垂体Rathke囊肿蛋白小体的影像学特征分析

目的 探讨垂体Rathke囊肿蛋白小体的影像学特征,提高对Rathke囊肿蛋白小体的认识。方法 回顾性分析2016年1月至2019年1月手术治疗的、术后病理检查确诊的12例含有蛋白小体的垂体Rathke囊肿的影像学资料,分析其术前影像学特点。结果 75%的含有蛋白小体的Rathke囊肿CT呈高密度,平均CT值(58.45±11.62)Hu;蛋白小体最大直径平均(4.53±1.62)mm。蛋白小体MRI平扫T₁相中呈稍高信号或高信号,T₂相呈明显低信号,增强扫描无明显强化。依据形态,蛋白小体可分球体型、块状型和干涸型。蛋白小体在Rathke囊肿内的位置可以分为悬浮型和贴壁型。结论 蛋白小体为Rathke囊肿内一种特有的内容物,CT和MRI具有多元的影像学特征,认识这些特征对Rathke囊肿的精准诊断和鉴别诊断有重要意义。     

结直肠癌脑转移的影像学特点

目的探讨结直肠癌脑转移的影像学特点。方法回顾性分析10例经手术治疗的结直肠癌脑转移病人的影像学和病理学等资料。结果 9例病灶MRI T2加权表现为低信号,实性结节状,呈不均匀强化,病变边缘强化明显。1例病人MRI T2加权表现为高信号,囊性,囊壁强化。5例病人术前CT检查提示病变呈不同程度的高密度,周围水肿明显。结论根据结直肠癌脑转移所特有的MRI T2加权呈现低信号及CT扫描呈高密度的影像学特点,有利于疾病鉴别,对提高临床诊断结直肠癌脑转移有一定帮助。     

小儿鞍区肿瘤17例临床与CT、MRI-FLASH序列T1W研究

目的探讨青少年鞍区肿瘤的CT和MRI Flash-T1W像的表现及临床价值.方法回顾性分析17例经临床及病理证实的青少年鞍区肿瘤的CT及MRI表现.男7例,女10例,年龄11～17岁.结果①颅咽管瘤8例,CT表现为鞍区囊性或囊实性肿块,部分囊壁蛋白壳样钙化;MRI T2W像表现为高信号,T1W像分别表现为高中低信号.②生殖细胞瘤5例,CT表现为鞍区等或稍高密度肿块,大部分均匀强化;MRI T2W像表现为高信号,T1W像等或低信号.③垂体微腺瘤2例,CT无异常发现,MRI T1W像表现为垂体内略低信号结节.④鞍区脑膜瘤2例,CT表现为鞍上池稍高密度类圆形肿块,强化均匀,MRI T2W像呈高信号,T1W像呈低信号.结论 MRI在青少年鞍区肿瘤的诊断中有重要价值,Flash-T1W像在临床应用中有优势.     

原发性垂体柄占位性病变的诊断和手术治疗(附10例报告)

目的：探讨垂体柄占位性病变的影像学诊断及手术方法。方法：回顾性分析10例垂体柄占位性病变的MR资料，其中男4例，女6例，平均年龄32岁。结果：MR的特征性表现为垂体柄球形增粗，3例生殖细胞瘤，T1、T2等信号，强化均匀一致，其中，1例经手术病理证实，3例均行放射治疗，疗效明显；7例Rathke’s囊肿，T1等、低信号，T2高信号，包膜环形强化，均行手术切除病理证实诊断。结论：MR可以清楚的显示原发性垂体柄占位形态，有别于继发性病灶，生殖细胞瘤放疗疗效肯定。     

小儿鞍区肿瘤17例临床与CT、MRI-FLASH序列T1W研究

目的探讨青少年鞍区肿瘤的CT和MRI Flash-T1W像的表现及临床价值。方法回顾性分析17例经临床及病理证实的青少年鞍区肿瘤的CT及MRI表现。男7例，女10例，年龄11—17岁。结果①颅咽管瘤8例，CT表现为鞍区囊性或囊实性肿块，部分囊壁蛋白壳样钙化：MRIT2W像表现为高信号，T1W像分别表现为高中低信号。②生殖细胞瘤5例，CT表现为鞍区等或稍高密度肿块，大部分均匀强化；MRIT2W像表现为高信号，T1W像等或低信号。③垂体微腺瘤2例，CT无异常发现，MRIT1W像表现为垂体内略低信号结节。④鞍区脑膜瘤2例，CT表现为鞍上池稍高密度类圆形肿块，强化均匀，MRIT2W像呈高信号，T1W像呈低信号．结论MRI在青少年鞍区肿瘤的诊断中有重要价值，Flash-T1W像在临床应用中有优势。     

