磁共振波谱MEGA-PRESS序列检测帕金森病纹状体γ-氨基丁酸的研究

目的 探讨MEGA-PRESS波谱编辑序列结合LCModel软件检测帕金森病(PD)患者双侧纹状体γ-氨基丁酸(GABA)浓度的价值.方法 选取符合诊断标准的45例PD患者和47例正常对照组作为研究对象,均行MEGA-PRESS波谱编辑序列扫描,获取GABA/Cr值;再应用LCModel软件获取GABA浓度.结果 (1)与对照组相比,PD组双侧纹状体GABA平均浓度升高,差异有统计学意义(P=0.045);GABA/Cr值均值升高,但无统计学意义(P=0.183).(2)PD患者症状严重侧的同侧、对侧纹状体GABA/Cr值及GABA浓度比较,无显著性差异(P＞0.05).(3) PD组双侧纹状体GABA浓度均值与临床病程、统一帕金森病评定量表(UPDRS)评分无显著相关性(r=0.108,0.031;P-0.438,0.823).结论 MEGA-PRESS序列结合LCModel软件可以较准确、客观检测PD患者纹状体GABA浓度.     

地中海贫血患儿造血干细胞移植后脑弓形虫病2例

例1, 男, 5岁, 因"造血干细胞移植术后43 d, 发热7 d"入院。入院后反复发热, 并逐渐出现精神症状, 颅脑磁共振成像可见多发病灶, 脑脊液及血液宏基因组二代测序检出高弓形虫序列, 未能及时治疗, 疾病进展死亡。例2, 男, 9岁, 因"造血干细胞移植术后4个月, 发热4 d"入院, 入院后反复发热, 偶伴头痛, 血液及脑脊液宏基因组二代测序检出高弓形虫序列, 脑脊液弓形虫PCR阳性。经及时予复方磺胺甲噁唑及阿奇霉素治疗后病情好转, 随访1年, 复查颅脑磁共振成像可见病灶逐渐缩小。     

眼眶淋巴瘤的影像学特征与病理对比分析

目的 分析眼眶淋巴瘤(orbital lymphoma)的CT及MRI表现特征,探讨其影像学诊断的价值.方法 回顾分析9例淋巴瘤患者的CT及MRI所见,并与病理结果相对照,其中7例行CT扫描,4例行MRI扫描.结果 均为单侧发病,其中右眶7例,左眶2例;部位以隔前眶周、外上象限多见;其中2例为局限性肿块影,呈条索状或结节状,边界清楚,密度(信号)均匀,其余为弥漫性肿块,多沿肌锥外间隙及眼环向眶内呈"铸型"浸润生长,与周围组织关系紧密.增强扫描病灶呈中度及以上均匀强化.结论 眼眶淋巴瘤的CT、MRI表现具有一定的特征性,尤其是MRI检查能准确定位及一定程度的定性,有助于临床治疗.     

