DSA对老年性颈内动脉重度狭窄或闭塞患者侧支循环的应用价值

Objective To investigate the diagnostic value of aortocranial DSA in collateral circulation in elderly patients with serious stenosis or occlusion of the internal carotid artery. Methods Twenty-three elderly patients with serious stenosis or occlusion of the internal carotid artery, admitted to our hospital from August 2008 to July 2010, were chosen; their DSA findings and prognoses were retrospectively analyzed. Results Of these 23 patients, the collateral circulation was seen in 18(78.3%), including compensations from anterior communicating artery (n=16), posterior communicating artery (n=6), anterior together with posterior communicating artery (n=3), anterior choroidal artery (n=5),meningina artery between anterior cerebral artery and posterior cerebral artery (n=5), meningina artery between posterior cerebral artery and middle cerebral artery (n=4), ophthalmic artery (n=15), blood vessel between posterior cerebral artery and superior cerebellar artery (n=3), and blood vessel among superior cerebellar artery, anterior inferior cerebellar artery and posterior inferior cerebellar artery (n=2); after conservative treatment and long time follow-up (1 to 22 months with a mean of 11.2 moths),disappearance of clinical symptoms and no recurrence were found in these 18 patients. Five patients were noted without compensatory collateral circulation: the 2 paralysis patients could not take care of themselves even with the improvement of myodynamia from grade 0 to grade Ⅲ; the 2 patients with disturbance of consciousness showed no recovery and died from lung infection; the left 1 patient was having aphasia. Conclusion DSA can accurately define ways and compensative ability of collateral circulation in elderly patients with serious stenosis or occlusion of the internal carotidartery, which can put forward reliable evidences for their treatments and prognoses.     

DSA对老年性颈内动脉重度狭窄或闭塞患者侧支循环的应用价值

Objective To investigate the diagnostic value of aortocranial DSA in collateral circulation in elderly patients with serious stenosis or occlusion of the internal carotid artery. Methods Twenty-three elderly patients with serious stenosis or occlusion of the internal carotid artery, admitted to our hospital from August 2008 to July 2010, were chosen; their DSA findings and prognoses were retrospectively analyzed. Results Of these 23 patients, the collateral circulation was seen in 18(78.3%), including compensations from anterior communicating artery (n=16), posterior communicating artery (n=6), anterior together with posterior communicating artery (n=3), anterior choroidal artery (n=5),meningina artery between anterior cerebral artery and posterior cerebral artery (n=5), meningina artery between posterior cerebral artery and middle cerebral artery (n=4), ophthalmic artery (n=15), blood vessel between posterior cerebral artery and superior cerebellar artery (n=3), and blood vessel among superior cerebellar artery, anterior inferior cerebellar artery and posterior inferior cerebellar artery (n=2); after conservative treatment and long time follow-up (1 to 22 months with a mean of 11.2 moths),disappearance of clinical symptoms and no recurrence were found in these 18 patients. Five patients were noted without compensatory collateral circulation: the 2 paralysis patients could not take care of themselves even with the improvement of myodynamia from grade 0 to grade Ⅲ; the 2 patients with disturbance of consciousness showed no recovery and died from lung infection; the left 1 patient was having aphasia. Conclusion DSA can accurately define ways and compensative ability of collateral circulation in elderly patients with serious stenosis or occlusion of the internal carotidartery, which can put forward reliable evidences for their treatments and prognoses.     

Cortical infarction of the right parietal lobe and neurogenic heart disease A report of three cases

Three male patients were diagnosed with new cortical infarctions of the right parietal lobe on the basis of head magnetic resonance imaging;high-intensity signals indicating lesions in the right parietal lobe were noted on diffusion-weighted images at admission.Two of them presented with left hand weakness,and one exhibited left upper limb weakness.Treatment for improving blood supply to the brain was administered.One patient died suddenly because of ventricular fibrillation 3 days after admission.The other two patients had increased troponin levels and abnormal electrocardiograms,and were diagnosed with acute myocardial infarction half a month after admission.When lesions exist in field 7 of the parietal cortex (resulting in paralysis of the contralateral hand),the sympathetic center of the posterior lateral nucleus of the hypothalamus demonstrates compensatory excitement,which easily causes tachyarrhythmia and sudden death.Our experimental findings indicate that close electrocardiograph monitoring and cerebral infarction treatment should be standard procedures to predict and help prevent heart disease in patients with cerebral infarction in the right parietal lobe and left upper limb weakness as the main complaint.     

