颅脑CT诊断甲状旁腺功能减退的价值：附14例报告

本文报道了甲状旁腺功能减退，低血钙，高血磷四肢抽搐１４例。ＣＴ表现：基底节，小脑齿状核，丘脑，尾状核，脑干及脑皮质与髓质之间对称性钙化。本文对甲旁减临床表现，病因，病理进行了讨论。     

Transcortical mixed aphasia with left frontoparietal lesions

We present a case of transcortical mixed aphasia following a left frontoparietal infarct caused by vasospasm after subarachnoid haemorrhage. Although CT showed low-density areas in the left frontal lobe and basal ganglia, single photon emission CT revealed a wider area of low perfusion over the entire left hemisphere, except for the left perisylvian speech areas. Hence, transcortical mixed aphasia may be caused by the isolation of perisylvian speech areas due to disconnection from surrounding areas.     

MRI of germinomas arising from the basal ganglia and thalamus

We reviewed the MRI findings of germinomas originating from the basal ganglia, thalamus or deep white matter in 13 patients with 14 germinomas, excluding those in the suprasellar or pineal regions. Ten cases were confirmed as germinomas by stereotaxic biopsy, three by partial and one by total removal of the tumour. Analysis was focussed on the location and the signal characteristic of the tumour, haemorrhage, cysts within the tumour and any other associated findings. Thirteen of the tumours were in the basal ganglia and one in the thalamus. Haemorrhage was observed in seven patients, while twelve showed multiple cysts. Associated ipsilateral cerebral hemiatrophy was seen in three patients. The signal intensity of the parenchymal germinomas was heterogeneous on T1- and T2-weighted images due to haemorrhage, cysts and solid portions. We also report the MRI findings of germinomas in an early stage in two patients. Received: 31 July 1997 Accepted: 6 January 1998     

肝豆状核变性的颅脑CT诊断(附39例报告)

目的分析肝豆状核变性的颅脑CT征象,进一步提高对W ilson病的认识及诊断的正确率。方法全部病例均行脑CT扫描,回顾性分析其CT征象及临床表现。结果31例壳核出现对称性带状或弓状向外新月形低密度区,形如“八字”或“展翅蝴蝶”样;3例尾状核头见卵圆形低密度区;4例丘脑见对称性卵圆形低密度区;1例脑实质内未见异常密度但有脑萎缩表现。全部病例均有不同程度的脑沟裂增宽等脑萎缩表现。结论肝豆状核变性颅脑CT最多见征象是脑萎缩与基底节低密度灶,特别是双侧豆状核区对称性低密度灶最具有特征性。     

Atrophy of the basal ganglia as the initial diagnostic sign of germinoma in the basal ganglia

Germ-cell tumors of the central nervous system generally develop in the midline, but the tumors can also occur in the basal ganglia and/or thalamus. However, MR images have rarely been documented in the early stage of the tumor in these regions. We retrospectively reviewed MR images obtained on admission and approximately 3 years earlier in two patients with germinoma in the basal ganglia, and compared them with CT. In addition to hyperdensity on CT, both hyperintensity on T1-weighted images and a small hyperintense lesion on T2-weighted images were commonly seen in the basal ganglia. These findings may be early MRI signs of germinoma in this region, and the earliest and most characteristic diagnostic feature on MRI was atrophy of the basal ganglia, which was recognizable before development of hemiparesis.     

Three-dimensional reconstruction and volumetry of intracranial haemorrhage and its mass effect

Intracerebral haemorrhage still causes considerable disability and mortality. The studies on conservative and operative management are inconclusive, probably due to inexact volumetry of the haemorrhage. We investigated whether three-dimensional (3-D), voxel-based volumetry of the haemorrhage and its mass effect is feasible with routine computed tomography (CT) scans. The volumes of the haemorrhage, ventricles, midline shift, the intracranial volume and ventricular compression in CT scans of 12 patients with basal ganglia haemorrhage were determined with the 3-D slicer software. Indices of haemorrhage and intracranial or ventricular volume were calculated and correlated with the clinical data. The intended measures could be determined with an acceptable intra-individual variability. The 3-D volumetric data tended to correlate better with the clinical course than the conventionally assessed distance of midline shift and volume of haemorrhage. 3-D volumetry of intracranial haemorrhage and its mass effect is feasible with routine CT examination. Prospective studies should assess its value for clinical studies on intracranial space-occupying diseases.     