常规MRI和1H-MRS在职业性锰暴露致中枢神经损害中的应用价值

Objective MRI and MR hydrogen proton spectroscopy (1H-MRS) were used to detect the abnormal signal and alteration of metabolites, in order to explore the efficacy of these method in evaluating the damages of central nervous system (CNS) induced by occupational manganese exposure.Methods Eighteen workers exposed to manganese without any manganism symptoms, 12 workers with slightly chronic manganese poisoning, and 19 healthy workers were scanned using routine MRI sequence and 1H-MRS.The blood manganese concentration was also collected for each subject.On cerebral axial T1 WI,the signal intensities of ipsilateral globus pallidus and frontal white matter were measured in the visually brightest area (try to select the signal homogeneous region), and the globus pallidus index (PI) was then calculated.The 1H-MRS data was calculated to get the values of the peak height of N-acetylaspartate (NAA), choline (Cho), inositol (mI) and creatine (Cr) and the ratios of NAA/Cr, Cho/Cr, and mL/Cr were also calculated.One way ANOVA was used to compare the values of PI, NAA/Cr, Cho/Cr, mI/Cr and MnB among the three groups, and the correlations between PI and the time span of manganese exposure or blood manganese concentration were analyzed by Pearson correlation analysis.Eight workers exposed to manganese were followed up one year, and their PI , NAA/Cr before and after follow-up were compared by t test.Results Fourteen of 18 cases exposed to manganese without any manganism symptoms showed symmetrically high intensity signal on T1 WI, while the T2 WI were normal.No high signal intensity was observed on T1WI in any of the healthy workers or manganese poisoning workers.We found that the average PI in manganese exposed group (1.16 ±0.09) was significantly higher (F =24.79 ,P =0.O00)than those of the poisoning ( 1.05 ± 0.07 ) and control groups ( 1.01 ± 0.05 ).The blood manganese concentration in manganese exposed group, the poisoning group and the control group were (0.051 ±0.024), (0.047 ±0.018 ), ( 0.043 ± 0.020 ) μg/ml respectively, which was not significantly different ( F = O.623, P =0.541 ) and did not exceed the upper limit of normal reference value ( < 0.10 μg/ml ).There was a significantly correlation between PI and the time span of manganese exposure ( r = 0.67, P = 0.002 ),however, there was no correlation between PI and blood manganese concentration ( r = 0.20, P = 0.427 ).Furthermore, the NAA/Cr ratio decreased variously in the manganese poisoning group ( 1.22 ± 0.07 ) which was significantly lower( F = 4.120, P = 0.023 ) than those of the poisoning( 1.33 ± 0.13 ) and control groups ( 1.31 ±0.13).No statistical significanees were found in the ratios of Cho/Cr and mI/Cr among these three groups(P>0.05).No obvious changes of the PI and NAA/Cr were found in the 8 manganese exposed workers after 1 year follow-up.Conclusion Manganese exposure could lead to the high intensity signal on T1 WI, therefore the increased PI may be the biomarkers of central nerve system damages caused by the occupational manganese exposure.     

常规MRI和1H-MRS在职业性锰暴露致中枢神经损害中的应用价值

Objective MRI and MR hydrogen proton spectroscopy (1H-MRS) were used to detect the abnormal signal and alteration of metabolites, in order to explore the efficacy of these method in evaluating the damages of central nervous system (CNS) induced by occupational manganese exposure.Methods Eighteen workers exposed to manganese without any manganism symptoms, 12 workers with slightly chronic manganese poisoning, and 19 healthy workers were scanned using routine MRI sequence and 1H-MRS.The blood manganese concentration was also collected for each subject.On cerebral axial T1 WI,the signal intensities of ipsilateral globus pallidus and frontal white matter were measured in the visually brightest area (try to select the signal homogeneous region), and the globus pallidus index (PI) was then calculated.The 1H-MRS data was calculated to get the values of the peak height of N-acetylaspartate (NAA), choline (Cho), inositol (mI) and creatine (Cr) and the ratios of NAA/Cr, Cho/Cr, and mL/Cr were also calculated.One way ANOVA was used to compare the values of PI, NAA/Cr, Cho/Cr, mI/Cr and MnB among the three groups, and the correlations between PI and the time span of manganese exposure or blood manganese concentration were analyzed by Pearson correlation analysis.Eight workers exposed to manganese were followed up one year, and their PI , NAA/Cr before and after follow-up were compared by t test.Results Fourteen of 18 cases exposed to manganese without any manganism symptoms showed symmetrically high intensity signal on T1 WI, while the T2 WI were normal.No high signal intensity was observed on T1WI in any of the healthy workers or manganese poisoning workers.We found that the average PI in manganese exposed group (1.16 ±0.09) was significantly higher (F =24.79 ,P =0.O00)than those of the poisoning ( 1.05 ± 0.07 ) and control groups ( 1.01 ± 0.05 ).The blood manganese concentration in manganese exposed group, the poisoning group and the control group were (0.051 ±0.024), (0.047 ±0.018 ), ( 0.043 ± 0.020 ) μg/ml respectively, which was not significantly different ( F = O.623, P =0.541 ) and did not exceed the upper limit of normal reference value ( < 0.10 μg/ml ).There was a significantly correlation between PI and the time span of manganese exposure ( r = 0.67, P = 0.002 ),however, there was no correlation between PI and blood manganese concentration ( r = 0.20, P = 0.427 ).Furthermore, the NAA/Cr ratio decreased variously in the manganese poisoning group ( 1.22 ± 0.07 ) which was significantly lower( F = 4.120, P = 0.023 ) than those of the poisoning( 1.33 ± 0.13 ) and control groups ( 1.31 ±0.13).No statistical significanees were found in the ratios of Cho/Cr and mI/Cr among these three groups(P>0.05).No obvious changes of the PI and NAA/Cr were found in the 8 manganese exposed workers after 1 year follow-up.Conclusion Manganese exposure could lead to the high intensity signal on T1 WI, therefore the increased PI may be the biomarkers of central nerve system damages caused by the occupational manganese exposure.     

