Alzheimer病和多发梗塞性痴呆的CT诊断价值

目的:对80例Alzheimer病(AD)和多发梗塞性痴呆(MID)患者进行分析,探讨CT的诊断价值. 方法:选80名受检者,全部通过简易精神状态检查(MMSE),以听耻线为扫描基线,常规头颅扫描,测量三脑室宽度,侧脑室体部最宽径及同一水平处颅内板间距.结果:发现AD的两脉络球间距离与侧脑室体部间最大外径之商和头颅内横径与侧脑室体部间最大外径之商均值比MID为小(P<0.001);第三脑室和外侧裂最大宽度比MID为大(P<0.01～0.001).AD和MID的CT表现主要区别在侧脑室体部最大宽度、三脑室及外侧裂最大宽度.结论:CT结果不是疾病的最后诊断结论,应从多方面综合分析作诊断.     

MRI测量脑室、脑裂在Alzheimer病的应用研究

目的：定量评价Alzheimer病（alzheimer disease,AD)组，血管性痴呆（vascular dementia,VD)组、与年龄、性别相匹配的健康对照（health control,HC)组脑萎缩情况，有助于完善AD MRI的研究。资料与方法。使用Toshiba 1.5T超导MR扫描仪，对20例临床诊断为AD的患者、20例VD患者、20名HC者进行检查。对脑室、脑裂进行定量测量，并进行统计学处理。结果：AD、VD组侧脑室体部宽宽指数、侧脑室颞角宽度指数小于HC组，第三脑室宽度大于HC组，两侧外侧裂宽度指数、前绷裂宽度指数、两侧脉络膜裂宽度指数小于HC组。而AD与VD组以上测量指标除侧脑室颞角宽度以外无差别。结论：整体脑萎缩可提示痴呆的存在，但不能作为AD诊断的特异性指标，最好选择测量脑实质萎缩的指标进行AD的研究。     

基于3.0T MR及MIMICS对阿尔茨海默病患者侧脑室的研究

目的 比较分析阿尔茨海默病(AD)患者与正常老龄人侧脑室容积及形态,实现间接对AD患者脑实质萎缩进行评估.方法 运用3.0T MR对20例AD患者及20例正常老龄人进行头颅扫描,获得侧脑室切面图,测量侧脑室容积及侧脑室前角、后角及颞角,并运用比利时MIMICS软件对切面图像进行重建分析.结果 与正常老龄人侧脑室容积相比,AD组左侧脑室容积(LV)、右侧脑室容积(RV)及整体容积(TV)均明显增大,差异有统计学意义(P<0.05);与正常老龄人侧脑室前后角及颞角相比,AD组双侧前角及颞角度数显著增大,差异有统计学意义(P<0.05);AD组患者LV、RV、TV、左侧脑室前角、右侧脑室前角、左侧脑室颞角及右侧脑室颞角均与认知功能评定简易智能状态检查表(MMSE)呈负相关且有统计学意义(P<0.05).结论 AD患者侧脑室容积及角度均显著大于正常老龄人,相关测量数据可更为便捷准确提示AD患者脑实质萎缩状况.     

Alzheimer''s病MRI线性测量与痴呆程度的相关性研究

目的：评价MRI线性测量与痴呆程度的相关性及对Alzheimer’s病的诊断价值。方法：对40例临床诊断为AD患者的MRI进行侧脑室额角宽度、钩回间距、颞角宽度等指标测量，其结果与神经心理测验做相关性分析。结果：颞角增宽和钩回间距扩大与心理测验结果关系密切，与痴呆严重程度呈正相关。结论：MRI线性测量颞角增宽和钩回间距扩大即可作为早期诊断AD的指标之一，又可作为判断痴呆程度的指标之一。     

