6例同心圆硬化患者的临床及影像学特征分析

目的探讨同心圆硬化的临床特征、影像学表现、治疗及预后。方法回顾性分析6例同心圆硬化患者的临床表现、影像学特征、病理结果、治疗及随访。结果 6例患者中,男4例、女2例,年龄23~63岁(平均发病年龄为41.8岁)。均呈急性或亚急性起病。首发症状:主要为偏侧肢体无力3例;其他临床症状:包括共济失调3例,智能减退2例,反应迟钝2例,病理征阳性3例。头颅MRI检查有同心圆样特征性改变。3例行立体定向脑组织活检,病理检查证实符合同心圆硬化改变。结论同心圆硬化常急性或亚急性起病,以运动障碍、精神异常、智能减退为主要临床表现,MRI检查有诊断价值,激素治疗常有效,预后多良好。     

Marchiafava-Bignami病的临床及影像学研究

目的 探讨Marchiafava-Bignami病(MBD)的临床及影像学改变.方法 回顾性分析了7例MBD患者的临床和CT、MRI资料,包括病灶形态、分布、信号或密度改变等影像学特征:4例同时行CT和MRI检查,2例仅行CT检查,1例仅行MRJ检查.结果 本组患者急性型5例,均表现为胼胝体肿胀及长T1、长T2信号改变,均有双侧脑室周围白质、额叶皮层下白质对称性累及:慢性型2例,胼胝体明显萎缩变薄,并呈长T1、长T2信号及FLAIR像点片状或线样低信号灶.5例患者DWI显示病灶区信号明显增高并有2例出现弥散受限改变.结论 MBD具有特征性MRJ表现,其影像学改变可能反映其临床及预后.     

急性脑梗死患者临床表现与磁共振扩散加权成像和磁共振血管成像的相关性分析

目的：分析急性脑梗死患者的临床表现与磁共振扩散加权成像（DWI）和磁共振血管成像（M RA ）的相关性。方法回顾性分析51例急性脑梗死患者行DWI和M RA检查的临床资料,分析影像学特征。结果 DWI检查显示51例急性脑梗死患者均为高信号,而M RA检查显示阳性患者38例。结论对于急性脑梗死患者,DWI能够早期定位病灶及其性质, M RA能够显示颅内大血管狭窄或闭塞位置与程度,动态检测溶栓治疗效果,二者结合在指导临床和判定预后方面具有重要的作用。     

扩散加权成像诊断散发性Creutzfeldt-Jakob病价值

目的评价扩散加权成像(DWI)对散发性Creutzfeldt-Jakob病的临床诊断价值。方法回顾性分析21例临床诊断为很可能Creutzfeldt-Jakob病患者临床和MRI资料,总结其DWI特征。结果21例散发性Creutzfeldt-Jakob病患者DWI表现为大脑皮质"飘带"样高信号、尾状核和(或)豆状核高信号。异常信号发生部位以大脑皮质合并基底节区最常见(16例,76.19%),单纯皮质受累3例(14.29%)、单纯基底节区受累2例(9.52%);大脑皮质病灶中以额叶受累最常见(15例,78.95%),其次依次为顶叶(13例,68.42%)、颞叶(12例,63.16%)和枕叶(9例,47.37%)。与常规MRI相比,DWI显示病灶更清晰,病灶部位表观扩散系数值下降。21例中5例随访时,DWI高信号强度和范围有所变化,仅1例异常信号范围缩小。结论散发性Creutzfeldt-Jakob病的DWI表现具有一定特异性,推荐作为拟诊散发性Creutzfeldt-Jakob病的检查方法。     

桥脑梗死患者临床及影像学特点

目的分析经磁共振成像(MRI)证实的15例桥脑梗死患者的临床及影像学特点。方法通过对15例桥脑梗死患者进行常规MRI和弥散加权成像(DWI)扫描,比较同一层面的所有磁共振图像,分析其临床表现及影像学特点。结果除1例急性桥脑梗死患者的临床表现符合经典定位理论外,其余大部分桥脑梗死患者均以一侧中枢性面、舌瘫,肢体偏瘫为主要临床表现。15例患者经MRI和DWI扫描,均可发现梗死灶,其中1例为发病3 h内的超急性期患者,DWI可见病灶显影,T_2WI未见异常。随着时间的推移,DWI逐渐变为等信号和低信号。结论大部分桥脑梗死患者的临床表现与幕上大脑半球基底核区的梗死相似。DWI可以显示超急性期桥脑梗死病灶,DWI结合T_2WI有助于多次脑梗死患者责任病灶的确定。     