甲状旁腺功能减退症的颅脑CT特征分析

目的探讨甲状旁腺功能减退症的颅脑CT表现及临床特点。方法对经临床确诊的甲状旁腺功能减退症11例患者进行颅脑CT平扫,将其cT表现进行分析。结果本组患者颅脑cT扫描均发现脑内有不同程度钙化,主要分布于双侧基底节区、丘脑、小脑齿状核、灰白质交界区及半卵圆中心,基底节区钙化为逗点状、三角形及倒八字形,丘脑钙化为斑点状,小脑齿状核钙化为肾形、片状,灰白质交界区钙化为钩子状,半卵圆中心钙化呈横行排列,而双侧内囊区未累及。脑内钙化部位频数依次为苍白球和壳核11例,丘脑10例,尾状核头部8例,小脑齿状核7例,额顶叶6例,半卵圆中心4例,枕叶2例。结论甲状旁腺功能减退症颅脑cT表现具有特征性,可为临床诊断提供可靠的影像学依据,结合低血钙、高血磷、甲状旁腺激素水平降低实验室检查即可明确诊断．     

氙气CT灌注用于脑血流及其储备功能的初步评价

目的:初步评价氙气CT(Xe-CT)脑血流灌注的临床应用价值.材料和方法:对6例健康人分别在静息状态和静脉注入乙酰唑胺(ACZ)后行Xe-CT脑血流灌注检查.用自动的皮质六分区模式和手工画法测量不同血管分布区的脑血流值(CBF),同时也测量了基底节各区和丘脑负荷试验前后的CBF.结果:基底节区的CBF最高;左侧丘脑的CBF高于同侧的尾状核和壳核,右侧也有这种趋势,但是没有统计学差异;两侧半球间脑血流没有统计学显著差异;注射ACZ后除了左侧丘脑外所有区域的脑血流均显著增加.结论:Xe-CT作为一种准确而无创的脑血流检查方法具有较高的临床应用价值.     

丘脑和基底节区生殖细胞瘤的MR影像

目的研究丘脑和基底节区生殖细胞瘤的MR影像特征。方法经手术及病理证实的丘脑和基底节区生殖细胞瘤17例,全为男性,年龄7～18岁,平均12.05岁。全部作了平扫和Gd-DTPA增强扫描。结果17例中,12例位于基底节区,2例位于丘脑,3例同时累及丘脑和基底节区,横断面上最大径65mm,最小径30mm,平均46.43mm,16例增强不均匀,11例无瘤旁水肿,5例水肿较轻,4例出现同侧大脑半球萎缩。结论丘脑和基底节区生殖细胞瘤的发病性别、年龄和MR影像表现具有一定特点,在多数情况下可作出术前诊断。     

家族性特发性基底节钙化的CT表现

目的探讨家族性特发性基底节钙化的CT表现。方法发生自两个家系两代5例特发性基底节钙化患者均经头颅常规CT扫描。对所有患者的CT表现、发病状况及临床表现结合文献复习进行回顾性分析。结果在CT像上,家族性特发性基底节钙化表现为双侧苍白球、尾状核、丘脑及齿状核的对称性钙化,钙化程度和年龄成正相关,钙化的先后顺序依次为苍白球→尾状核→丘脑→齿状核。5例患者中,1例男性35岁患者头部外伤后主诉头痛头晕,CT显示双侧基底节对称性钙化影。其父(65岁)与其弟(31岁)有类似于先证者的CT表现,但无神经精神异常;另一家系1例25岁女性患者因家庭纠纷出现精神抑郁,CT显示双侧基底节对称性钙化。其姐(31岁)有类似于先证者的CT表现,但无神经精神异常。结论家族性特发性基底节钙化具有明显的CT特征,但它是否为遗传性疾病以及何种遗传方式,尚需进一步研究。     

溴隐停及美多巴联合治疗脑外伤后迁延性植物生存状态的临床观察

目的研究溴隐停及美多巴联合治疗创伤性脑外伤（TBI）后迁延性植物生存状态（PVS）的临床价值及使用范围。方法对一组连续46例在常规治疗的基础上加用澳隐停及美多巴治疗的PVS病人的一般临床特点和CT特征与治疗结果进行观察分析。结果TBI后的PVS最多见于交通事故性脑外伤。除大脑皮质的损伤外,弥漫性轴素损伤（DAI）、深部核团的损伤、脑干上部的损伤、以及伤后包括基底节在内的弥漫性脑萎缩是PVS的主要病理类型。运用澳隐停及美多巴后,73．9％的PVS病人的意识状态及运动功能得到改善。结论在没有广泛大脑皮质损伤,主要表现DAI和脑深部核团损伤的PVS病人,增强大脑多巴胺系统的功能对PVS病人具有治疗作用。     

Dilated Virchow-Robin spaces in cryptococcal meningitis associated with AIDS: CT and MR findings