右侧侧脑室内原发性淋巴瘤伴出血1例

<正>患者女性,62岁。因胡言乱语半月入院,无头痛头晕及其他神经系统症状。影像学检查:CT显示透明隔、第三脑室及右侧脑室旁占位伴出血(图1),周围脑实质可见水肿带。MRI平扫显示透明隔、第三脑室及右侧脑室见大小约5.4cm×4.2cm的类圆形短T1、短T2信号,边缘呈分叶状,DWI呈稍低信号,FLAIR呈高低混杂信号,增强后明显强化,透明隔及侧脑室壁亦见强化(图2～7),右侧侧脑室少量积血;双侧半卵圆中心、双侧脑室前后角多发脱髓鞘改变。     

新生儿、婴儿正常脑发育的MRI研究Ⅱ．关于脑室大小及脑外间隙

目的：揭示发育期小儿脑室及脑外间隙随月龄变化的特征。材料和方法：选１００例２岁以内没有神经系统疾病的小儿，按月龄分７组，在Ｔ１ＷＩ上测量脑室大小，在加重Ｔ２加权像（ＨＴ２ＷＩ）上测量脑外间隙、外侧裂、纵裂的宽度。结果：（１）３～６个月时脑室前角指数、尾状核指数分别为０．３１±０．０４、０．１６±０．０３；（２）婴儿脑外间隙显示双层结构者占５０．８％，３～６个月时额叶及颞极前方脑外间隙、外侧裂、纵裂宽度分别为３．３１±１．２９ｍｍ、４．２５±２．３４ｍｍ、５．４８±１．８６ｍｍ、３．３８±１．３７ｍｍ；（３）侧脑室前角形态分三种，蜡烛台形２８．０％、Ｙ形６７．０％、平行形５．０％；新生儿透明隔腔占８３．３％。结论：（１）脑室指数中，前角指数和尾状核指数最可靠，是判定脑室大小的依据；（２）新生儿期存在透明隔腔是正常的。侧脑室前角形态在新生儿期以蜡烛台形为主，婴儿期以Ｙ形为主；（３）脑外间隙在３～６个月时最宽，脑外间隙可分出蛛网膜下腔和硬膜下腔，以前者为主     

阿尔茨海默病侧脑室变化的磁共振研究

目的 探讨阿尔茨海默病(AD)侧脑室变化的特征性磁共振表现,为临床诊断和鉴别诊断提供依据.方法 利用1.5T磁共振对20例AD患者和20名正常对照组行轴位全脑MRI扫描以测量左右侧脑室体积,并每隔一年对同一患者进行连续随访3年,以分析AD患者各侧侧脑室体积变化以及随时间变化的发展趋势.结果 AD组患者左侧、右侧及双侧侧脑室的体积于3年内均明显大于正常对照组(P =0.000);AD患者侧脑室的体积随着时间的推移不断增加且其增加的速率存在着逐渐递增趋势,且左侧侧脑室扩大的程度和速率要比右侧明显.结论 各侧侧脑室体积的动态变化可能是AD患者的特征性影像学表现之一,这也为临床上判别疾病的严重性及预后提供了一定的帮助.     

CT诊断弥漫性外伤性脑水肿的探讨

目的：探讨简单的ＣＴ测量诊断弥漫性外伤性脑水肿的可能性。方法：收集成人颅脑外伤后ＣＴ轴位扫描并有复查的ＣＴ资料１０９例和正常成人ＣＴ资料１２９例，取三脑室和侧脑室前角层面分别测量脑室的大小等，对照两组测量结果，并经统计学处理。病变组同时观察主要脑池的改变。结果：正常成人三脑室宽径为２．５～６．０ｍｍ。病变组１０９例中，三脑室变窄１０２例，侧脑室变窄者９５例。结论：大多数颅脑外伤者有脑水肿。三脑室宽径变窄（男性＜２．８ｍｍ，女性＜２．５ｍｍ）可作为诊断成人弥漫性外伤性脑水肿的一个重要指标。     

右侧脑室前角面积的CT测量用于脑萎缩诊断

以前曾做很多努力在CT 扫描测量脑室大小或大脑半球脑沟宽度做为判断脑萎缩诊断的定量的原则。作者强调测量层面必须是解剖结构相同的层面,目的是以便于比较。作者们使用的标准层面是室间孔显示最清楚的层面。材料为CT 扫描认为属正常的198例。年龄为17天至83岁。测量部位有侧脑室前角的最大宽度(a)、侧室前角的最小宽度(b)前角最大及最小宽度的和、脑室指数、室中部指数,脉络丛间距离(c)、侧室中央部最大外径(d)、颅骨外板间最大横径。c/a为脑室指数、     

