PD)的脑成像改变有了进一步认识。由于磁共振成像(MRI)技术在神经成像方面有其独特的用途和优势，尤其是功能磁共振成像(functional MRI，fMRI)具有很高的空间和时间分辨力，能将解剖和功能图像融为一体，因此在老化与PD基底核研究中MRI的应用越来越多。为进一步开展老化与PD基底核的MRI研究，现将有关文献综述如下：     

脑电地形图的临床应用

脑电地形图(Brain Atlas,BA)是80年代问世的一项具有国际先进水平的临床医学、电子工程学和计算机学相结合的新兴科学。是继CT和MRI(磁共振成像)技术之后,又一成像技术的重大发展,是基于电子计算机分析脑生物电的一种新的诊断技术。它既可进行功能诊断,又可协助进     

无创性癫痫病灶精准定位的研究进展

手术治疗可以去除产生癫痫发作所必需的脑组织,已成为治疗顽固性、耐药性癫痫的主要手段。术前对需要切除的癫痫病灶区和需要保留的脑功能区进行精准定位是手术成功的关键。由于脑组织结构和功能的复杂性,目前还没有单一的、特异性的检查和诊断方法可以对致痫区进行精准的鉴别和定位,因此需要使用多种无创性的方法进行综合评估和定位,包括详细的临床病史、长程视频脑电监测(LT-VEEG)、磁共振成像(MRI)和神经心理学检查等。对于没有或仅有微小MRI改变、电生理特点不明确的耐药性癫痫,术前需使用氟脱氧葡萄糖标记的正电子发射断层扫描(FDG-PET)、脑磁图和发作期单光子发射计算机断层扫描(ISPE-CT)等技术对病灶精准定位。另外,FDG-PET与三维MRI融合技术可以更好地检测局灶性皮质发育不良。这些方法对致痫区的精准定位具有互补作用,对于微小病灶的评估和确认至关重要。     

前连合及内囊断层解剖与MRI图像初步对照研究

目的探讨内囊与其毗邻结构的断层形态学特征、内囊前肢与前连合之间的空间定位,及其与MRI断层影像的对应关系,为中枢神经系统研究、脑深部刺激治疗精神神经方面的疾病提供可靠的断层解剖学依据。方法利用MRI技术对100例健康成年女性的脑部进行扫描,选取经福尔马林固定的成年女性尸体大脑标本12例,然后经火棉胶包埋技术制成厚为500μm的薄层连续切片,并与MRI图像进行对照研究。结果断层切片可详细阐明内囊及其毗邻结构在不同方位上形态特征,MRI图像不能清晰地辨认内囊与其毗邻结构边界,水平位、冠状位上可观察到前连合连接双侧内囊前肢。结论脑断层解剖切片较MRI图像更能清晰地显示内囊及其毗邻结构的位置关系,为脑深部电刺激内囊治疗某些精神神经疾病提供断层解剖学应用价值。     

老年患者术后认知功能障碍的多模态MRI研究进展

老年人术后认知功能障碍(postoperative cognitive dysfunction,POCD)严重地影响老年人的健康和生活,造成家庭和社会的严重负担,正日益受到人们的重视。近年来,脑MRI在检测老年人POCD中的脑结构、功能及代谢变化以及探讨其发病的神经机制方面的研究日益增多。结合多模态磁共振成像技术,能同时从细微结构、功能及代谢层面对疾病进行研究,为POCD的发病机制提供新的见解,为早期诊断治疗提供新的思路。     

脑电图及头颅MRI在早期小儿脑性瘫痪中的作用

目的探讨脑电图及头颅MRI在小儿脑性瘫痪早期诊断及治疗中的应用价值.方法对60例早期诊断脑性瘫痪患儿行脑电图及头颅MRI检查,并在康复治疗症状好转后3～12月对患儿进行脑电图随访.结果脑电图异常率85%,主要表现为双侧不对称,广泛性慢波节律改变及痫样波发作.头颅MRI异常率98.3%,主要表现为脑萎缩、外周性脑积水、脑白质发育不良等改变.脑电图及MRI异常符合率为85%.经过综合性康复治疗,脑电图随访90.2%恢复正常,脑电图的改善与临床症状的改善之间存在显著性关联(p＜0.05).结论脑电图及头颅MRI的结合应用可为脑性瘫痪的早期诊断提供较好诊断依据,并有助于判断预后及指导康复治疗.     

