MR在颅脑CT立体定向术中的应用

为减少单纯的颅脑ＣＴ立体定向术的盲目性，本文研究ＭＲ辅助下颅脑ＣＴ立体定向术方法的建立，通过对６３例病例在ＭＲ指导下脑ＣＴ立体定向术的成功应用，作者发现将ＭＲ三维成像能力及优良的软组织对比度应用在颅脑ＣＴ立体定向的术前靶点，框架平面和穿刺道的预设置上可以明显提高ＣＴ立体定向术的安全性和准确性，并为颅脑溶部肿瘤的立体定向后装治疗创造了条件，作者认为应用颅外解剖表记在ＭＲ指导下行颅脑ＣＴ立体定向术是行     

磁共振定位在帕金森病立体定向手术中的应用

目的　探讨磁共振 (MR)定位功能性立体定向手术的精确性及可靠性。方法　 1 0 0例帕金森病患者 ,术前行磁共振检查。选择丘脑Vim核、Gpi为手术靶点。采用正中矢状位T1 加权像 ,轴位、冠状位T1 成像及加权反向恢复序列扫描。手术后整体疗效评价 ,“开”状态改善率为 79 7% ,“关”状态改善 91 3%。结果　MR能清晰显示丘脑、Gpi、视束、内囊等重要结构 ,靶点定位准确。结论　①MR组织分辨率高、能清晰显示靶点区重要结构 ,达到直接解剖定位。②MR严格按照正中矢状位以及平行于头架的轴位成像。③在直视解剖靶点下直接测出数据 ,而不是采用传统的图谱坐标。④保证立体定向仪平行于AC -PC线、缩短手术时间、减少脑脊液外流的措施 ,保证靶点精确定位都同样重要     

磁共振成像在功能性立体定向靶点定位中的应用

目的：探讨磁共振成像在功能性立体定向靶点定位中的精确性及可靠性。方法：对100例帕金森病患者,进行MRI导向,选择靶点：左侧丘脑Vim核、苍白球腹后部（PVP）各15例,丘脑Vim核 PVP24例;右侧丘脑Vim核12例,PVP10例,丘脑Vim核 PVP24例,定位方法采用CRW立体定向仪,采用Philps GyroscanNT1,0tesla磁共振成像诊断仪扫描,在轴位影像上依据苍白球内侧部与内囊明确的分界,确定PVP的靶点,在冠状位上可直接观察到PVP、视束、内囊及丘脑腹外侧与比邻结构的关系。如果选择丘脑Vim核或PVP靶点,则在冠状位上和轴位上可直接选定该靶点。结果：采用本方法实施100帕金森病患者立体定向手术,测量AC-PC线长为22.0-32.3mm。平均25.3mm,确定PVP与视束间距1.0-2.0mm,至内囊距离2.0-3.0mm,手术后复查MR、CT,结果显示靶点定位准确,结论：（1）MR成像不仅组织分辨率高、多功能,多层面扫描,能清晰显示丘脑,PVP、视束,内囊等重要结构,达到直接解剖定位。（2）MR成像严格按照正中矢状位以及平行于AC-PC线的轴位影像,并在冠状位,矢状位、轴位验证靶点,（3）MR确定Vim、PVP与视束间距后,在直视解剖靶点下直接测出数据,而不是采用传统的靶点坐标,手术中通过微电极纪录细胞外电活动也证实了MR解剖定位精确性的原因是多方面的,因此,保证立体定向仪在头部固定牢靠、减少头部移动、缩短手术时间、减少脑脊液外流的措施,保证靶点精确定位都同样重要。     

颅内肿瘤立体定向放射治疗后MR变化及意义

目的：探讨颅内肿瘤立体定向放射治疗（ＳＲＴ）后的ＭＲ变化及意义。方法：收集资料完整的３８例颅内肿瘤的ＭＲ影像资料,其中胶质肿瘤１３例,脑膜瘤７例,转移瘤６例,听神经瘤５例,生殖细胞瘤４例,垂体瘤２例,三叉神经瘤１例。病例均采用１．０Ｔ超导型ＭＲ扫描仪检查。结果：颅内肿瘤立体定向放射后ＭＲ发生以下变化,（１）肿瘤中央长ＴＩＷ、Ｔ２Ｗ信号改变,周边强化;（２）瘤体失强化或囊变;（３）瘤灶变化可分为完全消失、明显缩小、轻度缩小或基本不变和增大;（４）瘤周不同程度水肿。结论：立体定向放射治疗后,肿瘤信号、病灶大小及瘤周可发生一系列生物学变化,ＭＲ能准确客观反映其变化特征,为临床确认颅内肿瘤性质,能否ＳＲＴ治疗或其他治疗提供可靠依据。     