伴自杀意念首发抑郁症患者小脑-大脑功能连接的fMRI研究

【摘要】目的：基于静息态fMRI探讨伴自杀意念的首发抑郁症患者小脑-大脑功能连接（FC）的改变。方法：前瞻性将2018年2月-2022年1月在本院就诊的58例伴自杀意念（SI组）和42例不伴自杀意念的抑郁症患者（NSI组）以及49例相匹配的健康志愿者（HC组）纳入本研究,对所有被试行静息态fMRI扫描。分别在双侧小脑的Crus-Ⅰ、-Ⅱ、-Ⅴ、-Ⅵ和蚓部勾画ROI,采用基于种子点的FC分析方法计算抑郁症患者小脑各ROI与大脑的FC值。对所有抑郁症患者进行抑郁相关的临床量表评估,包括24项汉密尔顿抑郁量表（HAMD24）和Beck自杀意念量表中文版（BSI-CV）,HAMD24评分包括HAMD24总分及焦虑/躯体化、体质量、认知障碍、日夜变化、阻滞、睡眠障碍和绝望感共7项因子的评分;BSI-CV评分包括自杀意念因子和自杀危险因子两项评分。采用Pearson或Spearman相关分析对组间差异有统计学意义的小脑-大脑FC值（SI组、NSI组和HC组两两比较）与临床变量（病程、HAMD24评分和BSI-CV评分）进行相关性分析。结果：与HC组相比,SI组和NSI组的小脑与颞上回、中央前回、中央钩盖、中央旁小叶的FC值升高,小脑与额中回、颞叶、角回和后扣带回的FC值降低;与NSI组相比,SI组的小脑与颞中回和颞下回的FC值升高,与右侧角回的FC值降低。右侧小脑Crus-Ⅰ与大脑间的FC值与HAMD24总分及阻滞、体质量、日夜变化和认知障碍四项因子的评分均呈负相关（r=－0.308、－0.315、－0.273、－0.311、－0.263,P均<0.05）;左侧小脑Crus-Ⅰ与额中回和后扣带回的FC值与体质量因子评分之间均呈负相关（r=-0.295、-0.289,P均<0.05）,左侧小脑Crus-Ⅰ与颞上回的FC值与自杀危险因子评分呈负相关（r=-0.277,P<0.05）,左侧小脑Crus-Ⅰ与中央钩盖的FC值与体质量因子评分呈正相关（r=0.278,P<0.05）;左侧小脑Crus-Ⅰ与中央旁小叶的FC值与睡眠障碍因子评分呈正相关（r=0.382,P<0.05）。结论：静息态fMRI证实伴自杀意念的抑郁症患者的小脑与大脑之间的功能连接出现了紊乱,主要发生于执行网络和默认模式网络,从而为伴自杀意念抑郁症患者发病机制的研究提供了新思路。     

Relationship between cognitive function and regional cerebral blood flow in Alzheimer's disease

The Mini-Mental State examination (MMSE) is frequently used to assess the cognitive function of neurological patients. The purpose of this study was to investigate associations between regional cerebral blood flow (rCBF) and MMSE scores in Alzheimer's disease (AD) and localization of cognitive functions. Fifty-nine patients with probable AD (21 males and 38 females; mean age 74 years) and 12 normal volunteers (five males and seven females; mean age 73 years) were studied. CBF was measured by SPECT using the N-isopropyl-p-[(123)I]iodoamphetamine autoradiography method. The CBF images were reconstructed in parallel with the orbitomeatal line and parallel to the long axis of the temporal cortex. Regions of interest were set in the cerebral and cerebellar cortex. Multivariate analysis was performed by the step-wise method, using each section of the MMSE as the dependent variable and the rCBF ratio as the independent variable. The decline in rCBF in the parietal cortex and hippocampus reflected disorientation, and the most significant cortex affecting scores on each section of the MMSE were found to be the anterior temporal cortex for registration, the frontal cortex for attention and calculation, the medial temporal cortex for recall, and the posterior temporal cortex for language.     