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影像特征。方法回顾性分析18例经病理或放射治疗证实的颅内生殖细胞瘤的CT和MRI表现。结果 18例肿瘤中,9例肿瘤位于松果体区,6例位于鞍区,3例位于基底节区及丘脑。松果体区肿瘤在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,增强扫描时肿瘤均匀显著强化。鞍区肿瘤MRI表现为垂体柄增粗,垂体后叶正常短T1信号消失,肿瘤在T1WI像呈等信号,T2WI像上信号可呈等或高信号;CT图像见肿瘤实体部分呈高密度,增强扫描时明显强化。基底节区及丘脑肿瘤瘤体较大,信号及密度不均匀,边缘欠清晰,出血多见,增强扫捕呈不均匀强化。结论颅内生殖细胞瘤的影像表现具有一定特征,结合临床表现可进一步提高诊断正确率。     

Rathke囊肿并垂体腺瘤2例报告并文献复习

目的总结垂体腺瘤伴Rathke囊肿的临床特征与治疗方法。方法回顾性分析2例经手术病理证实伴有Rathke囊肿的垂体腺瘤病例资料。结合临床特征、影像学表现、手术治疗以及相关文献进行分析。结果 2例病人均经翼点入路行开颅手术,术后病理结果为垂体腺瘤合并Rathke囊肿。1例术后随访13个月复查MRI示未见肿瘤及囊肿复发,1例术后视力较术前好转。结论伴有Rathke囊肿的垂体腺瘤临床罕见,鞍区MRI提示垂体腺瘤旁存在囊性信号应考虑合并Rathke囊肿。临床明确诊断依赖于组织病理学观察及免疫组化标记。对于压迫症状明显且伴有Rathke囊肿的垂体腺瘤可手术治疗。     

垂体Rathke囊肿的诊断和显微手术治疗

目的 分析和讨论垂体Rathke囊肿的诊断和手术治疗。方法 回顾分析41例经手术和病理证实的垂体Rathke囊肿的病例，男性16例，女性25例，平均年龄32.8岁，平均病程为20.6个月。主要临床表现包括头痛（62.5%)。垂体功能紊乱（55%），视功能障碍（32%）等。CT及MRI检查发现鞍区囊性肿物。39例采用经口鼻蝶窦入路显微外科手术，2例采用开颅手术，切除部分囊壁，敞开囊腔，清除囊肿内容物，结果 术前正确诊断为垂体Rathke囊肿的仅为7例。术后随诊3月至8年，头痛患的症状全部缓解，垂体功能紊乱患55%得到改善，视功能障碍患75%得到改善，41例患术后均无复发。结论 垂体Rathke囊肿术前较难明确诊断，MRI检查信号呈多样性，无特异性，经口鼻蝶窦入路显微外科手术可以明确诊断，缓解症状，患预后良好，是治疗垂体Rathke囊肿的有效方法。     

囊内结节的MRI特征对Rathke’s囊肿的诊断价值

目的探讨Rathke’s囊肿囊内结节的MRI特点反其对Rathke’s囊肿术前诊断的作用。方法回顾性分析22例经术后病理学证实的Rathke’s囊肿患者的影像学资料，评价囊内结节MRI特点的诊断价值。结果22例患者中14例病变位于鞍内，6例向鞍上发展，2例位于垂体上方.T1高信号12例，等或低信号6例，信号不均4例；T2高信号7例，等或低信号10例，信号不均5例。5例可见囊内结节，表现为T。高信号3例，等信号1例，未显示1例；T2均呈低信号，均无强化效应。5例伴囊内结节性患者术前正确诊断率100％，其余17例术前正确诊断率为64．7％（11／17）。结论Rathke’s囊肿的术前诊断较为困难，MRI显示囊内有结节的比例尽管不高，但具有特异性诊断价值。     

垂体脓肿的临床与影像学表现(附13例报告)

目的探讨垂体脓肿的临床表现及影像学特点。方法回顾性分析13例经手术及病理证实的垂体脓肿患者的临床及影像学资料。结果垂体脓肿最常见的临床表现为头痛、垂体功能障碍和视觉损害,有感染征象者仅1例。3例行CT,2例行MRI,8例同时行CT和MRI。CT和MRI表现为垂体占位,正常垂体结构消失;病灶CT平扫呈等或低密度;MRT1WI呈稍高、等、低或等高混杂信号,病灶边缘信号相对较高T2WI呈高信号或高低混杂信号,增强后8例病灶呈环状强化,2例无强化;此外有3例见垂体柄增粗强化,2例见临近脑膜强化。结论垂体脓肿的临床及影像学表现无特异性,综合分析两者表现可帮助术前作出正确诊断。     