Evaluation of corticospinal tract injury with three-dimensional diffusion tensor tract in patients with acute cerebral infarction

BACKGROUND: Three-dimensional diffusion tensor tract (DTT) is the newest imaging to describe the structure of white matter fiber in three-dimensions, it has great significance in dividing the concrete anatomic site of gray and white matter lesions, displaying the correlation with fibrous band and judging clinical prognosis, which is incomparable by other imagings. OBJECTIVE: To observe the conditions of corticospinal tract (CST) in acute cerebral ischemic stroke patients, and analyze the relationship between motor function and the severity of CST injury. DESIGN: A case-control observation. SETTING: Department of Medical Imaging, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. PARTICIPANTS: Fifteen patients with acute cerebral infarction were selected from Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from February to December in 2005. They all suffered from acute attack and motor disorder of hemiplegic limbs to different extent, and were conformed by CT or MRI. There were 9 males and 6 females, aging 16-87 years old, the median age was 51.7 years, and all were right handed. Fifteen right-handed normal subjects, who were matched by age and sex with the patients in the cerebral infarction group, were selected from the relatives of patients and physicians of the Imaging Department as the control group. All the subjects were informed and agreed with the study. METHODS: The patients with acute cerebral infarction and subjects in the control group received MR diffusion tensor imaging (DTI) with GE 1.5 T nuclear magnetic resonance system, fiber tracking with the software of dTV-Ⅱ. Fractional anisotropy (FA) maps and three-dimensional tractography of bilateral CST of all patients were created. Displacement, continuity and destroy of fibrous bands were observed. At the same time, muscle strength of ipsilateral hand of patients with cerebral infarction was measured with Brunnstrom standard. The correlation between the severity of CST injury and the muscle strength of ipsilateral hand was analyzed with spearman correlation analysis. MAIN OUTCOME MEASURES: ① FA values in the infarcted sites and those in the contralateral corresponding sites of patients with cerebral infarction; ② CST manifestations in the patients with cerebral infarction and the control group. RESULTS: All the 30 testees were involved in the analysis of results. ① The FA values in infarcted sites of white matter were significantly lower than those in the contralateral ones (t =4.570,P < 0.001). ② In the control group, bilateral CST were reconstructed, they originated from precentral gyrus, went downwards to internal capsule, and extended to pontine and medulla oblongata, each fiber had good uniformity in continuous form. In the patients with cerebral infarction, the forms of contralateral CST were consistent with those in the control group with good continuity. Due to the involvement by the infarcted site to different extents, the ipsilateral CST manifested as continuous interruption and loss of uniformity in anatomic structure and form. The CST involvements were divided into three grades: integrated CST for grade 1 (n =2); integrated CST but compressed or displaced for grade 2 (n =5); interrupted CST for grade 3 (n =8). ③ The severity of CST injury was obviously correlated with the muscle strength of the ipsilateral hand (r =0.888, P < 0.05). CONCLUSION: ① CST is injured to different extents in patients with acute cerebral infarction, and the severity of injury is associated with muscle strength. It is indicated that it can be used to judge the prognosis of rehabilitative treatment. ②DTT can directly display the status of pyramidal tract more three-dimensionally.     

Higher frequency of brain abnormalities in neuromyelitis optica spectrum disorder patients without primary Sj?gren's syndrome

Neuromyelitis optica spectrum disorder otfen co-exists with primary Sj?gren’s syndrome. We compared the clinical features of 16 neuro-myelitis optica spectrum disorder patients with (n = 6) or without primary Sj?gren’s syndrome (n = 10). All patients underwent extensive clinical, laboratory, and MRI evaluations. hTere were no statistical differences in demographics or ifrst neurological involvement at onset between neuromyelitis optica spectrum disorder patients with and without primary Sj?gren’s syndrome. The laboratory findings of cerebrospinal lfuid oligoclonal banding, serum C-reactive protein, antinuclear autoantibody, anti-Sj?gren’s-syndrome-related antigen A an-tibodies, anti-Sj?gren’s-syndrome-related antigen B antibodies, and anti-Sm antibodies were signiifcantly higher in patients with primary Sj? gren’s syndrome than those without. Anti-aquaporin 4 antibodies were detectable in 67% (4/6) of patients with primary Sj?gren’s syndrome and in 60% (6/10) of patients without primary Sj?gren’s syndrome. More brain abnormalities were observed in patients without primary Sj?gren’s syndrome than in those with primary Sj?gren’s syndrome. Segments lesions (> 3 centrum) were noted in 50% (5/10) of patients without primary Sj?gren’s syndrome and in 67% (4/6) of patients with primary Sj?gren’s syndrome. hTese ifndings indicate that the clinical characteristics of neuromyelitis optica spectrum disorder patients with and without primary Sj?gren’s syndrome are similar. However, neu-romyelitis optica spectrum disorder patients without primary Sj?gren’s syndrome have a high frequency of brain abnormalities.     

