Characteristics of spongiform leukoencephalopathy induced by heroin: MRI detection

Objective To elucidate the imaging characteristics of spongiform leukoencephalopathy induc ed by heroin and the diagnostic value of MRI examination.Methods Eleven cases of heroin addiction were examined by MRI.The seque nces included T(1)- weighted imaging (T(1)WI), T(2)- weighted imaging (T(2)WI) and fast fluid- attenuated inversion recovery pulse sequence (Flair).Results Bilateral symmetrical lesions were located in the white matter of the cerebrum and cerebellum, the internal capsule in all cases, and the callosum in 6 cases. Elliptical lesions in the mesencephalon were found in two cases.These lesions were shown as hypointense signals on T(1)WI and hyperintense signals on T(2)WI and Flair’s imaging.Cerebellar white matter suffered more severely, but the de ntate nuclei were not invaded.Conclusion Heroin- induced spongiform leukoencephalopathy has characteristic patterns in MR I, which are very specific to this form of the disease.     

Role of MR imaging in the diagnosis of intracranial germinoma

Objective: To investigate the role of MRI in the diagnosis of intracranial germinoma. Methods: MRI features of 19 cases of intracranial germinoma confirmed by operations and pathological findings were analyzed retrospectively. Results: Germinomas were found in the seUar region in 10 patients (including 5 males and 5 females), in the pineal region in 6 and in the thalamus and basal ganglia in 3, the 9 patients in the latter 2 groups all being males. The characteristic MRI findings of intracranial germinomas were as follows : ( 1 ) Lesions were isointense or slightly hypointense on TlWI while isointense or slightly hyperintense on T2WI. The germinomas in the seUar region and pineal region showed no edema, but lesions in the thalamus basal ganglia showed mild to moderate edema and space-occupying effects. (2) Homogeneous or inhomogeneous Gd-DTPA enhancement were seen in most of the tumors. Conclusion:Muhiaxial imaging and Gd-DTPA enhancement in MRI are helpful in the diagnosis and differentiation of intracranial germinomas on the basis of the patients gender, the location of the tumor and its imaging characteristics.     

Clinical and imaging findings in patients with severe acute respiratory syndrome

Objective To investigate the clinical and imaging characteristics of severe acute respiratory syndrome(SARS), and to study their relationship.Methods Forty-six SARS confirmed patients were admitted to our hospital from February to April,2003. X-ray examination documents were available in all cases and chest CT scanning was acquired in 6 cases, which were analyzed retrospectively, accompanied by their clinical features.Results Fever was found in 97. 8% of the patients. Clinical symptoms were mild, but X-ray and CT findings were distinct. CT scanning demonstrated ground glass like lesions and large patchy exudation and consolidation at the early stage in 6 cases. Different findings on radiography and CT were related to the different phases of the disease. After treatment, most lesions were absorbed completely, but slowly in patients with multi-lobe consolidation and/or extensive interstitial infiltration.Conclusion Special clinical and imaging findings could be found in SARS cases. The prognosis of SARS patients is related to the degree of lesions detected by radiography and CT.     

Megalencephalic Leukoencephalopathy with Subcortical Cysts-a New Child Leukoencephalopathy

Here we review a new variety of leukoencephalopathy with infantile megalencephaly and discrepant clinical course (MLC, MIM: 604004). These children had megalencephaly in the first year of life, with or without mild delay of motor function and/or seizures. After a few years, motor handicap was slowly progressive with unsteady gait, serious cerebeliar ataxia and mild plasticity. Eventually most of patients were confined to a wheelchair. Meanwhile mental development was relatively preserved, although the learning problems was increased from the midway of elementary school. Most of patients had tonic-clonic seizure and some might advance to status epilepticus. Antiepileptic drugs may effectively control seizure. The disorders of known metabolic defects were excluded. Neurophysiological examination showed that EEG had interictal epileptic discharges on the generalized slow wave background in most patients. The cerebral white matter had diffuse abnormality, with swelling of white matter, and cysts in the frontoparietal and anterior-temporal lobes on MRI examination. Some central white matter structures were spared, such as corpus caliosum. The severity of lesions on MRI is inconsistent with the clinical signs. Pathogenesis of this disease was unknown. The pathological findings found a spongiform leukoencephalopathy due to myelin splitting and intramyelinic vacuole formation but without myelin loss, This disease had probably an autosomal recessive inheritance, The geneKIAA027 on 22qtel was responsible for M LC.     