TIA患者不同b值磁共振弥散加权成像研究

目的观察短暂性脑缺血发作(TIA)患者磁共振弥散加权成像(DWI)提高b值后的影像学表现,探讨TIA患者DWI高b值的临床应用价值。方法收集2014年3月至2015年3月在河北医科大学第二医院临床诊断的TIA而结构影像学(CT,MRI)无责任病灶的TIA患者44例,所有患者均在发病3 d内行常规MRI和不同b值DWI(b=1000、b=2000和b=3000)检查。比较DWI不同b值对TIA责任病灶的敏感性、病灶范围及图像伪影的影响,定量分析TIA责任病灶的体积大小、ADC值变化。结果提高DWI b值,并没有提高发现TIA患者责任病灶的敏感性,但可以发现部分病例存在更多层面的责任病灶。定性分析发现全部患者的责任病灶随着b值的提高,病灶显示更明显,在25例DWI阳性病例中有12例,12/25例患者责任病灶的范围有所增加。当b值过度提高(b=3000),会降低图像的质量,导致伪影加重,而不易区分真正的责任病灶。定量分析发现随着b值的提高,责任病灶的平均体积也在增加(P<0.05),而ADC值却在下降(P<0.05)。结论提高DWI b值(b=2000,b=3000)更有助于反应TIA患者责任病灶的体积,有助于发现潜在的微小的不易发现的病灶,但b值过度提高(b=3000)会降低图像的质量,因此建议取DWI(b=2000)对诊断及评估TIA患者更有优势。     

脑梗死磁共振弥散加权成像信号改变和近似弥散系数的时间演变规律

目的 :确定脑梗死磁共振弥散加权成像 (DWI)信号改变和近似弥散系数 (ADC)的时间演变规律。方法 :分析 10 1例脑梗死患者的 13 5次DWI资料。结果 :超急性、急性和亚急性期脑梗死DWI为高信号 ,慢性早期多数病灶仍为高信号 ,慢性晚期绝大部分病灶为等或低信号。超急性期、急性期和亚急性期脑梗死ADC下降 ,慢性早期多数病灶接近或高于正常 ,慢性晚期明显升高。结论 :脑梗死的DWI信号和ADC变化具有特征性的时间演变规律 ,结合常规MRI ,DWI可以推断脑梗死所处的时期     

DWI和MRA在超急性期脑梗死中的临床应用

目的探讨磁共振弥散加权成像(DWI)和血管成像(MRA)在超急性期脑梗死中的临床应用价值。方法回顾性分析48例超急性期脑梗死患者的临床和磁共振资料,全部患者均行CT、常规MRI、DWI和MRA检查。结果 48例超急性期脑梗死的CT、常规T2WI、FLAIR及DWI阳性率分别为0、16.7%、37.5%和100%,MRA显示靶血管正常4例,动脉硬化36例,狭窄16例,闭塞8例。结论 DWI联合MRA能够准确显示责任病灶及靶血管受累情况,为超急性期脑梗死早期溶栓治疗提供切实可行的影像学依据。     

早期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 imagine,DWI)对早期脑梗死的诊断价值和确定DWI在区分常规MRI上所示的多发梗死灶中急性梗死方面的能力。方法 60例脑梗死均进行MRI常规程序及DWI（程度检查,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,重点分析信号强度的病灶大小。数据经统计学分析。结果 DWI对超急性合肥市急性期脑梗死可显示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。在急性后期,常规MRI及DWI均有较清晰的影像学改变,恢复期及慢性期,DWI影像学逐渐改变变成等信号、杂信号,部分为囊性信号,且不易显示病灶。结论 DWI能非常可靠地显示超急性及急性脑梗死,而在急性后期及慢性期不如T2WI。其具有区分急性和非急性脑梗死的能力。     

多发性硬化的磁共振成像研究进展

不断发展的磁共振成像(MRI)新技术,如磁化传递成像(MTI)、扩散加权成像(DWI)、扩散张量成像(DTI)、磁共振波谱(MRS)、MR灌注成像(PWI)、功能磁共振成像(fMRI)等,为多发性硬化(MS)研究提供了新的视角,在MS的早期诊断、鉴别诊断、病程进展监测、疗效评估、病理机制及神经心理变化等方面发挥越来越重要的作用。     