MRI and CT findings in Krabbe disease

The progression and characteristics of magnetic resonance imaging (MRI) and computed tomographic (CT) findings in 3 patients with infantile Krabbe disease (i.e., globoid cell leukodystrophy or galactocerebroside beta-galactosidase deficiency) are reported. We obtained initial CT and MRI studies when patients demonstrated hyperirritability and hypertonicity. The following results facilitated early diagnoses: increased density in the thalami, corona radiata, and cerebellar cortex on CT and plaque-like, high signal intensity in the periventricular region and cerebellar white matter on MRI T2-weighted images. After severe motor and mental deterioration and spasticity had developed, progressive brain atrophy, low density in the white matter, and calcification-like, symmetric, punctate high-density areas in the corona radiata were evident on CT and high signal intensity in T2-weighted images and low signal intensity in T1-weighted images in the white matter were present on MRI. In particular, linear patterns were observed in the centrum semiovale on MRI.     

Detection of a pineoblastoma with large central cyst in a young child

THE PATIENT: We present the very rare case of a pineoblastoma with large central cyst in a 7-year-old boy who presented with a short history of gradually worsening headache and upward gaze palsy.IMAGING INVESTIGATIONS: On CT and MRI studies, it was seen as a peripherally calcified, irregularly shaped mass with heterogeneous low signal intensity on T1-weighted images and ringed enhancement after gadolinium administration; there was homogeneous high signal intensity on T1-weighted images.DISCUSSION: We discuss differential diagnosis for several types of cystic tumors in the pineal region, including pineoblastomas.     

Repeated hyperglycemic hemichorea in a patient with venous angioma in the putamen]

We report a case of an 81-year-old diabetic woman who had three episodes of choreic involuntary movement in the left extremities. Brain CT revealed faintly increased density in the right putamen. On MRI performed 28 days after onset of the left hemichorea, the right putamen showed increased signal intensity on T1-weighted images and the so-called "medusa-like appearance" of medullary venous drainage into the thalamostriate vein on enhanced T1-weighted images. These findings indicated petechial hemorrhage of the right putamen from a venous angioma. We hypothesize that this hemorrhagic change due to a venous malformation in the basal ganglia may induce involuntary movements in diabetic patients during severe hyperglycemia.     

梯度回波T2*成像在蛛网膜下腔出血诊断中的应用

目的探讨MRI的梯度回波T2^＊成像（GRE-T2^＊WI）在蛛网膜下腔出血（SAH）诊断中的作用.方法对12例SAH患者进行CT和MRI的比较分析,MRI常规使用T1WI、T2WI、FLAIR和GRE-T2^＊WI.结果（1）急性期SAH患者,48 h内MRI检查FLAIR和GRE-T2^＊ WI均可见异常信号,而T1WI、T2WI检出率分别为66.6%和50.0%;（2）亚急性期（发病7～20 d）,CT已为阴性,MRI的T1WI、T2WI和FLAIR均不敏感（检出率为0～25.0%）,GRE-T2^＊ WI仍可见信号丢失;（3）不典型SAH,腰穿显示阳性结果,CT和MRI的FLAIR序列均为阴性,GRE-T2^＊WI可有阳性发现.结论MRI可应用于急性和亚急性SAH的诊断,其中GRE-T2^＊ WI是诊断SAH最敏感的序列,且对亚急性期和不典型SAH的诊断优于CT.     

原发性脑淋巴瘤CT与MRI诊断

目的分析原发性脑淋巴瘤的CT和MRI表现,以提高对其的认识,减少误诊。方法回顾性分析17例经手术病理证实的原发性脑淋巴瘤的CT和MRI资料。结果CT和MRI主要表现为：（1）CT平扫示脑内单发或多发的等密度或较高密度瘤灶,肿瘤可沿脑脊液播散;MRI T1WI呈等或稍低信号,T2WI呈等或稍高信号;1例出现坏死及出血;②少部分病例瘤周水肿及占位效应轻至中度;（3）MRI增强扫描大多呈团块状均匀强化;1例环形强化。④除病变主体位于胼胝体膝部和压部外,瘤灶长轴多与颅脑前后径走行平行或大致相同。结论原发性脑淋巴瘤多在大脑深部,明显强化,CT和MRI表现具有一定的特异性,结合CT与MRI影像特点和临床资料综合分析,有可能在术前作出正确诊断。     

Enhanced resolution of pituitary fossa by three-dimensional fat-suppressed gradient-echo magnetic resonance: before and after gadolinium enhancement.