帕金森病定向术磁共振靶点定位

目的　探讨帕金森病立体定向术核磁共振靶点定位最佳扫描方式。方法　 72例帕金森病患者行磁共振导向结合微电极记录定位 ,丘脑腹中间核 (Vim)毁损术。分为两组 ,采用中反转恢复序列 (IR)扫描直视定位和常规自旋回波 (SE)扫描解剖间接定位。以术中微电极记录和射频刺激验证确定的毁损靶点为标准 ,观察毁损靶点与影像定位靶点坐标的一致性 ,统计两种MRI定位方式下预定靶点与毁损靶点坐标符合率 ,结合疗效分析评价两种定位法。结果　 34例行IR扫描直视定位术中靶点符合率为 88.2 % ,38例行SE扫描间接定位术中靶点符合率为 31.6 %。两种定位法存在显著差异 (P <0 .0 5 )。MRI直视定位较解剖间接定位电生理靶点符合率高。结论　IR序列是MRI帕金森病立体定向靶点影像定位的优选扫描方式。其个体化直视定位靶点对提高疗效、减少并发症发生具有重要意义     

松果体瘤立体定向术下近距离内放疗

目的探讨松果体瘤颅脑立体定向术下近距离内放疗(SIRBT)的价值.方法在MR引导下对9例松果体瘤实施SIRBT.肿瘤平均直径为3.8cm.利用MR确定肿瘤的边界和空间几何,贯穿肿瘤生长轴的理想穿刺道,确定肿瘤治疗计划.结果后装管留置与术前计划符合.间质内放疗后肿瘤均迅速缩小,内放疗后肿瘤平均缩小为85%(78～96%),所有病人临床体症均有迅速减轻.结论间质内放疗是治疗松果体瘤理想的选择.     

脑立体定向术在癫痫外科治疗中的应用

脑立体定向术在癫痫外科治疗中的应用常义随着神经电生理、神经影象学和立体定向技术的发展和日臻完善，脑立体定向术已逐渐成为顽固性癫痫外科治疗的重要方法之一。本义结合近年有关文献和实践经验对该治疗方法有关问题进行讨论，以供商榷。概述癫痫是一种常见的严重疾病...     

MR imaging and CT of pituitary abscess: Case report and review

Abstract

Pituitary abscess is a rare disorder. However, preoperative diagnosis is important to prevent a cranial approach leading to severe meningitis. A case of a 55 year-old woman with pituitary abcess is reported. The patient was admitted with a several-week history of frontal headache and no signs of inflammation. Computed tomographic (CT) scan showed a slightly low-density suprasellar expanding mass lesion with an enhanced thin wall in the pituitary region. Magnetic resonance imaging showed a homogenous high- intensity signal relative to brain parenchyma on T1 -weighted images with an enhanced thin wall and a homogenous low-intensity signal on T2-weighted images. This was histologically shown to be a pituitary abscess. Our case and review of the available literature suggest that pituitary abscess generally shows a homogenous low-density on CT scan and a homogenous low- to iso- and high-intensity signals or homogenous high- and low-intensity signals on T1- and T2-weighted images, respectively, with a cystic appearance and enhanced smooth wall. [Neurol Res 1996; 18: 495-498]     

Hyperkinetic movement disorders caused by corpus striatum infarcts: brain MRI/CT findings in three cases.

Three patients with hemichorea/hemiballismus/hemidystonia caused by discrete contralateral infarction of the corpus striatum are presented. The infarcts were all small on CT or MRI brain scan and were lacunar in type. Small discrete infarction of basal ganglionic structures allows such adventitious movements to be manifested. Involvement of contiguous areas, seen with larger infarcts, can suppress such movements. The infrequency of such hyperkinetic movement disorders, and the subtle infarct appearance on brain scan, can lead to a delay in the diagnosis.     