长时程亚低温治疗对重度颅脑损伤患者脑损伤标志物及氧化应激指标的影响

目的:探讨长时程亚低温治疗对重度颅脑损伤患者脑损伤标志物及氧化应激指标的影响。方法:62例重度颅脑损伤患者根据治疗方式不同将其分为短时程（2 d）亚低温治疗组（对照组, n=30）和长时程（5 d）亚低温治疗组（观察组, n=32）,治疗后第6天时比较两组患者凝血功能指标、脑损伤标志物、氧化应激指标、并发症发生情况,随访期间观察患者昏迷时间及30 d致残率与30 d病死率。结果:治疗后第6天时,观察组血清凝血酶原时间、凝血酶时间、活化部分凝血酶原时间水平高于对照组（P<0.05）,观察组血清D-二聚体水平低于对照组（P<0.05）。治疗后第6天时,观察组患者血清髓鞘碱蛋白、神经元特异性烯醇化酶、S100蛋白、丙二醛、超氧化物歧化酶水平均低于对照组（P<0.05）。两组患者颅内血肿、胃肠动力减弱、泌尿系感染、肺部感染、应激性溃疡发生率无统计学差异（P>0.05）。观察组患者昏迷时间较对照组缩短（P<0.05）;观察组患者30 d致残率及30 d病死率均低于对照组,但两组间差异无统计学意义（P>0.05）。结论:长时程亚低温治疗有利于改善重度颅脑损伤患者凝血功能,降低脑损伤标志物水平及氧化应激损伤,缩短昏迷时间,且不增加并发症发生风险。     

The anatomy of concussion and chronic traumatic encephalopathy: A comprehensive review

Concussion is defined as a complex pathophysiological process that affects the brain as a result of traumatic biomechanical forces. Repeated unrecovered concussions can result in chronic brain injury syndrome which is referred to in the literature today as chronic traumatic encephalopathy.” There is an exponential increase in public and political interest in this condition in the recent times resulting in a significant investment in research to improve the current understanding of the disease, ways to decrease its incidence and determine its prognosis. Broadly the research involves three main disciplines of medicine including neuropathology, neuroradiology and biological markers. Although progress has been made, to date there is no definite pathological, radiological or neurobiological marker which has shown consistent promise to make the diagnosis and prognosticate the disease. Possible reasons are multiple such as inconsistencies in the methods studies have used, different time periods in which the tests were conducted, the small numbers of subjects included in the studies, and inconsistencies in the definitions of concussion or mild traumatic brain injury. Herein, we present a comprehensive review of the current literature on this topic. Positron emission tomography scans with radioactive ligands such as T807 as an imaging biomarker, and neurofilament light and ubiquitin C‐terminal hydrolase as serum biomarkers have shown some promise lately in diagnosing concussion and chronic traumatic encephalopathy and also determining their prognosis. Clin. Anat. 32:310–318, 2019. © 2018 Wiley Periodicals, Inc.     

颅脑损伤患者血浆NPY及CGRP检测的临床意义

目的探讨血浆神经肽Y（NPY）和降钙素基因相关肽（CGRP）水平在不同程度颅脑外伤患者中的临床意义。方法采用放射免疫方法（RIA）对91例依据GCS评分法分为轻度、中度和重度的颅脑损伤患者及35例正常对照组的NPY、CGRP和ET-1水平进行检测。结果轻、中、重三组颅脑损伤患者血浆NPY水平分别为（119.6±20.3）ng/L、（127.8±25.5）ng/L和（146.2±30.5）ng/L,显著高于正常对照组（65.2±13.2）ng/L,差异有统计学意义（P〈0.01）。轻、中度患者血浆CGRP含量分别为（54.3±5.6）ng/L、（57.5±7.4）ng/L,显著高于正常对照组（41.8±6.8）ng/L,差异有统计学意义（P〈0.01）;而重度患者组的CGRP水平（44.6±5.3）ng/L与对照组（41.8±6.8）ng/L间差异无统计学意义（P〉0.05）。结论血浆NPY及CGRP水平与不同程度颅脑损伤患者的病情密切相关,并对患者预后的判定具有一定的临床参考价值。     