MRI Features of Intracranial Primitive Neuroectodermal Tumors in Adults： Comparing with Histopathological Findings

The MRI appearances of 7 adult patients with pathologically proven intracranial primitive neuroectodermal tumors (PNET) were retrospectively analyzed. The MRI features were compared with findings in pathology and surgery. In this group, the tumor masses were most commonly found in the semisphere of cerebrum and in the vermis of cerebellum. They were relatively large and 4 were in lobulated shape. All of them had well-defined margins. MR images showed the tumors to be mildly or obviously hypointense on T1-weighted images and hyperintense on T2-weighted images. Most masses had heterogeneous appearances with some cystic and necrotic areas. Intratumoral haemorrhage and focal calcification were occasionally seen. Mostly, there was no or only mild surrounding edema. Marked inhomogeneous contrast enhancement on MRI was seen in 6 cases except one. Two patients with multiple intracranial metastases were revealed on MR images. In this series, there was good correlation between MRI features and findings in pathology and surgery.These results showed that certain MRI features might suggest the diagnosis of intracranial PNET in adults. MRI is an effective technique to detect these tumors and is helpful to treatment planning and follow-up.     

Early X-ray and CT appearances of severe acute respiratory syndrome：an analysis of 28 cases

Objective To study the early X-ray and CT findings of patients with severe acute respiratory syndrome (SARS).Methods Chest radiography and CT were performed in 28 patients with SARS within one to three days after onset of the disease. CT examinations included conventional spiral CT and high-resolution CT (HRCT). The radiographic and CT findings of these patients were analyzed retrospectively.Results Abnormal CT findings were noted in all the patients, but abnormal chest radiographic findings in 17 cases (60.7%, 17/28). CT showed single small focal patchy opacities in 23 patients (82.1%, 23/28), including oval ground-glass opacities in 20 patients, Iobular distribution ground-glass opacities in 2 and small patchy consolidation in one. Multi-focal ground-glass opacities were found in 2 patients and extensive opacities in three. In the 28 patients, a total of 31 lesions were found in the upper (7, 22. 6%), middle (3, 9.7%) ,and lower lobes (21, 67. 7%). The diameter of the lesions ranged from 20 to 35 mm.Conclusion The dominant feature of early SARS patients is focal patchy opacity in the lung, and oval small ground-glass opacities are the common morphological findinns an CT.     

原发于泪囊淋巴瘤的影像和病理分析

Background Lymphoma of the lacrimal sac is rare,often misdiagnosed clinically.This study aimed to investigate the imaging features of these tumors and provide suggestions to aid the diagnosis.Methods In this retrospective study,five cases were assessed according to magnetic resonance imaging （MRI）,computed tomography （CT）,and pathological findings.All five patients underwent MRI and contrast-enhanced T1-weighted imaging （CE-T1WI）,of which four patients underwent dynamic contrast-enhanced （DCE） MRI and three patients underwent CT.Results Four cases and one case had a lymphoma in left and right medial canthus,respectively.Soft tissue surrounding the eyelids,subcutaneous tissue in the nasal dorsum,and involvement of the entire nasolacrimal canal were demonstrated in all five lesions.In two cases,the mass invaded the extraconal space.In one case,the mass invaded the adjacent medial rectus muscle and nasal area.Well-defined margins were observed in three cases and ill-defined margins in two cases.All cases showed homogeneous isointense lesions on T1Wl.Four cases showed homogeneous isointensity and one case demonstrated heterogeneous isointensity on T2Wl.After contrast injection,the lesion showed slight homogeneous isointensity and moderate enhancement in four cases and heterogeneous isointensity and moderate enhancement in one case.In the four patients who underwent DCE-MRI,a plateau pattern was revealed in three cases and washout pattern in one case.In the three cases who underwent CT,two cases had isointense and one case had hyperintense lesions.The lacrimal duct was remodeled and the surrounding bone compressed.Conclusions Tumors of the lacrimal sac showed homogeneous and isointense patterns on T1WI and T2WI with mildto-moderate enhancement and a plateau pattern on DCE-MRI.CT showed remodeling of the lacrimal duct with bone compression.     