We present two patients with AIDS complicated by cryptococcal meningitis who displayed focal hypodense nonenhancing lesions in CT in the basal ganglia with corresponding areas of increased T2 and decreased T1 signal on magnetic resonance (MR). These lesions corresponded precisely to the distribution of the perforating arteries. Review of pathological specimens showed these lesions to be small cystic collections of cryptococcal organisms in the perivascular spaces of the arteries with minimal or no inflammatory reaction. The cryptococcal organisms spread from the basal cisterns through the Virchow-Robin spaces, dilating these spaces, to ultimately propagate in the basal ganglia, internal capsule, thalamus, and brain stem. Such lesions have been described as characteristic for cryptococcosis in the pathology literature before the AIDS epidemic, but the radiological manifestations have not been reported previously. The changes appear characteristic for cryptococcosis, which generally incites no host response in the form of perifocal edema or enhancement. These findings in a young adult, with otherwise normal CT or MR scans, may be the first indication that the patient has AIDS. The T2-weighted image sequences are more sensitive in the detection of these lesions when compared to CT or T1-weighted MR images.     

CT and MRI in severe hypophosphataemia with central nervous system involvement

We report a 38-year-old woman with extreme hypophosphataemia in whom CT and MRI disclosed bilateral lesions within the basal ganglia, thalamus and occipital lobes. After adequate substitution of phosphate the lesions grossly resolved and the patient recovered. This case is the first to demonstrate that profound changes of serum phosphate may be associated with reversible brain lesions. Received: 27 March 1999/Accepted: 16 June 1999     

Germinoma originating in the basal ganglia and thalamus: MR and CT evaluation.

PURPOSETo describe MR and CT features of germinoma originating in the basal ganglia and thalamus and to discuss the roles of each modality for its diagnosis.METHODSMR and CT studies of six cases of germinomas, five of which were histologically proved, were retrospectively reviewed. T1-weighted, T2-weighted, and contrast-enhanced T1-weighted conventional spin-echo images, and unenhanced and contrast-enhanced CT images were evaluated.RESULTSTypically, the tumor consisted of an irregular solid area with contrast enhancement and various-size cysts. Cystic components were found in five cases and calcification in four. Intratumoral hemorrhage was noted in one. Ipsilateral cerebral hemiatrophy and brain stem hemiatrophy were noted in three cases each. MR was superior to CT in evaluating precise tumor extension, cystic components, and intratumoral hemorrhage, although in one case, extension of the tumor was better defined on CT in its early stage. Calcification was difficult to identify by MR alone. The solid components of the tumors generally showed slightly high density on CT, which seemed to be characteristic compared with nonspecific intensity pattern on MR.CONCLUSIONThe combination of CT and MR findings allows early detection and appropriate diagnosis of the mass in the basal ganglia and/or thalamus.     

颅内生殖细胞瘤的CT和MRI表现

目的探讨颅内生殖细胞瘤的CT和MRI表现。方法经手术病理及放疗证实的颅内生殖细胞瘤19例,回顾性分析其治疗前CT和MRI图像。结果19例肿瘤中,12例位于松果体区,3例位于基底节区及丘脑,4例位于鞍区。松果体区肿瘤MRI呈长T1、等或长T2信号,边缘光滑,出血少见,CT呈均匀等密度或稍高密度,松果体钙化常被肿瘤包埋,增强呈均匀显著强化。鞍区肿瘤垂体柄增粗,垂体后叶正常短T1信号消失,肿瘤T1WI呈等信号,T2WI上信号可以表现为等或高信号,CT上肿瘤实体部分呈高密度,增强扫描有明显强化。基底节及丘脑肿瘤,呈弥漫性生长,瘤体较大,信号及密度不均匀,边缘欠清晰,出血多见,增强呈斑片或花环样强化。结论颅内生殖细胞瘤,根据发生性别、年龄和MR及CT影像表现具有一定特点,在多数情况下可做出术前诊断。     

儿童急性坏死性脑病的影像学分析

目的分析儿童急性坏死性脑病(ANEC)的颅脑影像学特征,探讨其对临床的指导价值。方法回顾性分析2013年1月至2018年10月武汉儿童医院22例确诊为ANEC患儿的临床及影像资料。患儿病初均有高热,前驱感染后迅速出现神经功能恶化。首次影像检查中,所有患儿均行头颅MRI检查,其中6例MRI检查前行头颅CT检查。MRI随访中,4例失访,6例仅行1次短期随访(<14 d),12例接受1~2次短期及1~4次长期随访(>14 d)。影像学检查重点观察丘脑、脑干、脑白质和基底节区等部位,以及整个随访中是否有出血及软化灶形成。结果所有ANEC患儿的影像学表现中均累及双侧丘脑,其他对称病变部位包括大脑白质(14例)、基底节区(15例)、脑干(16例)、小脑(9例)、胼胝体(2例)和海马(1例),不对称病灶患儿3例,分别见于大脑白质(2例)及小脑(1例)。最典型的头颅MRI表现为急性期在表观扩散系数(ADC)图上,丘脑呈"三色模式"(中央高信号和周围低信号环,以及丘脑周围高信号)或"双色模式"(丘脑中央低信号及边缘高信号)。影像学随访中,MRI上出现出血、脑软化可能提示临床预后差。结论ANEC为快速进展型脑病,具有典型影像学特点,出血、脑软化可能提示不良预后。     