颅内原发性淋巴瘤DWI及PWI表现

目的 探讨颅内原发性淋巴瘤扩散加权成像(DWI)和灌注加权成像(PWI)特点.方法 回顾性分析10例颅内原发性淋巴瘤的DWI表现和9例颅内原发性淋巴瘤的PWI特征,所有病例均经病理证实,并结合其病理特征与高级别(Ⅲ、Ⅳ级)星形细胞瘤作对照.结果 颅内原发性淋巴瘤DWI多呈均匀高信号,肿瘤实质ADC值为(79.73±10.21)×10-5mm2/s,明显低于高级别星形细胞瘤ADC值(99.81±19.57)×10-5mm2/s(P=0.002).9例行PWI检查,颅内原发性淋巴瘤肿瘤实质最大rCBV比值为1.71±0.59,而14例高级别星形细胞瘤肿瘤实质最大rCBV比值为5.17±1.73,与高级别旱形细胞瘤比较,颅内原发性淋巴瘤呈低灌注趋势(P=0.001).结论 颅内原发性淋巴瘤DWI、PWI具有一定的特征,术前行DWI、PWI有助于提高MRI对颅内原发性淋巴瘤的诊断水平.     

Linking structural, metabolic and functional changes in multiple sclerosis

In patients with multiple sclerosis (MS), conventional magnetic resonance imaging (MRI) has markedly improved our ability to detect the macroscopic abnormalities of the brain and spinal cord. New quantitative magnetic resonance (MR) approaches with increased sensitivity to subtle normal-appearing white matter (NAWM) and grey matter changes and increased specificity to the heterogeneous pathological substrates of MS may give information complementary to conventional MRI. Magnetization transfer imaging (MTI) and diffusion-weighted imaging (DWI) have the potential to provide important information on the structural changes occurring within and outside T2-visible lesions. Magnetic resonance spectroscopy (MRS) adds information on the biochemical nature of such changes. Functional MRI might quantify the efficiency of brain plasticity in response to MS injury and improve our understanding of the link between structural damage and clinical manifestations. The present review summarizes how the application of these MR techniques to the study of MS is dramatically changing our understanding of how MS causes irreversible neurological deficits.     

磁共振检查对基底动脉血栓形成患者的诊断价值

目的了解磁共振检查对基底动脉血栓形成患者的诊断价值。方法17例经证实为基底动脉血栓形成的患者于发病后48h时内接受磁共振T2加权成像、磁共振血管成像、弥散加权成像检查。结果所有患者都在磁共振血管成像上可见基底动脉血流信号消失和一侧或双侧椎动脉血流信号消失；弥散加权成像可见后循环区域不同形态散在分布的多发梗死灶；T2 成像可发现基底动脉内血栓形成。结论磁共振血管成像检查对颅内血管闭塞有较高的敏感性，弥散加权成像对后循环供血区域梗死灶的诊断能力优于传统影像学检查。     

Diffusion-weighted imaging in brain aspergillosis

Brain aspergillosis is a rare pathology, occurring mainly in immunocompromised patients, responsible for multiple cerebral septic infarctions. Some researchers have described magnetic resonance (MR) findings in cerebral invasive aspergillosis, but diffusion-weighted imaging (DWI) has rarely been reported, especially in typical non-enhancing lesions, while it may be helpful for early differential diagnosis and may allow earlier antifungal treatment. We describe three cases of patients presenting brain aspergillosis, with MR imaging including diffusion-weighted sequences and apparent diffusion coefficient (ADC) cartography. The three patients described in this study presented a total of 23 circular lesions, and one patient presented an infarction area in the territory of the right middle cerebral artery. Lesions were ring-enhancing for one patient, and presented no enhancement for the other two. Eleven lesions were very bright on DWI, with reduced ADC values. Twelve lesions, either enhancing or not enhancing, presented a 'target-like' aspect with central and peripheral hypointense areas on DWI, corresponding to higher ADC value areas, and intermediate marked hypersignal on DWI. This typical aspect of aspergillosis lesions on DWI may allow early diagnosis and treatment of cerebral aspergillosis, and is helpful for differentiating aspergillosis lesions from other infectious or malignant lesions affecting immunocompromised patients.     

Higher cerebral dysfunction in a case with atypical multiple sclerosis with concentric lesions

Abstract A patient with atypical multiple sclerosis (MS) with clear concentric structure was studied using high field magnetic resonance imaging (MRI). This case was considered to be Balo's concentric sclerosis. Magnetic resonance imaging showed diffuse multiple concentric demyelinating lesions in the bilateral centrum semiovales, which finally regressed with the necrotic lesions remaining when the patient was discharged. During his clinical course, he showed some higher cerebral dysfunctions, such as memory disturbance, constructual apraxia and acalculia. He was treated with glycerin, prednisone and rehabilitation; all of which were effective in his recovery. Over a 4 month period, the patient recoveredclinically, but some intellectual impairment remained.     

