急性CO中毒与正常人海马体1HMRS对照研究

目的:采用氢质子磁共振波谱成像(1 H-MRS)测量急性一氧化碳中毒(ACOP)患者与正常人海马区代谢物浓度(氮-乙酰天门冬氨酸NAA、胆碱Cho和肌酸Cr)并比较两组的差异.方法:所有受试者分为两组,ACOP组56例,平均年龄(48.9±10.9)岁;对照组27例,平均年龄(49.2±12.5)岁.所有病例均行两侧海马区MRS检查,记录两侧海马区NAA/Cr、Cho/Cr值,采用两个独立样本t检验比较对照组及ACOP组海马体部代谢物比值的差异.结果:ACOP组NAA/Cr值为1.014±0.683,对照组NAA/Cr值为1.697±0.711,差异有统计学意义(P=0.000).ACOP组Cho/Cr值为1.181±0.389,对照组Cho/Cr值为1.148±0.367,差异无统计学意义(P=0.602).结论:采用1 H-MRS可以准确反映ACOP患者海马区代谢物差异,为评估病情的严重性与早期诊断提供影像学支持.     

创伤后应激障碍患者海马活体MR波谱研究

目的探讨创伤后应激障碍（PTSD）患者双侧海马活体MR波谱（MRS）的特点,为创伤后应激障碍的诊断和病因学机制提供线索.方法应用多体素活体MRS成像技术,对12例PTSD患者和12例正常对照者进行波谱分析,检测双侧海马的N-乙酰天门冬氨酸（NAA）,肌酸（Cr）和含胆碱化合物（Cho）峰值,并进行统计学比较.结果PTSD患者左侧海马的NAA/Cr比值明显低于正常对照组（F=9.99,P=0.006）,Cho/Cr比值差异无统计学意义（F=0.36,P=0.55）;右侧海马的NAA/Cr比值、Cho/Cr比值差异均无统计学意义（F=1.44,P=0.25）.性别之间的波谱差异比较无统计学意义（F=0.56,P=0.82）;年龄、受教育时间、PTSD症状严重程度与左侧海马NAA/Cr比值的相关系数分别为0.47、0.35和0.18,差异无统计学意义（P＞0.05）.结论PTSD患者左侧海马存在病理性变化,NAA/Cr比值低于正常人.     

慢性阻塞性肺疾病海马1H-MRS成像研究

目的 研究慢性阻塞性肺疾病(COPD)患者海马氢质子磁共振波谱(1H-MRS)的特点.方法 随机选取32例COPD患者和30例健康志愿者分别纳入研究组和对照组.采用1H-MRS检测双侧海马的N-乙酰基天门冬氨酸(NAA)、胆碱复合物(Cho)和肌酸复合物(Cr).结果 研究组左右侧海马NAA/Cr值均显著低于对照组,差异有统计学意义(t=4.963,P=0.007和t=4.856,P=0.023);研究组左右侧海马Cho/Cr值均显著高于对照组,差异有统计学意义(t=3.469,P=0.013和t=3.019,P=0.047).结论 COPD患者存在海马神经元的代谢异常.     

外伤性脑损伤脑桥快速波谱成像研究

目的探讨颅脑外伤(TBI)所致脑桥代谢物变化规律及其与预后的关系。方法对34例TBI患者行快速波谱成像(TSI),获得NAA/Cr、Cho/Cr、Cho/NAA值,并与16例正常志愿者(对照组)进行对比。将TBI组根据格拉斯哥预后评分分为预后良好、中等、差3组,比较不同组间代谢物水平差别。结果 TBI组34例脑桥NAA/Cr、Cho/Cr、Cho/NAA均值分别为2.51±0.73、2.56±0.67、1.05±0.29;对照组16例NAA/Cr、Cho/Cr、Cho/NAA均值分别为2.70±0.37、1.92±0.09、0.72±0.08。两组间NAA/Cr均值差异无统计学意义(P=0.235),两组间Cho/Cr、Cho/NAA均值差异有显著统计学意义(P值均=0.000)。NAA/Cr在预后差组(2.15±0.56)与预后中等组(2.73±0.58)之间、预后差与预后良好组(2.98±0.90)间差异有统计学意义(P值分别为0.036、0.007)。Cho/Cr 3组之间差异无统计学意义。Cho/NAA在预后差组(1.22±0.31)与预后良好组(0.80±0.15)之间差异有统计学意义(P=0.001)。结论 TSI适合TBI脑桥MRS检测,TBI患者脑桥Cho/Cr和Cho/NAA较正常人升高,而NAA/Cr和Cho/NAA比值对TBI预后判断较有意义。     