Voxel-based analysis of MTR images: a method to locate gray matter abnormalities in patients at the earliest stage of multiple sclerosis

PURPOSE: To determine whether voxel-based analysis of magnetization transfer ratio (MTR) maps can provide evidence of a coherent pattern of gray matter (GM) macroscopic and microscopic tissue damage in patients at the earliest stage of multiple sclerosis (MS). MATERIALS AND METHODS: We acquired GM MTR maps in 18 patients with clinically isolated syndrome suggestive of MS (CISSMS), and 18 sex- and age-matched healthy controls. We evaluated the clinical status of the patients using the MS functional composite score and the expanded disability status scale. A two-sample t-test (P <0.0001, k=20, uncorrected for height threshold) was used to compare GM MTR maps from patients and controls on a voxel-by-voxel basis. We then extracted data from regions with t-values above the statistical threshold to verify the significance of differences using a nonparametric Mann-Whitney U-test. RESULTS: A between-groups comparison of GM maps revealed large abnormalities in the basal ganglia, including the bilateral thalamus, bilateral lenticular nucleus, bilateral head of caudate, and protuberance, and smaller abnormalities in the right insula, right BA 4, and left BA 40. The MTR measured in the left caudate and right insula was inversely correlated with duration following the first clinical event. CONCLUSION: These results suggest that although MS is a multifocal demyelinating disease that affects white matter (WM), a pattern of tissue damage is present inside the GM involving predominantly basal ganglia at the earliest stage of the disease.     

Innere Hirnvenenthrombose bei Colitis ulcerosa und leichtem Schädel-Hirn-Trauma

Thromboses of the cerebral veins which occur at a frequency of 3.75 to 9.3% in autopsy material are caused by local or systemic inflammatory processes, hematological disorders, neoplasms or traumatic brain damage. We report on a 14-year-old girl who suffered from colitis ulcerosa during the last 4 years of life. Immediately after a brawl with a schoolboy she complained of headache and vertigo, but no physical abnormality was detected by the physician. She was admitted to the hospital after becoming comatose during the following night. On neurological examination she was comatous with a decerebrate state, the pupils were small and non-reactive to light, divergent ocular bulbi and bilateral extensor plantar responses. A cerebral computer tomogramm showed a cerebral edema and a hemorrhage in the left basal ganglia and both cerebral ventricles which subsequently increased to the right cerebral ganglia, the corpus callosum and the right cerebral hemisphere. Despite antiedematous therapy the girl died on the second day after the brawl. A neuropathology examination revealed thrombosis of the superior sagittal sinus extending to the internal cerebral veins and a bilateral hemorrhagic infarction of the thalamus and the basal ganglia with intraventricular hemorrhage. As the thrombus in the sagittal sinus showed signs of organisation, a postraumatic origin alone is improbable and a hemorrheological disorder due to colitis ulcerosa seemed to be the main cause.     

A follow-up study by CT and MRI in 3 cases of Japanese encephalitis

Summary A follow-up study by CT and MRI in 3 cases of Japanese encephalitis (JE) was performed. Neurologically dementia, forced laughing, tetraplegia and parkinsonism were observed as sequelae. In the CT and MR scans about 3 years after the onset of JE, low-density areas (LDAs) or abnormal signal intensities had remained in the thalamus and basal ganglia. The abnormalities were also found in the brain stem. When the main lesions shown by CT and MRI were compared with those of the acute stage, T2-weighted MRI clearly revealed multiple small areas with high signal intensities, although those in the acute stage had shown diffuse abnormal signals. These findings may be useful in helping to identify JE a long time after the onset.     

Recovery from primary deep cerebral venous sinus thrombosis with recanalisation

A 50-year-old woman with idiopathic deep cerebral sinus and vein thrombosis (DCVT) had cerebellar disturbance prior to impaired consciousness. CT and MRI revealed haemorrhagic infarction in the cerebellum and signal changes suggesting infarction in the thalamus and basal ganglia bilaterally. The straight sinus and internal cerebral vein (ICV) were dense on CT. On angiography, the vein of Galen (VG) and straight sinus were not seen. Following clinical recovery, CT and MRI became normal, and angiography showed recanalization of the VG and ICV. The relationship between cerebellar infarction and DCVT, and signal changes on CT and MRI are discussed.