Serum alkaline phosphatase and γ-glutamyl transpeptidase levels in patients with neuromyelitis optica and multiple sclerosis

Objective To investigate the serum alkaline phosphatase (ALP) and γ-glutamyl transpeptidase (GGT) levels in patients with neuromyelitis optica (NMO) and multiple sclerosis (MS).Methods Serum ALP and GGT levels in patients with NMO and MS from the database of demyelinating diseases in our hospital were analyzed.Eighty-five healthy controls were chosen.The differences of serum ALP and GGT levels in patient groups and controls were compared, and the correlations between clinical features (age of the subjects, course of disease, times of relapse and scores of EDSS) and both ALP and GGT levels were analyzed. Results The serum ALP and GGT levels in patients with NMO were significantly higher than those in patients with MS and the controls (P<0.05).Patients with NMO still had significantly higher serum ALP level in acute phase than patients with MS,and the serum ALP levels in male patients with NMO and the serum GGT levels in female patients with NMO were, respectively,statistically higher than that of male patients with MS and female patients with MS (P<0.05). In patients with NMO, significantly positive correlations between serum GGT level and both age and times of relapse were noted (P<0.05). Conclusion Serum ALP and GGT levels differ in patients with NMO and MS, indicating their differential diagnostic value in NMO and MS to certain extent.     

Serum alkaline phosphatase and γ-glutamyl transpeptidase levels in patients with neuromyelitis optica and multiple sclerosis

Objective To investigate the serum alkaline phosphatase (ALP) and γ-glutamyl transpeptidase (GGT) levels in patients with neuromyelitis optica (NMO) and multiple sclerosis (MS).Methods Serum ALP and GGT levels in patients with NMO and MS from the database of demyelinating diseases in our hospital were analyzed.Eighty-five healthy controls were chosen.The differences of serum ALP and GGT levels in patient groups and controls were compared, and the correlations between clinical features (age of the subjects, course of disease, times of relapse and scores of EDSS) and both ALP and GGT levels were analyzed. Results The serum ALP and GGT levels in patients with NMO were significantly higher than those in patients with MS and the controls (P<0.05).Patients with NMO still had significantly higher serum ALP level in acute phase than patients with MS,and the serum ALP levels in male patients with NMO and the serum GGT levels in female patients with NMO were, respectively,statistically higher than that of male patients with MS and female patients with MS (P<0.05). In patients with NMO, significantly positive correlations between serum GGT level and both age and times of relapse were noted (P<0.05). Conclusion Serum ALP and GGT levels differ in patients with NMO and MS, indicating their differential diagnostic value in NMO and MS to certain extent.     

老年人外伤性硬膜下积液的CT诊断(附52例分析)

目的 探讨老年人外伤性硬膜下积液(TSE)的CT诊断,以及与老年性脑萎缩的鉴别要点.方法 福建省平潭县医院外科自2008年3月至2010年3月共收治60岁以上的老年TSE患者52例,回顾性分析患者的临床资料和CT表现,并与同期40例老年性脑萎缩患者的CT征象进行比较.结果 本组患者TSE共91处,其中发生于颞额部31例(34.1%),额部30例(33%);合并老年性脑萎缩34例;首次CT检查发现TSE者32例,首次CT检查阴性而复查发现TSE者20例.短期内复查CT发现积液量增多32例,TSE患者中具有局部脑回变平、脑沟变浅等占位表现者30例,具有"蛛网膜内移征"者9例,而老年性脑萎缩患者CT检查均无上述表现.结论 老年人TSE好发于颞、额部,与老年性脑萎缩的鉴别要点为脑外间隙改变的部位与范围、局部脑回变平脑沟变浅等占位征象、"蛛网膜内移征"、短期CT复查时积液量的变化.

Abstract：

Objective To investigate how to diagnosis traumatic subdural effusion (TSE) and differentiate it with senile encephalatrophy in aged people by CT scan. Methods Fifty-two aged patients with TSE and 40 aged patients with encephalatrophy, admitted to our hospital from March 2008 to March 2010, were chosen in the study. Their clinical data and CT manifestations were retrospectively analyzed and compared. Results Fifty-two patients with TSE had 91 sites of the lesion, including 31 lesions located in temporal-frontal lobe and 30 lesions in frontal lobe. Among the 52 patients, 34 were also noted as having encephalatrophy. First-time CT demonstrated 32 patients with TSE, and the second-time CT on the left patients showed 20 having TSE too. Among the 52 patients, increasing amount of fluid in a short term was noted in 32 patients; local widened gyri with a flattened surface and narrowed sulci was presented in 30; "compressed arachnoid sign" was found in 9. CT results demonstrated that no above-mentioned manifestations were presented in patients with encephalatrophy.Conclusion For aged person, TSE is usually located in the temporal and frontal lobe, and should be differentiated with senile encephalatrophy. The key-points for differentiation include the location and the extent of changes of extra-cerebral space, the space-occupying signs as local flattened gyri and narrowed sulci, the appearing of "compressed arachnoid sign" and the changes of effusion in a short-term review.     