MRI study of Baló's concentric sclerosis before and after immunosuppressive therapy

Summary An intra vitam diagnosis of Baló's concentric sclerosis in a 39-year-old male is described. To our knowledge this is the first reported case of ante-mortem diagnosis based solely on magnetic resonance imaging (MRI) findings. MRI showed features unique to this process. After high-dose intravenous therapy with prednisone, the clinical symptoms improved, and MRI showed marked changes of the concentric lesions.     

磁敏感加权成像在出血性脑梗死诊断中的初步应用

目的探讨磁敏感加权成像（SWI）诊断出血性脑梗死的临床价值。方法20例亚急性期出血性脑梗死患者分别行常规MRI、扩散加权成像（DWI）和SWI检查,根据图像分析结果比较不同扫描序列所显示的梗死灶内出血灶数目及其阳性检出率;测量SWI序列出血最大层面出血灶面积和T2WI序列梗死灶最大层面的梗死灶面积,并行相关分析;观察SWI序列对梗死灶内静脉血管的显示程度,以及梗死灶以外区域微出血灶的诊断敏感性。结果20例患者SWI序列均显示梗死灶内出血,两名医师共诊断43个出血灶,其中SWI序列显示42个、T1WI序列25个、DWI序列15个、T2WI序列12个;SWI序列阳性检出率与T1WI、T2WI、DWI序列相比,差异具有统计学意义（X^2=51．516,P=0．000）。T2WI序列梗死灶最大层面的梗死灶面积为（18．08±12．47）cm^2,SWI为（5．02±6．27）cm^2,梗死灶面积与出血灶范围之间呈明显正相关（r=0．562,P=0．010）。其中,13例患者SWI序列检出梗死灶以外区域的微出血灶;12例显示梗死灶内小静脉血管分支减少和（或）变细,6例血管增多、增粗和（或）扭曲。结论SWI序列对出血性脑梗死病灶内出血的显示优于常规MRI和DWI序列,并能显示梗死灶内静脉血管的变化及梗死灶以外区域的微出血灶,可作为诊断出血性脑梗死的MRI常规扫描序列。     

磁敏感加权成像在出血性脑梗死诊断中的初步应用

目的 探讨磁敏感加权成像(SWI)诊断出血性脑梗死的临床价值.方法 20例亚急性期出血性脑梗死患者分别行常规MRI、扩散加权成像(DWI)和SWI检查,根据图像分析结果比较不同扫描序列所显示的梗死灶内出血灶数目及其阳性检出率;测量SWI序列出血最大层面出血灶面积和T2WI序列梗死灶最大层面的梗死灶面积,并行相关分析;观...     

Correlation between magnetic resonance imaging and clinical parameters in multiple sclerosis

In this study, the course of 60 consecutive multiple sclerosis patients (relapsing-remitting (RR), relapsing-progressive (RP), primary-progressive (PP)) was compared with the number and mean size of the lesions as well as the total load of the lesions as shown on magnetic resonance imaging (MRI). Significant differences were found between RR and RP patients in total load and number of lesions. Between RR and PP patients statistical significant differences were found in total load, number and size of the lesions when correlated with EDSS. Between RP and PP patients statistical differences were found in total load and size of the lesions on MRI. Patients with a relapsing course of the MS (RR or RP) had a higher total load and size of the lesions than PP patients. The total load, number and size of the lesions corrected for EDSS were also lower compared to relapsing patients. Factor analysis showed a correlation between clinical progression rate and progression rate of MRI abnormalities. No correlation between EDSS and total load of MRI lesions could be found. In conclusion, this study confirms the results of previous studies of differences between MRI scans of patients with a different course of MS.     

The value of diffusion-weighted imaging in the diagnosis of Marchiafava-Bignami disease: apropos of a case.

Marchiafava-Bignami disease (MBD) is characterized by demyelination and necrosis of corpus callosum encountered in chronic alcoholic patients. Etiology is the deficiency of vitamin B complex. Magnetic resonance imaging (MRI) in MBD typically reveals focal lesions of high T2 and FLAIR signal intensity in the corpus callosum. We here present a 42-year-old male alcoholic diagnosed as MBD on the basis of MRI and diffusion-weighted imaging (DWI) features. The patient totally recovered following appropriate vitamin B complex replacement therapy, despite reduced diffusion in the initial setting. This case report emphasizes on the important role played by MRI and DWI in the early diagnosis and follow-up of this potentially fatal disease.