首发抑郁症患者脑兴趣区的磁共振质子波谱分析

目的 探讨首发抑郁症患者额叶白质、海马及杏仁核的脑代谢有无异常.方法 利用质子磁共振波谱分析(1HMRS)技术检测20例首发抑郁症患者和20名健康志愿者的额叶白质、海马及杏仁核的多个代谢指标,包括N-乙酰天门冬氨酸盐(NAA)、胆碱复合物(Cho)、肌醇(MI)、肌酸(Cr).结果 与对照组相比,抑郁症组患者双侧额叶白质的Cho/Cr值上升(左:t=2.62,P=0.04;右:t=2.68,P=0.05),MI/Cr值下降(左:t=2.9,P=0.03;右:t=3.1,P=0.02);抑郁症组患者双侧海马的NAA/Cr、Cho/Cr均低于对照组(NAA/Cr:左t=3.06,P=0.004;右t=3.54,P=0.001.Cho/Cr:左t=2.94,P=0.006;右t=4.02,P=0.001);抑郁症组患者双侧杏仁核的Cho/Cr、NAA/Cr比值均明显低于对照组(Cho/Cr:左t=5.035,P=0.007;右t=8.681,P=0.001,NAA/Cr:左t=9.899,P=0.001;右t=7.227,P=0.002).结论 额叶白质、海马及杏仁核的代谢异常可能构成首发抑郁症的神经生物学基础.     

多体素质子磁共振波谱检测非器质性颞叶癫痫患者海马亚区代谢变化

目的 通过研究多体素氢质子磁共振波谱成像(¹H-MRS)N-乙酰天冬氨酸(NAA)/[胆碱(Cho)+肌酸(Cr)]比值在海马亚区的改变，探讨¹H-MRS在颞叶癫痫(TLE)中的定侧价值。方法 对60例经临床诊断为TLE的患者及60名年龄相匹配的健康对照组行常规MRI和¹H-MRS检查。测量癫痫组和对照组海马亚区NAA/(Cho+Cr)比值。以NAA/(Cho+Cr)比值的阈值和NAA/(Cho+Cr)比值的双侧差异作为TLE癫痫灶的定侧标准。结果 两名具有十年以上工作经验的放射科医师盲法测量的重复性较好[组内相关系数(ICC)=0.822～0.869]。对照组海马各亚区间NAA/(Cho+Cr)差异无显著性(P>0.05),TLE组海马各亚区△NAA/(Cho+Cr)值均大于对照组，差异有统计学意义(P<0.05)。TLE各亚区间，海马头部的NAA/(Cho+Cr)最低，△NAA/(Cho+Cr)比值差异最大，且NAA/(Cho+Cr)值明显低于△NAA/(Cho+Cr)比值，△NAA/(Cho+Cr)比值...     

首发精神分裂症偏执型患者的MRS研究

目的:利用磁共振质子波谱成像(~1H-MRS)探讨首发偏执型精神分裂症(SP)患者双侧额叶、海马头部、扣带前回代谢物质的特点。方法:利用1H-MRS检测22例首发偏执型SP患者(患者组)和22例健康志愿者(对照组)双侧额叶白质、海马头部及扣带前回的NAA、Cho及Cr值,得出NAA/Cr及Cho/Cr比值,后行组内及组间配对t检验。结果:(1)患者组组内比较:左侧额叶白质NAA/Cr低于右侧(P0.05),左侧海马头部Cho/Cr、NAA/Cr低于右侧(均P0.05);双侧额叶白质Cho/Cr及双侧扣带前回NAA/Cr、Cho/Cr差异均无统计学意义(均P 0.05)。(2)组间比较:患者组左侧额叶白质及左侧海马头部NAA/Cr均低于对照组(均P0.05);右侧额叶白质、右侧海马头部及双侧扣带前回NAA/Cr与对照组差异均无统计学意义(均P 0.05)。双侧额叶白质、双侧海马头部及扣带前回的Cho/Cr与对照组差异均无统计学意义(均P 0.05)。结论:首发偏执型SP患者左侧额叶白质、海马头部神经元数量和(或)功能普遍降低,提示SP患者早期存在脑生物学功能异常,支持SP病因学偏侧化特征假说。     

海马硬化MR质子波谱分析与MRI的对比研究

目的　评价MR质子波谱分析 (1HMRS)和MRI对海马硬化的诊断价值。方法　对 8例病理证实的海马硬化病人和 8例健康志愿者分别进行1HMRS和MRI海马体积定量研究。通过计算峰下面积 ,对代谢产物氮 乙酰天门冬氨酸 (NAA)、肌酸 (Cr)及胆碱复合物 (Cho)的浓度进行定量并观察NAA/Cr、NAA/ (Cr Cho)及Cho/Cr各参数的变化 ,同时用右侧海马体积和左侧海马体积差值(DHF)的方法分析形态学的异常。结果　病变组病侧NAA/Cr、NAA/ (Cr Cho)及Cho/Cr值分别为0 5 5、1 77及 1 38,对照组分别为 0 77、1 38及 1 0 6。海马硬化病人NAA/Cr和NAA/ (Cr Cho)值下降 ,统计学上差异有显著性意义 (t值分别为 2 15和 4 83,P值均 <0 0 5 ) ,Cho/Cr值升高 ,统计学上差异有显著性意义 (t值为 2 34 ,P <0 0 5 )。根据NAA/ (Cr Cho)值的不对称降低可对 6例病人进行定侧诊断 ,其中错误 1例 ;根据DHF值的变化可诊断海马萎缩 2例。所有病例均经手术病理证实为海马硬化 ,病变程度与NAA/ (Cr Cho)值的降低相一致。NAA/ (Cr Cho)减低与癫痫发作次数无相关性 (r=- 0 134 ,P >0 0 5 )。结论　1HMRS能够早期发现海马硬化。1HMRS和MRI互相补充有利于海马硬化的术前诊断。     