DSA对老年性颈内动脉重度狭窄或闭塞患者侧支循环的应用价值

目的 探讨DSA对老年性颈内动脉重度狭窄或闭塞患者侧支循环的诊断价值.方法 广西右江民族医学院附属医院神经内科自2008年8月至2010年7月收治一侧颈内动脉重度狭窄或闭塞的缺血性脑血管病患者23例,回顾性分析患者的DSA表现与预后.结果 DSA显示有充分侧支循环代偿18例(78.3%),其中前交通动脉代偿16例,后交通动脉代偿6例,前交通动脉和后交通动脉代偿3例,脉络膜前动脉代偿5例,大脑前动脉和大脑中动脉之间的软脑膜动脉代偿5例,大脑后动脉和大脑中动脉之间的软脑膜动脉代偿4例,眼动脉代偿15例,大脑后动脉与小脑上动脉之间吻合3例,小脑上动脉、小脑前下动脉和小脑后下动脉之间吻合2例;随访1～22个月,患者临床症状全部消失并未再复发.无侧支循环代偿5例,其中2例瘫痪患者肌力由0级恢复到Ⅲ级,生活无法自理;2例意识障碍没有恢复,因肺部感染而死亡;1例患者失语无法恢复.结论 DSA可以准确判断老年性颈内动脉重度狭窄或闭塞患者侧支循环的存在方式和代偿能力,为治疗方法的选择和预后的判断提供可靠依据.

Abstract：

Objective To investigate the diagnostic value of aortocranial DSA in collateral circulation in elderly patients with serious stenosis or occlusion of the internal carotid artery. Methods Twenty-three elderly patients with serious stenosis or occlusion of the internal carotid artery, admitted to our hospital from August 2008 to July 2010, were chosen; their DSA findings and prognoses were retrospectively analyzed. Results Of these 23 patients, the collateral circulation was seen in 18(78.3%), including compensations from anterior communicating artery (n=16), posterior communicating artery (n=6), anterior together with posterior communicating artery (n=3), anterior choroidal artery (n=5),meningina artery between anterior cerebral artery and posterior cerebral artery (n=5), meningina artery between posterior cerebral artery and middle cerebral artery (n=4), ophthalmic artery (n=15), blood vessel between posterior cerebral artery and superior cerebellar artery (n=3), and blood vessel among superior cerebellar artery, anterior inferior cerebellar artery and posterior inferior cerebellar artery (n=2); after conservative treatment and long time follow-up (1 to 22 months with a mean of 11.2 moths),disappearance of clinical symptoms and no recurrence were found in these 18 patients. Five patients were noted without compensatory collateral circulation: the 2 paralysis patients could not take care of themselves even with the improvement of myodynamia from grade 0 to grade Ⅲ; the 2 patients with disturbance of consciousness showed no recovery and died from lung infection; the left 1 patient was having aphasia. Conclusion DSA can accurately define ways and compensative ability of collateral circulation in elderly patients with serious stenosis or occlusion of the internal carotidartery, which can put forward reliable evidences for their treatments and prognoses.     

Evaluation of corticospinal tract injury with three-dimensional diffusion tensor tract in patients with acute cerebral infarction