Original article ：Cerebral microbleeds prevalence,distribution and risk factors in northeast population without preceding large-area stroke

Background Cerebral microbleeds （CMBs） occur frequently in patients suspected of cerebrovascular disease and they are the principle radiographic findings in patients with sub-clinical neurological impairment. The objective of this study was to assess the prevalence, distribution, severity and associated clinical features of CMBs in a prospective hospital patient based cohort undergoing brain MRI for suspected cerebrovascular disease, excluding cases with known intracranial hemorrhage or prior large-area stroke. Methods The study population consisted of 447 patients who were evaluated with T2＊-gradient echo sequences to detect the CMBs lesion number, location, and their association with white matter hyperintensities and clinical parameters, including blood pressure. Results CMB lesions were presented in 95 of the 447 patients （21.3%）. The distribution of CMBs was 43.95% cortical, 19.77% thalamic, 14.41% in the brainstem, 11.58% cerebellar, 6.21% periventricular white matter, 5.64% involving the basal ganglia regions, and 0.28% involving the hippocampus. There was a statistically significant association between the presence of CMBs and advancing age （adjusted OR 2.082, P 〈0.01）, the severity of hypertension （adjusted OR 2.208 P 〈0.01）. Also there was a statistically significant （P 〈0.01） correlation between the presence of CMBs and the severity of hypertension and white matter lesions. Conclusions CMBs occur frequently in patients with no prior large-area stroke who were referred for brain MRI for suspected cerebrovascular disease. The severity of CMBs correlates with the severity of hypertension and the presence of cerebral white matter changes detected by MRI.     

Surgical treatment of lesional temporal lobe epilepsy

Objective To discuss the presurgical evaluation and surgical treatment of lesional temporal lobe epilepsy （LTLE）. Methods We retrospectively studied the patients whose MRI or CT showed lesions on one of the temporal lobes among patients who underwent epilepsy surgeries in our institute. All patients were divided into satisfactory and unsatisfactory group according to outcomes after operation . The characteristics of the lesions, neurophysilolgical features and results of pathologies were analyzed statistically. Results Favorable surgical outcome was obtained in 24 patients, the satisfactory rate was 75 %. The lesions of 17 patients were cortical malformations and the satisfactory rate of this group was 65 %,     

Features of hyperintense white matter lesions and clinical relevance in systemic lupus erythematosus

Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by complex and various clinical manifestations. The study aimed to analyze clinical features and cerebral magnetic resonance imaging (MRI) changes of hyperintense white matter (WM) lesions in SLE patients.Methods: This was a retrospective study based on a consecutive cohort of 1191 SLE patients; 273 patients for whom cerebral MRI data were available were enrolled to assess hyperintense WM lesions ass...     

海洛因白质脑病的CT和MRI表现(附1例报告)

目的：总结海洛因白质脑病的CT及MRI的特征及诊断价值。方法：对1例烫吸海洛因引起的海绵状白质脑病的患者进行临床和CT、MRI的观察。查阅文献对该病影像学特征结合临床表现进行讨论。结果：本例患者以小脑共济失调、智力减退为主要临床表现。CT显示对称性分布的小脑齿状核、双侧基底节内囊及双侧半卵圆中心为主的低密度改变;MRI显示对称性分布的小脑齿状核、双侧基底节内囊及双侧半卵圆中心为主的T1、T2高信号改变。结论：烫吸海洛因引起的海绵状白质脑病的CT与MRI影像学改变具有特征性,能为临床确诊提供可靠的依据。     

海洛因海绵状白质脑病的临床和病理(附1例报告)

报道1例海洛因海绵状白质脑病的临床和病理,并复习文献进行分析。 海洛因海绵状白质脑病具有如下特点：有经鼻吸海洛因史;亚急性或急性起病;多以小脑受损为首发症状,亦可表现为突然昏迷、抽搐;以运动障碍为主;脑脊液正常;尿吗啡实验可为阴性;影像学具有特征性的脑白质广泛受累,小脑白质受累最早、最严重,病变双侧对称,CT呈低密度,无占位效应,增强无强化。主要病理改变为脑白质海绵状变性。推测病因可能与海洛因不纯含有杂质有关。有海洛因吸入史者,一旦出现脑部症状,要及早行影像学检查,明确诊断。本病为我国大陆第1次在海洛因吸食者中发现,对预防和治疗吸毒所引起的并发症有指导意义。     

海洛因海绵状白质脑病MRI诊断特征

目的探讨海洛因海绵状白质脑病（HSLE）的临床病理表现和磁共振诊断特征。方法回顾性分析20例吸服海洛因致海洛因海绵状白质脑病患者的临床资料及MRI图像特征。结果 20例患者均有吸服或合并静脉注射海洛因病史,并出现不同程度的神经系统症状。MRI检查提示病变均累计大脑半球白质,双侧呈对称性分布的长T1、长T2异常信号,小脑有不同程度的受累。结论海洛因海绵状白质脑病影像学有特征性改变,MRI检查对海洛因海绵状白质脑病的诊断有重要价值,可以指导临床治疗。     