Does Swedish amateur boxing lead to chronic brain damage? 2. A retrospective study with CT and MRI

It is well known that professional boxers can develop chronic traumatic encephalopathy (dementia pugilistica) due to repeated head trauma. Beside CT findings indicating cerebral atrophy, the presence of a cavum septum pellucidum has been reported to indicate encephalopathy. CT findings in amateur boxers are not as well documented. The aim of this study was to find out if morphological changes could be demonstrated among former amateur boxers using CT and MRI. Two control groups of soccer players and track and field athletes in the same age-range were used for comparison. No significant differences in the width of the ventricular system, anterior horn index, width of cortical sulci, signs of vermian atrophy, or the occurrence of a cavum septum pellucidum were found between boxers and controls. A cavum septum pellucidum was found more often in the controls than in the boxers and is probably not a sign of earlier head trauma. MRI confirm no more findings than CT in this retrospective study.     

磁共振仿真内窥镜在脑动脉血管方面的初步应用

目的探讨磁共振仿真内窥镜在脑血管方面的临床应用。方法运用磁共振彷真内窥镜技术对50例受检者脑动脉血管进行观察,并与常规MRI、MRA、DSA及临床资料对比。结果正常29例,表现为类圆形的光滑的管腔,沿血管中心轴线观察,可见同心圆样图像。并可观察到7～8级以上的分支血管;血管病变21例,包括:血管狭窄9例,动脉瘤6例。结论磁共振仿真内窥镜可通过血管内膜面的光滑程度、侧壁开口形态及数目、管腔大小等对病变进行判断,为诊断及治疗提供更多信息。     

螺旋CT血管造影在脑动脉瘤诊断及治疗中的应用兼与MR血管造影比较

目的探讨无创性的螺旋CT血管造影(SCTA)与MR血管造影(MRA)对脑动脉瘤的诊断价值以及对治疗的指导价值,并对两者作比较。方法28例病人同时行SCTA、MRA、DSA,以DSA作为金标准,对SCTA与MRA作比较。结果①23例行SCTA及时间飞跃法(TOF)MRA者,SCTA诊断脑动脉瘤的准确性高于TOFMRA(P<0.05)。②SCTA较TOFMRA测量脑动脉瘤的最大径准确性高(P<0.01),TOFMRA测量值常偏小。③SCTA测量的栓塞治疗最佳投照角度与DSA符合率94.7%。④动态增强(DCE)MRA的图像清晰度及价值与SCTA相似。结论SCTA对体积小、破裂出血的脑动脉瘤的诊断准确性以及对动脉瘤测量的精确性高于TOFMRA,SCTA可较准确地测量动脉瘤栓塞治疗的最佳投照角度,DECMRA是脑动脉瘤电解可脱弹簧圈栓塞术后随访的较好方法,DCEMRA的实用价值与SCTA相似。     

The value of CT and very low field MRI in the etiological diagnosis of dizziness

A total of 79 dizziness patients were examined by either computed tomography (CT), or very low field magnetic resonance imaging (MRI), or both. In most cases, the patients were selected for the neuroimaging because preliminary clinical examination had suggested central nervous system (CNS) involvement. Abnormal CT or MRI findings with probable clinical relevance to the etiology of dizziness were obtained in 34%. The most common abnormalities were atrophy, infarction, and demyelination.; 29% of the CT scans and 40% of the MRI showed relevant abnormalities. The present results emphasize the diagnostic usefulness of head CT and MRI when dizziness of CNS etiology is suspected.     

