大脑脚血管周围间隙的MR表现及解剖分析

目的:分析总结大脑脚血管周围间隙MRI表现及解剖学特点,提高其与其他疾病的影像鉴别诊断能力.方法:随机选择200例颅脑磁共振检查的患者,显示有大脑脚血管周围间隙的病例43例.所有病例均常规行T1WI、T2WI、FLAIR及弥散加权成像,其中10例行MR增强扫描,7例行CT检查,2例行CT增强扫描.随机选取1例脑干大脑脚标本,5μm连续切片,选取3张切片行常规HE染色,观察大脑脚血管周围间隙及其形态.结果:其中年龄<20岁者3例,20～60岁者23例,>60岁者17例.43例血管周围间隙MRI表现为单侧或双侧多发,呈圆形或椭圆形、点状、条状或线状,多成簇出现,沿着大脑脚背侧分布,边界清晰锐利.MRI不同序列显示间隙信号与脑脊液信号相似,增强扣描无强化.小血管周围间隙见于任何年龄组的所有43例病例,而10例可见大血管周围间隙,其中1例有轻度占位效应.解剖标本中1例清晰可见血管周围间隙,表现为血管外裂隙状无染色区.结论:大脑脚血管周围间隙可见于任何年龄段,呈条形或线形、圆形或卵圆形,边界清晰锐利,无或轻度占位效应,MR成像各种序列显示与脑脊液信号相似.     

鞍区蛛网膜的显微外科解剖学研究

目的：了解鞍区蛛网膜的解剖学特点，为鞍区病变的显微手术提供解剖学依据。方法：采用显微外科技术解剖和观察8例脑标本鞍区蛛网膜。结果：鞍区蛛网膜包括颈内动脉内侧蛛网膜、颈内动脉外侧蛛网膜、后交通蛛网膜、脉络膜前蛛网膜、大脑前蛛网膜、视交叉蛛网膜、Liliequist膜、外侧裂蛛网膜、嗅神经蛛网膜、基底动脉分叉蛛网膜、后穿蛛网膜和动眼神经外侧蛛网膜，分割鞍区蛛网膜下腔，与下丘脑和动眼神经关系密切。结论：（1）颅内蛛网膜分为颅底蛛网膜、凸面蛛网膜和小梁蛛网膜；（2）鞍区蛛网膜与下丘脑关系密切，手术时强调锐性分离；（3）鞍区蛛网膜汇聚于动眼神经，为术中解剖和保护动眼神经提供了可靠的界面。     

MR评价胎儿后颅窝池扩张的临床价值

目的探讨MR评价胎儿后颅窝池扩张的临床价值。方法参照目前较为公认的标准:胎儿后颅窝池深度≥10mm即为后颅窝池扩张,回顾分析56例胎儿后颅窝池扩张的检查结果。结果将ECM分为10mm-13mm、13.1mm-14.9mm、≥15mm三个组,其中10mm-13mm组39例占69.6%(单纯性小脑延髓池扩张37例、蛛网膜囊肿2例),13.1mm-14.9mm组14例占25.0%(单纯性小脑延髓池扩张8例、蛛网膜囊肿6例),≥15mm组3例占5.4%(Dandy-walker畸形2例、蛛网膜囊肿1例)。结论 MR可清晰准确地显示胎儿后颅窝的发育情况,是产前检查的重要手段,经MR检查获得胎儿后颅窝数据可为围产期检查提供重要参考依据。     

胎儿胼胝体发育不全产前MRI的诊断价值

目的探讨产前胎儿胼胝体发育不全的MRI诊断价值。方法运用磁共振快速扫描序列进行扫描,回顾性分析21例胎儿胼胝体发育不全的MRI表现。结果本组胎儿胼胝体发育不全中完全性胼胝体缺如15例,胼胝体部分缺如6例,其中11例伴有其他先天性脑部畸形,交通性脑积水2例,脑萎缩1例,脑室扩大伴枕大池增宽2例,Dandy-Walker畸形2例,蛛网膜囊肿1例,中线脂肪瘤1例,脑纵裂池蛛网膜囊肿1例,灰质异位1例。结论 MRI对胎儿胼胝体发育不全有较高的诊断价值,在产前超声怀疑胼胝体异常时,MRI是最好的补充手段,其能明确诊断胼胝体是否缺如,是否伴有其他脑部畸形,为临床提供可靠的诊断依据,对预后评估具有重要价值。     