Three-dimensional diffusion tensor tract (DTT) is the newest imaging to describe the structure of white matter fiber in three-dimensions, it has great significance in dividing the concrete anatomic site of gray and white matter lesions, displaying the correlation with fibrous band and judging clinical prognosis, which is incomparable by other imagings.OBJECTTVE: To observe the conditions of corticospinal tract (CST) in acute cerebral ischemic stroke patients,and analyze the relationship between motor function and the severity of CST injury.DESIGN: A case-control observation.SETTTNG: Department of Medical Imaging, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.PARTTCTPANTS: Fifteen patients with acute cerebral infarction were selected from Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from February to December in 2005. They all suffered from acute attack and motor disorder of hemiplegic limbs to different extent, and were conformed by CT or MRI.There were 9 males and 6 females, aging 16-87 years old, the median age was 51.7 years, and all were right handed. Fifteen right-handed normal subjects, who were matched by age and sex with the patients in the cerebral infarction group, were selected from the relatives of patients and physicians of the Imaging Department as the control group. All the subjects were informed and agreed with the study.METHODS: The patients with acute cerebral infarction and subjects in the control group received MR diffusion tensor imaging (DTI) with GE 1.5 T nuclear magnetic resonance system, fiber tracking with the software of dTV- Ⅱ. Fractional anisotropy (FA) maps and three-dimensional tractography of bilateral CST of all patients were created. Displacement, continuity and destroy of fibrous bands were observed. At the same time, muscle strength of ipsilateral hand of patients with cerebral infarction was measured with Brunnstrom standard. The correlation between the severity of CST injury and the muscle strength of ipsilateral hand was analyzed with spearman correlation analysis.MAIN OUTCOME MEASURES: ① FA values in the infarcted sites and those in the contralateral corresponding sites of patients with cerebral infarction; ② CST manifestations in the patients with cerebral infarction and the control group.RESULTS: All the 30 testees were involved in the analysis of results. ① The FA values in infarcted sites of white matter were significantly lower than those in the contralateral ones (t =4.570, P ＜ 0.001 ). ② In the control group, bilateral CST were reconstructed, they originated from precentral gyrus, went downwards to internal capsule, and extended to pontine and medulla oblongata, each fiber had good uniformity in continuous form. In the patients with cerebral infarction, the forms of contralateral CST were consistent with those in the control group with good continuity. Due to the involvement by the infarcted site to different extents, the ipsilateral CST manifested as continuous interruption and loss of uniformity in anatomic structure and form. The CST involvements were divided into three grades: integrated CST for grade I (n =2); integrated CST but compressed or displaced for grade 2 (n =5); interrupted CST for grade 3 (n =8). ③ The severity of CST injury was obviously correlated with the muscle strength of the ipsilateral hand (r=0.888, P＜ 0.05＝.CONCLUSION: ① CST is injured to different extents in patients with acute cerebral infarction, and the severity of injury is associated with muscle strength. It is indicated that it can be used to judge the prognosis of rehabilitative treatment. ②DTT can directly display the status of pyramidal tract more three-dimensionally.     

早期腔隙性脑梗死的临床与磁共振弥散加权成像

目的:从临床角度探讨磁共振弥散加权成像(diffusion weighted i maging,DWI)对早期腔隙性脑梗死(lacu-na cerebral infarction,LI)的诊断价值。方法:分析60例早期腔隙性脑梗死患者的临床资料,同时进行MRI常规序列及DWI序列检查,并由4位经验丰富的医师在不了解患者临床体征的情况下进行阅片,记录出病变所在的详细的神经解剖部位,对同一层面所有的磁共振像进行比较,重点分析信号强度和病灶大小。数据经统计学分析。结果:60例患者中高血压病45例(75%)、高脂血症21例(35%)、糖尿病18例(30%);常见临床类型为纯运动性轻偏瘫(PMH)及变异型20例,腔隙状态(LS)12例,无症状腔隙性梗死(ALI)10例,感觉运动性卒中(SMS)8例。病灶部位主要为尾状核(29.1%)、豆状核(23.3%)、放射冠(15.1%)、丘脑(10.5%)、内囊(7.0%)。60例患者中超急性期(≤6小时)20例,DWI扫描均检出病灶,常规MRI扫描均未检出病灶;急性期(7~24小时)患者22例,DWI扫描均检出病灶,DWI检出率为100%,而常规MRI共检出12例,检出率为55%(P<0.05)。DWI在超早期及急性期可显示T2加权像不能显示的病灶,并随时间延长显影范围逐渐增大。在T2加权像上可显示的病灶中,DWI可更清楚、更全面地显示病灶,大于T2病灶。结论:高血压病是LI的直接原因;腔隙病灶主要位于基底节,LS及ALI的检出率有上升趋势,DWI对早期LI的诊断显著优于常规MRI。DWI应作为早期LI的首选检查方法。     

Detection of intracranial aneurysms with unenhanced and echo contrast enhanced transcranial power Doppler

OBJECTIVE: To assess transcranial power Doppler and the effect of an intravenous ultrasonic contrast agent for detecting intracranial aneurysms in patients admitted with a subarachnoid haemorrhage METHODS: 203 patients with subarachnoid haemorrhage were examined with the operator blind to the results of the admission CT and subsequent digital subtraction angiogram (DSA). In 98 cases patients were imaged using unenhanced transcranial power Doppler, and in 105 cases, patients were imaged both using unenhanced and echo contrast enhanced (Levovist, Schering AG) transcranial power Doppler. RESULTS: DSA detected 168 intracranial aneurysms in 128 patients (24 patients had multiple lesions) and 75 patients had an aneurysm negative DSA. There was agreement between DSA and transcranial power Doppler in 87 intracranial aneurysms of which 20 were only detected after infusion of contrast agent. Without contrast infusion, transcranial power Doppler showed a sensitivity of 40% and specificity of 91%. A significant increase in detection was noted when using a contrast agent (chi(2) = 9.49, p<0.001). With a contrast study the sensitivity increase to 55% with a specificity of 83%. Intracranial aneurysm detection by transcranial power Doppler was significantly dependent on position using a contrast infusion (chi(2) = 15.87, p<0.05). A positive correlation was also found between the size of intracranial aneurysms measured by transcranial power Doppler and DSA (r = 0.55, p<0.05). The transcranial power Doppler sensitivity and specificity increased with larger aneurysms and reached 100% for intracranial aneurysms greater than 12 mm diameter. Detection by transcranial power Doppler was also dependent on morphology (chi(2) = 14.46, p<0.001). CONCLUSIONS: The detection of intracranial aneurysm by transcranial power Doppler is dependent on aneurysm location, size, and morphology and is enhanced with the use of an intravenous contrast agent.     