关于血管内亚低温治疗重型颅脑创伤临床研究

目的 对血管内降温治疗急性重型颅脑创伤患者的安全性及有效性进行前瞻性的研究.方法 共30例患者,均于伤后12 h内行血管内降温治疗,体内温度控制在33℃～35℃之间,持续4～7 d平均(21.5±13.7)h.患者均于伤后6个月时根据GOS评估法判定疗效.结果 经6个月随访,良好11例,中残5例,重残6例,植物生存6例,死亡2例、本组患者没有出现与血管内降温系统相关的严重并发症.结论 血管内降温具有降温速度快、目标温度维持稳定、波动性小以及复温速度容易控制等优点.对于重型颅脑损伤的患者是一种安全、有效的治疗方法.     

Perfusion deficits in patients with mild traumatic brain injury characterized by dynamic susceptibility contrast MRI

Perfusion deficits in patients with mild traumatic brain injury (TBI) from a military population were characterized by dynamic susceptibility contrast perfusion imaging. Relative cerebral blood flow (rCBF) was calculated by a model‐independent deconvolution approach from the tracer concentration curves following a bolus injection of gadolinium diethylenetriaminepentaacetate (Gd‐DTPA) using both manually and automatically selected arterial input functions (AIFs). Linear regression analysis of the mean values of rCBF from selected regions of interest showed a very good agreement between the two approaches, with a regression coefficient of R = 0.88 and a slope of 0.88. The Bland–Altman plot also illustrated the good agreement between the two approaches, with a mean difference of 0.6 ± 12.4 mL/100 g/min. Voxelwise analysis of rCBF maps from both approaches demonstrated multiple clusters of decreased perfusion (p < 0.01) in the cerebellum, cuneus, cingulate and temporal gyrus in the group with mild TBI relative to the controls. MRI perfusion deficits in the cerebellum and anterior cingulate also correlated (p < 0.01) with neurocognitive results, including the mean reaction time in the Automated Neuropsychological Assessment Metrics and commission error and detection T‐scores in the Continuous Performance Test, as well as neurobehavioral scores in the Post‐traumatic Stress Disorder Checklist–Civilian Version. In conclusion, rCBF calculated using AIFs selected from an automated approach demonstrated a good agreement with the corresponding results using manually selected AIFs. Group analysis of patients with mild TBI from a military population demonstrated scattered perfusion deficits, which showed significant correlations with measures of verbal memory, speed of reaction time and self‐report of stress symptoms. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.     

面部碰撞对行人创伤性脑损伤影响的生物力学研究

为预测和评判行人面部碰撞对创伤性脑损伤机理及生物力学响应,结合计算机断层扫描（CT）和磁共振（MRI）医学成像技术,建立符合中国人体特征的50百分位头颈部几何模型和有限元模型。有限元模型中颅骨与脑之间的相对运动采用切向滑动边界条件,摩擦系数定义为0.2,模拟鼻骨斜碰撞、鼻外侧软骨正面碰撞、牙齿正面碰撞、下颌骨碰撞和颧骨外侧斜碰撞等5种典型面部碰撞交通事故场景,探讨应力波在颅骨和脑内传播路径,得到颅内压力、von Mises等效应力和剪切应力等生物力学响应参数分布规律。结果显示,鼻骨斜碰撞颅内压力峰值为236.7 kPa,von Mises应力为25.97 kPa,超过了大脑耐受阈值;颧骨外侧斜碰撞最大横向剪切应力分别为14.56 kPa和-18.07 kPa,促使脑组织产生了较大的剪切变形,存在严重脑损伤风险。结论表明：面部碰撞的位置和方向是导致面部骨折严重程度的关键因素,面骨骨折的位置决定创伤性脑损伤的部位,面骨骨折都带有一定程度的创伤性脑损伤;头部受到冲击时,面部结构能够吸收大量的冲击能量来保护大脑,降低颅脑损伤的风险。     

Dynamic Changes in Neural Circuit Topology Following Mild Mechanical Injury In Vitro

Despite its enormous incidence, mild traumatic brain injury is not well understood. One aspect that needs more definition is how the mechanical energy during injury affects neural circuit function. Recent developments in cellular imaging probes provide an opportunity to assess the dynamic state of neural networks with single-cell resolution. In this article, we developed imaging methods to assess the state of dissociated cortical networks exposed to mild injury. We estimated the imaging conditions needed to achieve accurate measures of network properties, and applied these methodologies to evaluate if mild mechanical injury to cortical neurons produces graded changes to either spontaneous network activity or altered network topology. We found that modest injury produced a transient increase in calcium activity that dissipated within 1 h after injury. Alternatively, moderate mechanical injury produced immediate disruption in network synchrony, loss in excitatory tone, and increased modular topology. A calcium-activated neutral protease (calpain) was a key intermediary in these changes; blocking calpain activation restored the network nearly completely to its pre-injury state. Together, these findings show a more complex change in neural circuit behavior than previously reported for mild mechanical injury, and highlight at least one important early mechanism responsible for these changes.     