24孕周胎儿标本听小骨3.0 T MR影像的解剖形态观察

目的探讨24孕周胎儿标本听小骨3.0 T MR影像的解剖形态。方法以1具24孕周流产胎儿冷冻标本为研究对象, 女性, 发育指标正常, 双顶径62 mm, 头围22.3 cm, 腹围18.9 cm, 身长27.5 cm, 体质量580 g。使用西门子3.0 T MR对胎儿标本的双侧颞骨进行扫描, 获取中耳的各向同性薄层MR断层图像。选取山东大学解剖教研室胎儿标本库中的1具25孕周发育指标正常的女性胎儿标本的颞骨CT扫描图像, 以及1例来山东省妇幼保健院就诊的发育正常的2岁儿童颞骨CT图像, 将CT图像与24孕周流产胎儿的MRI进行形态结构对照。观察项目:观察胎儿听小骨的MRI信号特点;比较CT图像与MRI对听小骨的显示效果;经多向调整多平面重组(MPR), 分别显示锤骨、砧骨、镫骨及相关结构的典型断层解剖形态, 标识重要解剖结构;通过最大密度投影(MIP)重组对听骨链进行三维显示。结果 (1)MRI信号特点:胎儿听小骨在MR T2WI上显示为低信号, 其中骨化完全部分呈明显低信号、未完全骨化部分为较低信号;中耳鼓室中充满羊水, 表现为均匀T2WI高信号, 在羊水信号衬托下, 听小骨可清晰...     

经脉络膜裂颞部到环池的显微解剖

目的:研究经脉络膜裂颞部到环池的解剖特点,为经脉络膜裂入路治疗环池区域病变提供解剖学依据。方法:经10%甲醛固定的完整成人湿性尸头标本10例(20侧),观察脉络膜裂颞部的神经血管结构,显微镜下模拟经脉络膜裂颞部到环池手术入路。结果:脉络膜裂颞部是位于侧脑室颞角内侧壁的一条自然裂隙,从丘脑枕下方的房部向前延伸进入颞叶,脉络膜前动脉自环池经下脉络膜点进入侧脑室颞角,是辨认脉络膜裂颞部顶点的标志;经脉络膜裂颞部可从环池的外上方显露环池内的结构,对环池内的大脑后动脉P2段、基底静脉、颞叶内侧海马、中脑等结构有良好的显露,而对于位置较低的滑车神经、小脑上动脉等结构显露欠佳。结论:脉络膜裂颞部及环池周围神经血管结构复杂,熟悉其解剖特点十分重要,经脉络膜裂入路为治疗环池及颞叶内侧病变提供了一条良好的路径。     

慢 性 胰 腺 炎 MR 诊断

目的探讨磁共振(MR)多种成像技术对慢性胰腺炎诊断的准确性及其临床应用价值。方法选择25例经手术病理、临床追踪和其他影像学方法证实的慢性胰腺炎MRI进行回顾性分析,其表现包括胰腺形态和体积改变、信号特征、动态增强扫描和MRCP所见。检查方法包括平扫冠状位T2WI,轴位T1WI,轴位T2WI,轴位T1WI FS(脂肪抑制)序列,磁共振胰胆管水成像(MRCP),动态增强前后的T1WI FS序列。结果胰腺体积弥漫性增大、T1WIFS病变区信号减低、动态增强扫描同步强化及串珠状扩张胰管穿透病变区是慢性胰腺炎的典型表现。结论MRI能更早发现慢性胰腺炎,显示胰管的改变和假性囊肿,对慢性胰腺炎诊断具有重要价值。     

垂体柄增粗病变的MR诊断

目的:通过总结14例垂体柄增粗病变的MR表现,探讨引起垂体柄增粗病变诊断和鉴别诊断。方法:14例垂体柄增粗病变,均行MR平扫及增强检查,经手术切除或穿刺,病理证实。结果:2例生殖细胞瘤,Rathke囊肿3例,1例垂体结核,2例垂体转移瘤,4例垂体腺瘤,2例下丘脑星形细胞瘤。源自垂体柄的生殖细胞瘤及Rathke囊肿MR信号不同;垂体的腺瘤、转移瘤、垂体结核均表现为垂体增大,临床资料及增强扫描对鉴别病变非常重要;下丘脑的星形细胞瘤强化有特异性。结论:垂体柄增粗的病变MR诊断有一定的特异性,鉴别诊断需要结合那个部位,磁共振信号、增强特点,临床病史进行综合分析。     