Identification of lacunar infarcts before thrombolysis in the ECASS I study

BACKGROUND: The identification of lacunar infarcts before thrombolysis would make it possible either to exclude them from treatment or to show that they also may benefit from it. OBJECTIVE: To determine whether clinical presentation or early CT findings of patients enrolled in the first European Cooperative Acute Stroke Study (ECASS I) trial would identify lacunar infarcts before treatment. METHODS: Predictive values, sensitivity, specificity, and accuracy of clinical presentation as pure motor hemiparesis (PMH) or sensorimotor stroke (SMS) syndromes and of baseline CT findings in predicting lacunar infarcts were calculated in the ECASS I patients. RESULTS: Of 514 patients, 44 placebo (17%) and 44 recombinant tissue plasminogen activator (rt-PA) (18%) patients had PMH/SMS involving at least two of three areas. Thirty-one placebo (12%) and 32 rt-PA (13%) patients had PMH/SMS involving three areas. The 7-day CT was compatible with a lacunar infarct in 32 placebo (12%) and 44 rt-PA (18%) patients. PMH/SMS involving at least two areas had a positive predictive value of 30% both in placebo and rt-PA patients, whereas positive predictive values of the involvement of three areas were 23% and 31%. Those of absence of early CT signs were 21% and 30%, and those of leukoaraiosis or previous lacunar infarcts were 21% and 23%. Positive predictive values of PMH/SMS involving at least two areas combined with absence of early CT signs were 36% in placebo and 33% in t-PA patients, and those of PMH/SMS plus leukoaraiosis or previous lacunes were 28% and 7%, respectively. CONCLUSIONS: In the ECASS I trial, lacunar infarcts were not recognizable on clinical grounds, and early CT findings, alone or in combination with the clinical picture, added poorly to the differential diagnosis.     

CTA对颅内多发动脉瘤的诊断准确性

目的探究三维CT血管造影技术(Three dimentional computed tomography angiography,3D-CTA)在诊断颅内多发动脉瘤方面的价值。方法回顾性分析2011年7月至2015年3月我科数字减影血管造影术(Digital subtraction angiography,DSA)诊断的74例颅内多发动脉瘤患者的CTA与DSA资料,对比两种检查方法对动脉瘤的检出差异。结果 DSA诊断动脉瘤177个,CTA诊断动脉瘤175个,以DSA为金标准,CTA正确检出动脉瘤171个,正确检出率96.6%,其中165个诊断正确,正确诊断率96.5%。CTA漏诊动脉瘤6个,误诊动脉瘤10个。结论CTA对颅内多发动脉瘤的检出率和正确诊断率均较高,但栓塞手术史、血管痉挛、动脉瘤大小、数目及阅片者经验影响CTA对多发动脉瘤的诊断,临床上有必要将其与DSA检查相结合,避免漏诊及误诊。     

急性脑梗死散在和单一弥散加权成像病损与其供血动脉狭窄的关系

目的 探讨急性脑梗死弥散加权磁共振成像(DWI)上大脑中动脉(MCA)供血区散在性或单一性缺血性病损与其脑供血动脉狭窄或闭塞的关系.方法 回顾性分析73例连续积累的DWI显示一侧MCA供血区脑梗死的病例,入组病例均排除心源性栓塞性脑梗死,所有患者均在发病24 h内进行MRI和MRA等检查,7例患者并进行DSA.采用DWI急性缺血性病损分类方法 分为散在病损组和单一病损组,比较两组的病灶同侧MCA、颈内动脉(ICA)颅内段和颅外段狭窄或闭塞的发生率.结果 散在病损组42例,单一病损组31例.在病损同侧ICA颅外段和MCA闭塞或重度狭窄方面两组差异有统计学意义(28.6%与0,x2=10.6,P=0.001).在病损同侧ICA颅内段并MCA轻中度狭窄方面,两组间差异具有统计学意义(31.0%与9.7%,x2=4.717,P=0.03).散在病损与MCA和(或)ICA严重或多发狭窄呈正相关(OR值为13.7,95%CI:3.6～52.5).在MRA或DSA未发现颅内外大血管狭窄方面,两组间差异具有统计学意义(11.9%与32.3%,x2=4.526,P=0.033).散在病损组与无明显血管狭窄呈负相关(OR值为0.284,95%CI:0.09～0.94).结论 (1)脑梗死急性期DWI显示的MCA区散在性病损患者,MCA和ICA狭窄、甚至闭塞的可能性较大,以ICA颅外段闭塞较为常见;(2)DWI显示单一病损时提示脑供血动脉狭窄程度较轻,范围较局限,小血管病变的可能性相对较高,很少为严重的ICA颅外段狭窄或闭塞.