慢性硬膜下血肿患者33例手术后认知功能改善分析

目的：探讨慢性硬膜下血肿（chronic subdural hematoma）对轻度认知功能损害的相关关系。方法：对33例通过CT扫描确诊的慢性硬膜下血肿患者,术前进行认知功能评价。并于手术后1周再次进行认知功能评估,通过对术前术后认知功能的评估结果,分析慢性硬膜下血肿是否导致患者认知功能障碍,并初步判断手术是否早期可以改善患者认知功能障碍。结果：33例患者中,有32例出现认知功能障碍,但都表现为轻度认知功能障碍,手术后,患者认知功能障碍有好转（MMSE评分有统计学意义）。结论：慢性硬膜下血肿可以伴随认知功能改变,手术治疗后,可以改善患者认知功能障碍。     

海马体积测量联合 MMSE 评分在认知障碍中的应用

目的：探讨测量海马体积(HV)联合简易智力状况检查量表(MMSE)评分评估不同程度认知功能障碍的价值。方法收集阿尔茨海默病(AD)患者、轻度认知障碍(MCI)患者、正常对照(NC)各30例,应用西门子 MRI 行 HV 测量,综合分析3组患者标准化后的 HV、MMSE 评分。结果与 MCI、NC 组比较,AD 组总 HV、左右侧均减小,差别有统计学意义(P 值均<0.05);MCI 与 NC 2组之间 HV 无显著差异;分析3组患者的 MMSE 评分,AD 组分值均小于 MCI、NC 组,差别有统计学意义(P 值均<0.05),MMSE 评分在MCI 与 NC 2组间无差别。结论HV 测量联合 MMSE 评分,有助于为 AD 患者诊断提供有价值的信息,而在 MCI 中的诊断灵敏度不高。     

Focal vulnerability of developing brain: CT studies on disproportionally dilated lateral ventricles

Summary Cranial computed tomography (CT) of 108 cases with dilated lateral ventricles was reviewed to elucidate the relationship between focal vulnerability of developing brain and disproportional dilatation of lateral ventricles. CT findings of 108 cases with symmetrical dilatation of lateral ventricles were classified into three types by morphometry of lateral ventricles: anterior horn predominant type (31 cases), diffuse type (36 cases), posterior horn predominant type (41 cases). Posterior horn predominant type has a tendency to occur in congenital anomalies and premature brain damage, and anterior horn predominant type in infantile brain damage. This disproportional dilatation of anterior or posterior horns suggests a vulnerability of periventricular structure in developing brain.     

ESWAN序列在小血管病性血管性认知障碍非痴呆型中的应用研究

目的探讨多回波采集的重度T2*加权的三维梯度回波序列(enhanced T2star weighted angiography,ES-WAN)在小血管病性血管性认知障碍非痴呆型(vascular cognitive impairment-no dementia with small vessel disease,VCIND-SVD)中的应用价值。方法 VCIND-SVD患者27例(VCIND-SVD组);年龄、性别、受教育程度时间基本匹配的正常对照者11名(正常对照组),同时行ESWAN序列扫描和蒙特利尔认知评估量表(montreal cognitive assess-ment,MoCA)评估。在T2*mapping及R2*mapping上测量双侧前额叶内侧回、楔叶、背外侧前额叶白质、侧脑室后角旁白质、半卵圆中心、尾状核头、豆状核、丘脑等感兴趣区(ROI)的T2*值和R2*值,计算各ROI区T2*值和R2*值及MoCA各项得分之间的相关性,采用SPSS 13.0软件进行统计分析。结果与正常对照组相比,VCIND-SVD患者双侧前额叶内侧回、背外侧前额叶白质、侧脑室后角旁白质、半卵圆中心、丘脑的T2*值升高,R2*值降低,差异有统计学意义(P<0.05);而尾状核头及豆状核T2*值降低,R2*值升高,差异有统计学意义(P<0.05)。VCIND-SVD患者双侧背外侧前额叶白质、侧脑室后角旁白质、半卵圆中心的T2*值和R2*值分别与记忆力得分具有中度相关性(P<0.05);双侧背外侧前额叶白质的T2*值和R2*值与抽象思维得分具有中度相关性(P<0.05)。结论 T2*值和R2*值能反映VCIND-SVD患者部分微细结构及氧代谢变化,且有助于反映VCIND-SVD患者认知缺损可能的病理学基础。     