侧裂池蛛网膜结构及其与大脑中动脉分级关系的解剖学研究

目的研究颅内侧裂池蛛网膜层次及其和大脑中动脉(MCA)各级分支间的关系及其临床意义。方法取成人尸头6例(12侧),显微镜下观察外侧裂膜性结构层次及侧裂池构成,解剖MCA各支分布及其和膜性层次间的关系。结果侧裂池由外向内共有4层蛛网膜结构,分别是远外侧侧裂膜(FLSa)、外侧侧裂膜(LSa)、中间侧裂膜(MiSa,内层和外层)和内侧侧裂膜(MeSa)。12侧标本中,4层膜性结构均完整的6侧。FLSa通常菲薄,覆盖在侧裂浅静脉表面,和静脉外膜粘连紧密;LSa相对致密,构成了侧裂池的真正外侧壁,并分隔MCAM3和M4段;沿MCAM3段走行,有相对菲薄的MiSa浅层覆盖并将其固定在侧裂池内;在M2和M3段交汇处,见相对致密的MiSa深层,包绕M3段起始部,并将侧裂池分为前后两部,3侧标本中该层菲薄稀疏,呈网眼状;而在M1和M2段间有非常致密的MeSa,分隔侧裂池和颈内动脉池,5侧标本中,该膜菲薄呈网眼状。结论侧裂池蛛网膜的分层分布和MCA各级动脉关系密切,掌握其解剖特点有利于术中充分解剖侧裂池和颈内动脉池。其膜性分布的个体化差异,可能影响MCA动脉瘤的出血方式。     

颈静脉孔区的解剖学结构与影像显示

目的:探讨颈静脉孔区正常解剖结构特点及影像学表现,为该区疾病诊断、手术治疗提供解剖学与影像学依据.方法:取10个成人头颅标本(20侧颈静脉孔)通过采用Fisch颞下窝手术入路进行解剖和观察,测量相关解剖学数据;采用MSCT与MR对10名健康自愿者进行头颅扫描,获取MSCT与MR影像表现,将测得数据进行统计学分析.结果:在20侧颈静脉孔中,有18侧(90%)的舌咽神经和迷走神经之间存在纤维性硬膜,颞突比较恒定,枕突少见,3侧(15%)有完整骨桥;舌咽神经、迷走神经、副神经都有很多根丝,迷走神经根丝可多达13条;右侧颈静脉球高度高于左侧,P<0.05.MSCT颅底层面可清晰显示颈静脉孔大小、形态及其内颞突、枕突、骨桥等骨性结构;MR3D-TOF法可显示颈内动脉、基底动脉、大脑后动脉等血管影像.结论:颈静脉孔区解剖结构复杂,通过颈静脉孔区的解剖学和影像学研究,能够为颈静脉孔区骨质消磨术和该区血管病变手术提供客观依据,从而降低该区手术对神经、血管的损伤,提高手术疗效.     

Foramen magnum arachnoid cyst induces compression of the spinal cord and syringomyelia: case report and literature review

It is very rare that a foramen magnum arachnoid cyst induces compression of the spinal cord and syringomyelia, and currently there are few treatment experiences available. Here we reported the case of a 43-year-old male patient who admitted to the hospital due to weakness and numbness of all 4 limbs, with difficulty in urination and bowel movement. MRI revealed a foramen magnum arachnoid cyst with associated syringomyelia. Posterior fossa decompression and arachnoid cyst excision were performed. Decompression was fully undertaken during surgery; however, only the posterior wall of the arachnoid cyst was excised, because it was almost impossible to remove the whole arachnoid cyst due to toughness of the cyst and tight adhesion to the spinal cord. Three months after the surgery, MRI showed a reduction in the size of the arachnoid cyst but syrinx still remained. Despite this, the symptoms of the patient were obviously improved compared to before surgery. Thus, for the treatment of foramen magnum arachnoid cyst with compression of the spinal cord and syringomyelia, if the arachnoid cyst could not be completely excised, excision should be performed as much as possible with complete decompression of the posterior fossa, which could result in a satisfying outcome.     