In imaging small anatomical parts such as the pituitary fossa, thin sections enhance the spatial resolution. Gradient recalled images (GRASS) using three-dimensional volume data produce ultrathin contiguous sections with a high signal-to-noise ratio. In this study, conventional spin-echo magnetic resonance images (MRIs) of the pituitary fossa were compared to three-dimensional gradient recalled MRI in 5 volunteers and 10 patients suspected of having pituitary gland abnormalities. Utility of fat suppression was also assessed, along with gadolinium enhancement. Conventional spin-echo and three-dimensional spoiled GRASS images, three-dimensional spoiled GRASS images without and with fat suppression (Group II), and three-dimensional spoiled GRASS images with fat suppression before and after gadolinium enhancement were compared. Three-dimensional spoiled GRASS images provided better delineation of the pituitary fossa structures. There was differential enhancement between the normal gland and pituitary tumors. The fat suppression technique following gadolinium administration helped separate the high signal of tumor from the high signal of the clivus marrow. In conclusion, T1-weighted three dimensional gradient-echo images with fat suppression following gadolinium enhancement appear promising in evaluation.     

Symptomatic Rathke cleft cyst

Rathke cleft cysts (RCC) are uncommon intrasellar lesions. Although their clinical manifestations, radiological features and treatment are frequently reported, controversy remains as a result of their rarity. We reviewed the preoperative clinical manifestations, neurological examination findings, visual acuity and fields, endocrinological function, radiographic study findings, surgical and pathological records, and prognosis of 45 patients with RCC (21 males, 24 females, average age: 47 years) admitted to our department between January 2002 and January 2011. The most common clinical manifestations included headaches, and visual and hormonal disturbances. Most RCC were intrasellar with a suprasellar extension. The most common MRI patterns were hypointense on T1-weighted and hyperintense on T2-weighted images, isointense on T1-weighted and hyperintense on T2-weighted images, and hyperintense on T1-weighted and hyperintense on T2-weighted images. Aspiration and biopsy of the cyst wall were performed in most patients. Most patients experienced improved headaches and visual disturbance, but the hormonal disturbance rarely returned to normal, especially in those patients with a serious preoperative hormonal disturbance. The recurrence rate was 14%, which was associated with the extent of cyst removal, inflammation and rim enhancement, as well as the surgical approach. Aspiration and biopsy of the cyst wall still seems to be an effective treatment for most RCC for its low morbidity and good prognosis. Conservative treatment and close follow-up may be suitable for small cysts with subtle clinical manifestations.     

Magnetic Resonance Imaging in Complex Partial Seizures

Abstract: Magnetic resonance imaging (MRI) and computed tomography (CT) were performed on 45 patients with intractable complex partial seizures. MRI was performed with a super conducting whole-body scanner operating at 0.5 tesla (T) and 1.5 T. In patients with temporal lobe epilepsy, 8 of 24 patients had abnormal CT, but 16 of 24 patients showed abnormal MRI. 1.5 T MRI detected more abnormality than 0.5 T MRI when CT was normal. In patients with frontal lobe epilepsy, 5 of 7 patients had normal CT and MRI. In 2 other patients, MRI demonstrated an arachnoid cyst and increased signal intensity area on the T2-weighted images, which were not detected by CT. In patients with occipital lobe epilepsy, 5 of 6 patients show abnormal CT and MRI. In patients with tuberous sclerosis, MRI revealed some increased signal intensity areas on the T2-weighted images in the occipital and temporal lobe, which were not detected by CT. Most surface EEG foci corresponded with the side of MRI abnormality. These data indicate that MRI is more informative than CT in complex partial seizures. MRI is the imaging technique of choice in the diagnosis of complex partial seizures.     

Magnetic resonance imaging (MRI) of pituitary adenomas

MRI of 20 patients, 17-82 years old, with pituitary adenomas confirmed histopathologically, and 30 normal patients without pituitary dysfunction were reviewed. The studies were performed with a 0.5 Tesla MR scanner with a slice thickness of 10 mm. Inversion recovery sequences were employed as T 1-weighted examination, with repetition time (TR) of 2100-2500 msec, an inversion time (TI) of 600 msec and an echo time (TE) of 40 msec. The T 2-weighted examination had a TR of 1800-2500 msec and a TE of 120 msec. T 1-weighted images were obtained in all cases and T 2-weighted images in 14 cases. Spin echo images with a TR of 600-1000 msec and a TE of 40 msec (SE 40/600-1000) were also obtained in 14 cases. On T 1-weighted images, 20 adenomas were classified into six groups, according to their signal intensities; marked low intensity (1), low intensity (1), isointensity (11), high intensity (3), marked high intensity (1) and mixed intensity (3). On T 2-weighted images, 14 adenomas were classified into five groups; low intensity (1), isointensity (2), high intensity (4), marked high intensity (6) and mixed intensity (1). On SE 40/600-1000 images, 14 adenomas were also classified into four groups; low intensity (8), high intensity (2) and mixed intensity (3). Two adenomas with recent intratumoral hemorrhage had marked high intensity on both T1 and T2-weighted images. SE 40/600-1000 images were useful in evaluating the size and the extent of the visual pathway was best appreciated on IR images. Comparison between normal and involved cavernous sinus by adenomas was made.