磁敏感加权成像检测帕金森病患者黑质铁含量

目的 探讨磁敏感加权成像(SWI)检测帕金森病(PD)患者黑质铁含量的应用价值.方法 42例PD患者(PD组)和41例健康人(对照组)均行SWI检查,选取相位图进行数据分析,背侧及腹侧黑质各选取3个等大圆形感兴趣区(ROI),分别测量每个ROI相位偏移值,利用公式计算出相位值.结果 与对照组比较,PD组黑质相位值减小(P＜0.05);PD组黑质前、中、后部位相位值及黑质腹侧、背侧相位值均低于对照组(P＜0.05);PD组症状明显侧黑质相位值与对侧黑质相位值比较,差异无统计学意义(P＞0.05).结论 PD患者黑质铁含量呈同步性增加;选取黑质内多个ROI研究黑质相位值,能较客观、整体评价PD患者黑质铁含量变化.     

脊髓栓系综合征27例的MRI诊断

目的探讨脊髓栓系综合征（TCS）的MRI表现及临床价值。方法27例脊髓栓系综合征患者均行胸椎、腰椎、骶部MRI扫描,并与手术和/或病理结果相对照。结果27例TCS中MRI扫描示脊髓圆锥低位27例,脊髓终丝增粗24例,终丝、马尾粘连22例,脊柱裂20例,脊髓缺血性改变及脊髓空洞16例,脊髓脊膜膨出14例,腰骶管发育不良13例,椎管内脂肪12例,椎管内外及皮下脂肪堆积10例,脊膜膨出5例,腰骶部皮毛窦4例,椎体畸形3例,脊柱侧弯畸形3例。结论MRI具有良好的组织分辨率,是脊髓栓系综合征首选检查方法,可为其诊断与手术提供准确的影像学资料。     

重症手足口病的中枢神经系统MRI表现

目的 探讨重症手足口病(hand-foot-mouth disease,HFMD)中枢神经系统病变的MRI表现.方法 回顾性分析35例确诊为重症HFMD住院患儿临床及MRI影像资料,均行头颅MRI常规扫描,其中4例加做脊髓MRI扫描.结果 35例患儿MRI检查,25例为阴性表现,临床上无明显的神经系统定位体征;10例为阳性表现(男8例,女2例,平均年龄2岁4个月),其中5例病变累及脑干及节段脊髓,5例病变累及深部核团、两侧半卵圆中心及额、顶叶脑白质区.MRI影像表现,病变呈斑点、斑片状、条带状,等或稍长T1稍长T2信号,FLAIR呈高信号,1例FLAIR呈等信号,急性期病灶边界模糊,脑干、脊髓外形稍增粗.结论 MRI在重症HFMD的中枢神经系统病变诊断中具有重要的价值.