骶管内蛛网膜囊肿的诊断及治疗体会

目的 探讨骶管内蛛网膜囊肿的发病机理、临床特点及治疗方法。方法 9例患者经MRI检查确诊，全部采取手术摘除治疗。结果 随访9例，时间8月～5年，平均2．8年，手术摘除治疗骶管内囊肿的疗效满意，随访中未发现囊肿复发和神经损伤再加重。结论 骶管内囊肿是相对常见的疾病，好发于40岁以上人群，与退变性腰椎疾病的临床表现有很大的相似处，易误诊；本病最好的诊断方法是行腰骶椎MRI检查；治疗以手术切除囊肿壁为主，具有较好的疗效。     

骶管内蛛网膜囊肿的诊断及治疗体会

目的探讨骶管内蛛网膜囊肿的发病机理、临床特点及治疗方法.方法 9例患者经MRI检查确诊,全部采取手术摘除治疗.结果随访9例,时间8月～5年,平均2.8年,手术摘除治疗骶管内囊肿的疗效满意,随访中未发现囊肿复发和神经损伤再加重.结论骶管内囊肿是相对常见的疾病,好发于40岁以上人群,与退变性腰椎疾病的临床表现有很大的相似处,易误诊;本病最好的诊断方法是行腰骶椎MRI检查;治疗以手术切除囊肿壁为主,具有较好的疗效.     

侵袭性纤维瘤病的影像分析及组织病理学分析

目的 分析侵袭性纤维瘤病的影像特点,以及组织病理学特征。方法 回顾性分析2013年1月～2018年3月湖北省荆门市第一人民医院经术后病理证实的 15例AF患者的 CT 和 MRI表现,及MR与组织病理对照分析。结果 15 例患者全部行 CT 平扫,8例行CT增强;9例行 MRI平扫,6例行MRI增强。CT 平扫示13 例呈不均匀等、低密度,2 例呈较均匀稍低密度;12例边界不清,3例边界清楚;CT 增强8例均呈渐进性不均匀明显强化。MRI平扫提示T1WI、T2WI、压脂、DWI等序列肿瘤均为不均匀信号,夹杂不规则低信号,肿块边缘呈爪形浸润或边缘不清。MRI增强 6例均呈不均匀明显强化。结论 CT和MRI 都能从不同方面为AF的诊断提供信息,MRI能更好地显示肿瘤的形态、范围及边缘,且可推断肿瘤的大致成分,对AF的诊断更有帮助。     

Magnetic resonance imaging of the ovarian cyst: its diagnostic value of endometrial cyst

The role of magnetic resonance imaging (MRI) in diagnosing the ovarian cyst was reviewed with emphasis on its diagnostic value of endometrial cyst. 94 cystic ovarian masses in 77 patients were evaluated using 0.15 Tesla MRI just before laparotomy at Okayama University Hospital from 1984 to 1987 and these images were followed up by histopathological data. From these obtained images, 6 parameters; that is (1) laterality and (2) delineation of the cyst, (3) presence or absence of septal image, and (4) homogeneity, (5) signal intensity and (6) T1 value of the cyst contents, were extracted and analyzed respectively. In 95.5% of endometrial cysts, homogenous internal pattern was observed in all 3 images (short spin echo (SE), inversion recovery (IR) and long SE) and its signal intensity was at the same level or higher than that of myometrium. On the other hand, in all cases of follicular cyst, para-ovarian cyst, corpus luteum cyst and in 95.0% of serous cystadenoma and in 90.9% of mucinous cystadenoma, cyst contents showed either lower signal intensity than the myometrium or similar to it in T1 contrast images (short SE and IR). 93.1% of dermoid cyst showed heterogenous signal intensity in all 3 images and their signal intensity levels were widely ranging. High signal intensity of cyst contents in all 3 images could be observed in 72.7% of endometrial cyst, 5.0% of serous cystadenoma with internal hemorrhage, 9.1% of mucinous cystadenoma with internal hemorrhage and 3.4% of dermoid cyst consisted of fatty tissue only. Endometrial cyst showed markedly shortened T1 value (209.6 +/- 102.7 ms) and the other hemorrhagic cyst showed comparatively short value (360-970 ms). On the other hand, T1 value of non hemorrhagic cyst was as high as the level of urine. All of endometrial cysts were clearly defined from the other pelvic structures. In result, endometrial cysts were found to exhibit the characteristic findings in MRI images such as homogenous high signal intensity of internal fluid and clear delineation of cyst contour. The diagnostic accuracy of MRI in endometrial cyst were considered 96.8% in our cases.     