海洛因中毒性海绵状白质脑病临床研究(附3例报告)

海洛因中毒性海绵状白质脑病是一种罕见的脑部疾病,2000年3月我国发现首例.本文报道作者所见的3例,均以小脑性共济失调为首发症状,均有吸食海洛因史、戒毒后发病,一例有锥体束症状.体检以小脑性共济失调为主、2例有右下肢腱反射高,MRI均有小脑白质长T1长T2 信号边界较清,2例内囊后肢对称性长T1长T2 信号,1例丘脑、脑干及半卵圆中心有相似改变,2例脑电图未见异常.3例均以激素等治疗症状有所缓解.并综述文献,以进一步认识与研究本病.     

慢性海洛因成瘾者的脑部MRI表现及其机理探讨

目的 :阐述慢性海洛因成瘾者脑部的核磁共振成像 (MRI)表现及其诊断价值。方法 :本组 ( 6例 )均进行MRI检查 ,其序列包括T1WI、T2WI和FLAIR。结果 :本组幕上半球脑白质、小脑半球、内囊后肢及膝部、胼胝体压部及膝部均见双侧、对称性异常改变。MRI均表现为T1WI呈低信号 ,T2WI及FLAIR序列为不均匀或均匀高信号。结论 :慢性海洛因成瘾者所致脑白质病具有典型的MRI表现。MRI对海洛因成瘾机制的研究有较好的应用前景。     

嗜海洛因者海绵状白质脑病SPECT脑灌注显像10例临床分析

目的 了解嗜海洛因者海绵状白质脑病的脑循环改变，方法 利用单光子发射计算机断层扫描仪对10例嗜海洛因致海绵状白质脑病患者进行脑血流灌注断层显像。结果 10例均见幕上及小脑白质区不同程度扩大，白质放射性减低或缺损，双侧对称，灰质可见局灶性多发性血流灌注减低。结论 海洛因海绵状白质脑病患者脑白质血流量降低。脑的灰质亦不同程度受到波及。     

海洛因中毒性脑病临床分析

目的：探讨海洛因中毒性脑病的临床特点及影像学改变。方法：对21例海洛因中毒性脑病患者的临床及影像学资料进行观察和分析。结果：21例患者临床特点主要为亚急性起病。小脑性共济失调和精神症状为突出表现的脑弥漫性损害。CT或MR主要表现累及双侧颞、枕叶白质区及小脑半球齿状核和脑干，具有散在、多发、对称性和无占住效应为特点。2例死亡原因主要是肺水肿、呼吸衰竭。结论：本病诊断主要依靠明确海洛因吸毒史及具有特征性的临床表现和影像学特征。     

海洛因海绵状白质脑病的临床及影像学探讨(附1例报告)

目的分析和探讨海洛因海绵状白质脑病(HSLE)的临床特点和影像学特征,及其与吸毒方式和戒毒的相关性。方法详细报道1例HSLE病人的临床及影像特点,并结合国内文献进行分析。结果本例患者经鼻烫吸摄入海洛因10年,间断戒毒4次。慢性起病,逐渐加重;主要表现为记忆力减退、反应迟钝、小脑性共济失调及双下肢音叉震动觉减退。MRI可见双侧小脑半球近中线实质内(齿状核及其附近白质)、内囊后肢、双侧侧脑室旁、半卵圆中心及皮质下白质的后2/3、中脑等处多发对称长T1、长T2信号;经高压氧、纳洛酮、金钠多、胞二磷胆碱、能量合剂及各种维生素等综合治疗,病情略好转。结论HSLE的发病与经鼻烫吸海洛因及戒毒密切相关,并且MRI有特异性表现,建议在戒毒治疗的同时应用神经保护剂,或许可减少HSLE的发生或减轻HSLE的临床症状。     

嗜海洛因者海绵状白质脑病SPECT脑灌注显像10例临床分析

目的　了解嗜海洛因者海绵状白质脑病的脑循环改变。方法　利用单光子发射计算机断层扫描仪对10例嗜海洛因致海绵状白质脑病患者进行脑血流灌注断层显像。结果　10例均见幕上及小脑白质区不同程度扩大,白质放射性减低或缺损,双侧对称;灰质可见局灶性多发性血流灌注减低。结论　海洛因海绵状白质脑病患者脑白质血流量降低,脑的灰质亦不同程度受到波及。