Abstract：

Objective To investigate the relationship between scattered or single lesion of acute cerebral infarction in middle cerebral artery territory on diffusion-weighted imaging (DWI) and stenosis of middle cerebral artery (MCA) or internal carotid artery (ICA). Methods With exclusion of cardioembolism, 73 consecutive patients with acute cerebral infarction of the unilateral MCA territory on DWI were analyzed. All patients got magnetic resonance imaging (MRI) and angiography (MRA) within 24 hours after onset, and 7 patients also had digital subtraction angiography (DSA). The patients were classified into single lesion group or scattered lesions group according to the DWI findings. The incidence of stenosis or occlusion of ipsolateral MCA, intracranial and extracranial ICA were compared between the two groups. Results 42 patients had scattered lesions and 31 patients had single lesion. The scattered-lesions group had a high incidence of ipsilateral extracranial ICA or MCA occlusion or severe stenosis ( 25.6%versus 0, x2 = 10.6, P = 0.001 ) and a high incidence of ipsilateral intracranial ICA or MCA moderate or mild stenosis (31.0% versus 9.7% ,x2 =4.717, P =0.03 ). A positive correlation was found between the scattered lesions and severe or multifocal stenosis of ipsilateral ICA and MCA ( OR: 13.7, 95% CI: 3.6 to 52.5). There was a low incidence of absence of extra- and intracranial stenosis on MRA or DSA in the scattered-lesions group ( 11.9% versus 32.3%, x2= 4.526, P = 0.033 ). A negative correlation was found between the scattered lesions and absence of large-artery stenosis ( OR: 0.284, 95% CI: 0.09 to 0.94).Conclusions ( 1 ) Patients with acute cerebral infarction and scattered lesions on DWI were more likely to suffer from stenosis or occlusion of ICA or MCA, especially over the extracranial ICA. (2) Patients with single lesion were less likely to have severe or multiple stenosis of MCA and ICA, indicating the relevance of small-vessel pathogenesis.     

3D—TOF法磁共振血流成像对脑血管疾病的诊断价值

报告55例脑血管疾病的3D-TOF法和MRA和常规MRI(其中21例经DSA证实)。结果3D-TOF法MRA不仅能较为清晰地显示脑血管疾病的异常血管,且能作出定性、定位诊断。提出3D-TOF法MRA对脑血管疾病的诊断价值高于MRI、SPECT、X-CT,尤其是动静脉畸形、静脉型血管畸形(静脉瘤)、瘤体直径>5mn的动脉瘤和严重狭窄和闭塞的动脉。     

功能磁共振成像在脑梗死患者运动功能评价中的作用探讨

目的 利用功能磁共振成像（functional magnetic resonance imaging，fMRI）分析单侧放射冠梗死患者大脑半球的激活部位及偏侧化指数（laterality index，LI）与运动功能康复水平的关系。方法 选取12例单侧放射冠梗死的患者为卒中组，5例正常志愿者为对照组。所有入选者均进行血氧水平依赖功能磁共振成像（blood oxygenation level dependent-functional magnetic resonance imaging，BOLD-fMRI）检查，扫描设备为德国西门子3.0T磁共振扫描系统。试验采用Block设计，采取患手顺序对指任务。扫描结果采用统计参数图（Statistical Parametric Mapping，SPM2）进行数据分析和脑功能区定位，计算不同感兴趣区激活体素数目及LI。扫描结束后记录患者上肢运动功能评分（Fugl-Meyer评分，F-M评分），分析LI与F-M评分之间的相关性。结果 与对照组相比，卒中组脑部激活范围较广泛，表现为双侧运动传导通路的激活；双侧大脑半球、初级感觉运动区（sensory motor cortex，SMC）、第一躯体运动区（M1区）LI明显减少（P=0.004，0.008，0.027）。卒中组LI（半球、SMC、M1）与F-M评分之间的相关性无统计学意义（r=0.133，P=0.618；r=0.558，P=0.059；r=0.297，P=0.348）；卒中组最强激活点位于中央前回（Precentral gyrus，PRE）患者F-M评分较高（52±22），最强激活点位于中央后回（postcentral gyrus，POS）患者F-M评分较低（36±27），以上两组F-M评分之间差异无统计学意义（P>0.05）。结论 fMRI可以显示卒中患者运动康复过程中功能区的变化；单侧放射冠脑梗死后，与运动任务相关的脑区激活范围存在明显偏侧化现象；偏侧化程度与患者上肢运动功能之间可能无明显关系。     