Further characterization of NFIB-associated phenotypes: Report of two new individuals

Nuclear Factor I B (NFIB) haploinsufficiency has recently been identified as a cause of intellectual disability (ID) and macrocephaly. Here we report on two new individuals carrying a microdeletion in the chromosomal region 9p23-p22.3 containing NFIB. The first is a 7-year 9-month old boy with developmental delays, ID, definite facial anomalies, and brain and spinal cord magnetic resonance imaging findings including periventricular nodular heterotopia, hypoplasia of the corpus callosum, arachnoid cyst in the left middle cranial fossa, syringomyelia in the thoracic spinal cord and distal tract of the conus medullaris, and a stretched appearance of the filum terminale. The second is a 32-year-old lady (the proband' mother) with dysmorphic features, and a history of learning disability, hypothyroidism, poor growth, left inguinal hernia, and panic attacks. Her brain magnetic resonance imaging findings include a dysmorphic corpus callosum, and a small cyst in the left choroidal fissure that marks the hippocampal head. Array-based comparative genomic hybridization identified, in both, a 232 Kb interstitial deletion at 9p23p22.3 including several exons of NFIB and no other known genes. Our two individuals add to the knowledge of this rare disorder through the addition of new brain and spinal cord MRI findings and dysmorphic features. We propose that NFIB haploinsufficiency causes a clinically recognizable malformation-ID syndrome.     

The radiological evaluation of the child with a myelomeningocele

Seven hundred fifty-five children with myelomeningoceles were evaluated radiologically at the Children's Memorial Hospital in Chicago. From our material, we propose a diagnostic radiologic model to accurately evaluate the neurological problems in the myelomeningocele child. This model is based on the clinical symptoms in these children and the radiologic modalities of magnetic resonance imaging (MRI), computed tomography (CT), ultrasound, myelography, and plain radiographs. We found MRI to be the best modality to evaluate the posterior fossa and total spine. Computed tomography and ultrasound are used to evaluate ventricular size. At times MRI may not adequately diagnose subtle cases of tethering of the spinal cord, cord infarction, arachnoid cysts, or diastematomyelia. In these cases, further evaluation may be necessary with real time ultrasound to look at cord pulsations and water soluble myelography with follow through CT to differentiate cord infarction, arachnoid cyst, localized hydromyelia, or diastematomyelia. If MRI is not adequate to completely visualize the cord because of the severe nature of the scoliosis, then water soluble myelography with CT is indicated.     

Arachnoid cyst and chronic subdural haematoma in a child with osteogenesis imperfecta type III resulting from the substitution of glycine 1006 by alanine in the pro alpha 2(I) chain of type I procollagen.

The features of a child with osteogenesis imperfecta type III (OI III) resulting from the heterozygous substitution of glycine 1006 by alanine in the pro alpha 2(I) chain of type I procollagen were studied. He was born at term with the clinical features of severe OI, including deep grey-blue sclerae. He had severe osteopenia and all long bones were smaller than normal with cortical thinning, metaphyseal expansion, poor metaphyseal modelling, and multiple fractures. However, the vertebrae, pelvis, and shoulder girdle were of normal shape and there were few rib fractures. Histological examination of the calvarium and tibial shaft showed woven bone without lamellar bone or Haversian systems. The shafts of the long bones were widened owing to repeated fractures. Progressive enlargement of the calvarium occurred between 3 and 4.5 months of age owing to bilateral chronic subdural haematomata and a large arachnoid cyst in the Sylvian fissure. The cyst was probably developmental in origin while the subdural collections were probably the result of perinatal skull trauma. The cyst and the subdural collections resolved following drainage but ventricular dilatation with normal cerebrospinal fluid pressure followed. The proband is the first reported case of OI with a glycine substitution by alanine in the pro alpha 2(I) chain of type I procollagen.