Five-year retrospective changes in hippocampal atrophy and cognitive screening test performances in very mild Alzheimer's disease: the Tajiri Project

The medial temporal lobe, especially the hippocampus, is important for normal cognitive function. especially for memory, and is the region with the earliest and most extensive pathological changes in Alzheimer's disease (AD). We investigated the atrophic changes of the hippocampus over a 5-year period and its relation to cognitive screening test performances in normal elderly subjects, those with very mild AD, and patients with AD. Fifty-seven elderly subjects without a moderate or greater degree of cerebrovascular disease as shown by MRI were randomly selected from the town of Tajiri. Thirty-three subjects with a clinical dementia rating (CDR) of 0 (normal), 18 CDR-0.5 (very mild AD) subjects, and six CDR-1&2 (AD) subjects underwent MRI and the Mini Mental State Examination (MMSE) twice during the period. Retrospective changes in the hippocampal width and the MMSE scores were evaluated. There were significant CDR group effects for the changes in the mean bilateral hippocampal widths and the MMSE scores. Normal subjects did not show cognitive decline, although there was a slight tendency for hippocampal atrophy. A significant and meaningful Spearman's correlation was noted between left hippocampal atrophy and the MMSE scores over the 5-year period for the CDR-0.5 group. These CDR-0.5 subjects met the MCI (mild cognitive impairment) criteria as proposed by the consensus paper. Findings suggested that normal elderly subjects maintain a high level of cognitive functions for at least 5 years, although hippocampal atrophy might occur. Atrophic change of the left hippocampus might be a good marker of the very early stage of AD.     

基于体素的遗忘型轻度认知障碍和轻度阿尔茨海默病全脑白质MR扩散张量成像分析

目的 采用基于体素的分析(VBA)方法研究遗忘型轻度认知障碍(aMCI)患者和轻度阿尔茨海默病(AD)患者全脑白质微观结构改变的特点及其与灰质萎缩模式的关系.方法 选取33例aMCI患者(aMCI组)、32例轻度AD患者(轻度AD组)和31名正常老年人(健康对照组),对全脑进行3.0 T DTI及三维快速扰相梯度反转回波(3DFSPGR)脉冲序列扫描.采用统计参数图(SPM)5软件对被试者的结构图像及各向异性(FA)图进行预处理,然后采用t检验对aMCI组、轻度AD组和正常对照组的全脑灰质体积及FA值进行基于体素的统计学比较,计算出有统计学意义的脑区.结果 与正常对照组比较,aMCI组的双侧额颞叶和左侧枕叶白质、左侧扣带前部、左侧顶下小叶、右侧脑室三角区外上方白质的FA值减低;轻度AD组的双侧额颞枕叶、海马旁白质、扣带前部、胼胝体、侧脑室三角区旁白质、顶下小叶、左侧颞于、左侧丘脑、右侧楔前叶FA值减低.基于体素的形态测量学(VBM),分析发现,aMCI患者组左侧海马、海马旁回、舌回、颞上回,双侧岛叶、颞中回出现了灰质萎缩;轻度AD患者组双侧海马、海马旁回、杏仁核、丘脑、额叶、颞叶、顶叶、枕叶皮质出现了灰质萎缩.aMCI与轻度AD患者组全脑白质FA值减低的模式与灰质萎缩模式不同.aMCI组与轻度AD组比较未发现具有统计学意义的FA值减低脑区.aMCI、轻度AD患者组全脑白质FA值与简易智能精神状态检查量表(MMSE)评分没有相关性.结论 基于体素的MR DTI全脑白质分析能够较全面、客观地揭示aMCI、轻度AD的脑白质损害的模式.aMCI、轻度AD患者白质损害的模式与灰质不同,提示脑白质病变是多种病理机制导致的.aMCI患者向轻度AD进展过程中,脑白质各向异性改变不显著,脑白质FA值的改变可能无法反映患者认知功能障碍的严重程度.