The earliest MR imaging and proton MR spectroscopy abnormalities in adult-onset Krabbe disease

BACKGROUND: Adult-onset Krabbe disease is an uncommon form of leukodystrophy. Its magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) manifestations are not well documented. AIM OF THE STUDY: To describe early MR findings in adult-onset Krabbe disease. MATERIALS AND METHODS: A 28-year-old woman who had spastic paraparesis and a 5-year history of gait problems underwent MRI of the brain and cervical spine. Proton MRS was performed at 1.5 T using a short echo time. Metabolites were analyzed in the areas of MR signal abnormalities and normal-appearing brain. Six healthy volunteers were examined as controls. RESULTS: MRI revealed changes in the upper corticospinal tracts, splenium and, minimally, adjacent to the atria of the lateral ventricles. MRS showed decreased creatine, choline, N-acetylaspartate and glutamate and probably elevated lactate in the upper corticospinal tract but not in the normal-appearing frontal lobe. The spinal cord was thin. Laboratory tests verified Krabbe disease. CONCLUSIONS: These results indicate early involvement of the upper corticospinal tract in adult-onset Krabbe disease. The cases reported earlier had imaging changes indicating a more advanced disease or no MR findings. Thinning of the spinal cord is a new finding in Krabbe disease.     

影像学引导的立体定向脑活检手术

目的探讨现代神经成像技术(CT、MRI)引导的立体定向脑病变活检术对组织病理学诊断的可靠性和正确性,总结手术操作方法和技术要点。方法采用CT、MRI与立体定向技术相结合,进行脑部病变的活检手术共605例,其中450例用CT或MRI片目测靶点坐标定位,155例采用计算机辅助的立体定向手术(CAPN)工作站,自动计算靶点和规划活检入路。结果522例确诊为各种脑肿瘤,39例为炎性病理,23例为寄生虫或先天性囊肿,16例未能提供可供确诊的病理,阳性诊断率为97.36%。并发症15例,其中2例死亡。结论先进影像技术引导下的立体定向脑病变活检术是神经内、外科脑部病变获得定性诊断安全、可靠的手术方法。术中应注意改进操作方法,以提高病理诊断的阳性率,并达到微侵袭性手术的要求。     

Acute Pediatric Encephalitis Neuroimaging: Single-Institution Series as Part of the California Encephalitis Project

PurposeDiagnosing pediatric encephalitis is challenging because of varied clinical presentation, nonspecific neuroimaging features, and rare confirmation of causality. We reviewed acute neuroimaging of children with clinically suspected encephalitis to identify findings that may correlate with etiology and length of stay.MethodsImaging of 141 children with clinically suspected encephalitis as part of The California Encephalitis Project from 2005 to 2012 at a single institution was reviewed to compare the extent of neuroimaging abnormalities to patient age, gender, length of stay, and unknown, possible, or confirmed pathogen. Scan review was blinded and categorized by extent and distribution of abnormal findings.ResultsAbnormal findings were evident on 23% (22/94) of computed tomography and 50% (67/134) of magnetic resonance imaging studies in the acute setting. Twenty children with normal admission computed tomography had abnormal findings on magnetic resonance imaging performed within 2 days. Length of stay was significantly longer among children with abnormal acute magnetic resonance imaging (P < 0.001) and correlated with increased complexity (Spearman rho = 0.4, P < 0.001) categorized as: no imaging abnormality, meningeal enhancement and/or focal nonenhancing lesion, multifocal lesions, confluent lesions, and lesions plus diffusion restriction, hemorrhage, or hydrocephalus. There was no correlation between neuroimaging findings and an identifiable pathogen (P = 0.8).ConclusionAbnormal magnetic resonance imaging findings are more common than abnormal computed tomography findings in pediatric encephalitis. Increasing complexity of magnetic resonance imaging findings correlated with disease severity as evidenced by longer length of stay, but were not specific for an identifiable pathogen using a standardized diagnostic encephalitis panel.     

Familial cerebral cavernous angiomas

Three families with two or more members affected by cavernous angiomas of the brain are described and the other 17 reported in the literature are reviewed. The familial occurrence of cerebral cavernous angiomas has been considered a rare event; nevertheless, the experience of the authors (positive familiarity in three patients where two or more relatives have been explored radiologically) suggests that cavernous angiomas of the brain might be, at least in most cases, a familial disease. Therefore, when a patient with cerebral cavernous angioma is observed, a careful familial history and the exploration of the familial members by computerized tomography or better still by magnetic resonance must be performed. The high frequency of multiple lesions in familial cases, the surgical indications and the role of the ultrasonic prenatal diagnosis are also discussed.