颅内动脉瘤手术入路的选择

目的 探讨颅内动脉瘤手术入路的选择原则,以提高显微外科手术治疗动脉瘤的疗效。方法 1985年3月～2001年12月施行手术治疗经脑血管造影明确诊断的颅内动脉瘤患者362例,其中69例手术前行三维CT血管造影术。手术入路分为常规入路、颅底入路和匙孔入路,共11种方法。常规入路包括翼点入路(269例)、纵裂入路(23例)、颞下入路(9例)、枕下经大幕入路(2例)和枕下正中入路(3例);颅底入路分别为眶颧入路(3例)、额眶入路(6例)、岩骨入路(2例)及远外侧枕下入路(5例);匙孔入路有额下眶上匙孔入路(5例)和翼点匙孔入路(7例)。结果 手术前行三维CT血管造影检查的69例患者,与脑血管造影检查结果相一致。根据GOS评估标准,362例患者中恢复良好者278例(76.80％),轻残56例,重残13例,死亡15例,病死率为4.14％。手术后仅1例经额眶入路者发生眼底出血,其余均未发生与手术入路有关的并发症。结论 三维CT血管造影术可清楚地显示动脉瘤的形状、大小、瘤颈以及与相邻血管及解剖结构的关系,可为制定手术方案提供依据。翼点入路迄今仍是颅内动脉瘤手术的标准入路,适用范围广泛,颅底入路和匙孔入路虽各有所长,但仍不能取代翼点入路。     

不同临床类型的初发腔隙性脑梗死对患者认知功能的影响

目的 研究初次发病的腔隙性脑梗死患者的不同临床类型对认知功能的影响.方法 选择初次发病的腔隙性脑梗死患者91例,其中纯运动性轻偏瘫(PMH)25例(27.47%),纯感觉性卒中(PSS)13例(14.29%),感觉运动性卒中(SMS)17例(18.68%),共济失调性轻偏瘫(AH)和构音障碍-手笨拙综合征(DCHS)共15例(16.48%),其他类型21例(23.08%).于发病1周内进行神经心理学测验,包括简易精神状态检查量表、汉化的韦氏成人智力量表(数字广度、图片排列、数字符号和积木测验)、世界卫生组织-加利福尼亚洛杉矶大学听觉词语学习测验、简化的Rey复杂图形测验、Stroop测验、语义分类流畅性测验、加利福尼亚卡片分类测验和画钟测验.评估患者的认知功能情况.结果 SMS型的大部分认知功能测试为五型中最差.SMS型的WHO-UCLA听觉词语学习测验(F=4.074,P=0.005)与词语再认(击中-虚报)(F=2.952,P=0.024)评分低于其他四型,SMS型的大部分的记忆力评分较其他类型患者低(P＜0.05),尤其是低于PSS型和AH/DCHS型;SMS型在部分的执行能力和视空间结构能力方面较PMH型差(P＜0.05),差异有统计学意义.结论 SMS型患者在记忆力、执行能力和视空间结构能力方面的障碍较其他类型的初发腔隙性脑梗死患者更为严重,应加强重视和早期干预.     

DSA对颅内动脉瘤形态与体积的诊断价值

目的探讨DSA对颅内动脉瘤的形态与体积的诊断,统计各型颅内动脉瘤的检出率,为手术及血管内介入治疗提供直观依据。方法回顾性分析2009-01—2015-01我院120例经CTA、MRA、DSA确诊的颅内动脉瘤患者,CTA、MRA确诊者再行DSA检查,根据颅内动脉瘤形态学特点及大小,总结各型的检出率。结果根据颅内动脉瘤形态学特点分型:囊状动脉瘤(包括圆形、椭圆形、球形、葫芦形、漏斗形、哑铃型、分叶形、多角形、腊肠形、不规则形)检出率94.0%,梭形动脉瘤检出率4.2%,夹层动脉瘤检出率0.8%。根据颅内动脉瘤大小:小动脉瘤(直径0.5cm)检出率47.9%,一般动脉瘤(0.5cm≤直径1.5cm)检出率42.2%,大型动脉瘤(1.5cm≤直径2.5cm)检出率7.7%,巨型动脉瘤(直径≥2.5cm)检出率2.2%。结论 DSA对动脉瘤形态与体积作出准确诊断与直观显现,为手术及血管内介入治疗提供依据。