Abstract：

Objective To evaluate the microstructural integrity of white matter (WM) in patients with amnestic mild cognitive impairment (aMCI) and mild Alzheimer's disease (AD) using voxel-based analysis (VBA), and investigate the relationship between WM abnormalities and gray matter(GM) atrophy.Methods Thirty-three cases with aMCI, 32 cases with mild AD and 31 normal aging volunteers as control subjects were scanned on a 3.0 T MR system using diffusion tensor imaging (DTI) and three-dimensional spoiled gradient-recalled(3DSPGR) sequences. Fractional anisotropy (FA) maps and morphological images were preprocessed by SPM5 and voxel-based comparisons between the 2 patient groups and the control group were performed by t test. Results Relative to the control group, patients with aMCI showed significantly reduced FA value in bilateral frontal, temporal and left occipital WM, left anterior part of cingulum, left inferior parietal lobule, and the W M adjacent to the triangular part of the right lateral ventricle(k≥20 voxels).In mild AD,significantly reduced FA value was found in bilateral hippocampal,inferior parietal lobular,frontal,temporal,and occipital WM,bilateral corpus callosum,anterior part of cingulums,the WM adjacent to the triaangular part of the bilateral lateral ventricles,left temporal stem,left thalamus,right precuneus(k≥20 voxels).Significantly reduced GM volume was found in left hippocampus,parahippocampal gyrus,lingual gyrus and superior temporal gyrus,bilateral insulae and middle temporal gyri in aMCl group whencompared with control group(k≥50 voxels).In mild AD,significantly reduced GM volume was found in bilateral hippoeampi,parahippocampal gyri,amygdalae,thalami,temporal,parietal,frontal,occipital cortex(k≥50 voxels).The pattern of areas with reduced FA differs;from that of the GM volumetric reduction.No areas with significantlv reduced FA was detected in aMCl compared with mild AD. There was no significant correlation between FA value of WM in patient groups and Mini-Mental State Examination(MMSE)scores.Conclusions Voxel-based MRI DTI analysis of whole brain white matter can objectively reveal widespread white matter abnormalities in early-stage AD.The difierence between WM FA reduction pattern and GM volumetric reduction pattern indicates that the pathological WM changes in earlyslage AD were caused by multiple mechanisms. FA did not vary significantly in patients pr0gressing from aMCI to mild AD and can hardly reflect the severitv of cognitive function damage in these patients.     

Computed tomography in patients with Ehlers-Danlos syndrome

Summary Three patients with Ehlers-Danlos syndrome were reported. Unusual findings on computed tomography were seen in two of the three patients. One case showed peculiar and marked dilatation of the 4th ventricle, supracerebellar cistern and lateral ventricle. The other case presented disproportionate enlargement of the anterior horn of the lateral ventricle. These CT findings in the two patients suggest that developmental abnormalities may constitute a structural defect.     

亨廷顿病的影像学表现

目的 报道亨廷顿病的影像学表现. 资料与方法 分析1例经基因检测证实的亨廷顿病患者CT、MRI、氢质子磁共振波谱(1H-MRS)、正电子发射体层成像(PET/CT)影像学表现,并复习文献. 结果 头颅CT及MRI提示双侧尾状核萎缩,侧脑室前角扩大.尾状核头部最大直径、壳核最大直径值减低、双尾状核比率和双额角比率值增高.1H-MRS出现异常乳酸峰并提示基底节区N-乙酰天门冬氨酸/肌酸值减低,胆碱复合物/肌酸值增高.PET/CT示双侧基底节代谢减低. 结论 1H-MRS代谢异常及PET/CT基底节区代谢减低有助于诊断亨廷顿病.