Alpha-2 adrenergic challenge with guanfacine one month after mild traumatic brain injury: Altered working memory and BOLD response

Alterations in working memory (WM) are common after traumatic brain injury (TBI). Frontal catecholaminergic systems, including the alpha-2 adrenergic system, modulate WM function and may be affected in TBI. We hypothesized that administration of an alpha-2 adrenergic agonist might improve WM after mild TBI (MTBI). Thirteen individuals with MTBI 1 month after injury and 14 healthy controls (HC) were challenged with guanfacine and placebo prior to administration of a verbal WM functional MRI task. Guanfacine was associated with improved WM performance in the MTBI but not the HC group. On guanfacine the MTBI group showed increased activation within a WM task-specific region of interest. Findings are consistent with the hypothesis that alterations in WM after MTBI may be improved with the alpha-2 agonist guanfacine.     

A model of posttraumatic epilepsy induced by lateral fluid-percussion brain injury in rats

Although traumatic brain injury is a major cause of symptomatic epilepsy, the mechanism by which it leads to recurrent seizures is unknown. An animal model of posttraumatic epilepsy that reliably reproduces the clinical sequelae of human traumatic brain injury is essential to identify the molecular and cellular substrates of posttraumatic epileptogenesis, and perform preclinical screening of new antiepileptogenic compounds. We studied the electrophysiologic, behavioral, and structural features of posttraumatic epilepsy induced by severe, non-penetrating lateral fluid-percussion brain injury in rats. Data from two independent experiments indicated that 43% to 50% of injured animals developed epilepsy, with a latency period between 7 weeks to 1 year. Mean seizure frequency was 0.3+/-0.2 seizures per day and mean seizure duration was 113+/-46 s. Behavioral seizure severity increased over time in the majority of animals. Secondarily-generalized seizures comprised an average of 66+/-37% of all seizures. Mossy fiber sprouting was increased in the ipsilateral hippocampus of animals with posttraumatic epilepsy compared with those subjected to traumatic brain injury without epilepsy. Stereologic cell counts indicated a loss of dentate hilar neurons ipsilaterally following traumatic brain injury. Our data suggest that posttraumatic epilepsy occurs with a frequency of 40% to 50% after severe non-penetrating fluid-percussion brain injury in rats, and that the lateral fluid percussion model can serve as a clinically-relevant tool for pathophysiologic and preclinical studies.     

非人灵长类动物超高场磁共振脑成像技术进展

非人类灵长类动物是神经科学研究中的重要动物模型,可以兼容多种侵入式和非侵入式神经信号探测和神经活动调控方法。结合侵入式和非侵入式方法的非人灵长类动物的神经科学研究,有助于将大量基于动物模型的基础研究成果进行临床转化。其中磁共振脑成像技术是目前最主要的非侵入式大脑神经信号探测手段。非人灵长类动物磁共振脑成像研究,对于深入理解磁共振脑成像生理机制、基于磁共振技术的定量生理探测技术研发、神经科学基础研究、心理学以及临床病理机制研究等都具有重要作用。但是非人灵长类动物磁共振脑成像面临着诸多技术挑战,包括:缺少适配的商用磁共振成像系统以及配套的成像硬件、需要更高的成像分辨率,以及对多样化动物实验需求的兼容性等。超高场(场强>3 T)磁共振具有高信噪比、高脑血氧水平依赖(BOLD)信号检测灵敏度和亚毫米级高分辨率成像能力等优势,有潜力应用于非人灵长类动物超高分辨率脑成像研究。综述目前非人灵长类动物超高场磁共振脑成像应用、面临的技术挑战、以及当前的技术解决方案等,归纳各方法的各自优势与局限性,同时对发展趋势进行展望。