热射病患者小脑的磁共振波谱研究

目的 应用磁共振波谱技术(MRS)探讨热射病(HS)患者小脑的代谢物变化.方法 研究对象来源于2013年8月滨州医学院烟台附属医院重症医学科收治的8例HS患者和同期7名年龄相匹配的健康志愿者(对照组),采用化学位移成像采集MRS数据,测量HS患者及正常对照组小脑的代谢物比值NAA/Cr、NAA/Cr2、Cho/Cr、Cho/Cr2、NAA/Cho,采用Mann-Whitney U检验比较两组间MRS代谢参数之间的差异,HS患者小脑的代谢物比值并与Glasgow昏迷评分法(GCS)进行Pearson相关性分析.结果 HS患者小脑的NAA/Cr显著低于对照组(0.79±0.10 vs 1.03±0.11,P=0.004),Cho/Cr低于对照组(0.85 ±0.13 vs 0.99 ±0.05,P=0.032),NAA/Cr2、Cho/Cr2、NAA/Cho与对照组差异无统计学意义(均P＞0.05);HS患者小脑的NAA/Cr与其GCS评分存在显著正相关(r=0.748,P=0.033).结论 应用MRS技术可敏感地探测HS患者小脑的代谢物异常,并可通过小脑的代谢物比值NAA/Cr判断病情的轻重.     

慢性酒精依赖患者海马体积的MRI及1H-MRS测量结果

目的 观察慢性酒精依赖(CAD)患者双侧海马体积变化及1H-MRS表现,为CAD患者的临床诊断起量化指导作用.方法 选取临床确诊的16例CAD患者(CAD组)和18名正常志愿者(对照组)分别进行MR常规扫描、三维快速扰相位梯度回波(3D-FSPGR)扫描以及海马1H-MRS扫描,分别测量两组受试者海马体积,并对CAD组及对照组的双侧海马标准化体积进行比较;测量两组双侧海马头部的N-乙酰天冬氨酸(NAA)、胆碱(Cho)、肌醇(ml)以及肌酸(Cr),对Cho/Cr、Cho/NAA、NAA/Cr及mI/Cr比值进行比较.两组间海马体积及双侧海马头部1H-MRS监测值的比较采用t检验.结果 CAD组左、右侧海马体积分别为1.881±0.292、2.139±0.328,对照组分别为2.106±0.245、2.267-±0.271,CAD组及对照组内左、右侧海马体积差异无统计学意义(t值分别为0.232、0.147,P值均＞0.05);两组间左、右侧海马体积差异也无统计学意义(t值分别为0.424、0.131,P值均＞0.05).CAD组的右侧海马头部Cho/Cr、NAA/Cr分别为1.225±0.210、1.145±0.034,对照组分别为1.429±0.286、1. 612±0.444,两组间差异有统计学意义(t值分别为0.321、0.408,P值均＜0.05).两组间海马头部右侧Cho/NAA、mI/Cr及左侧Cho/Cr、Cho/NAA、NAA/Cr及mI/Cr差异均无统计学意义.结论 CAD患者尚未出现脑组织形态学改变之前,1H-MRS的表现具有为临床早期诊断提供客观量化依据的潜能.     

含软骨基质型肉瘤的MR钆喷替酸葡甲胺增强和扩散加权成像特点

Objective To study the Gadolinium-enhanced MRI and diffusion weighted imaging (DWI) characteristics of the chondroid matrix-forming sarcomas.Methods Contrast-enhanced MRI and DWI were performed in 14 eases of chondroid matrix-forming sarcomas (10 chondrosarcomas,4 chondroblastic esteosarcomas) and 13 cases of other types of osteosarcomas.DWI was obtained with a single-shot echo-planar imaging (EPI) sequence using a 1.5 T MR imager with two different b values of 0 and 700 s/mm2.The apparent diffusion coefficient (ADC) values were obtained in GE Functiontool software.The contrast-enhancement pattern was evaluated and the ADC values of ehondroid matrix-forming sarcomas was compared with that of other types of asteosarcoma.Independent sample t-test was performed to evaluate the difference of ADC values between the group of chondroid matrix-forming sarcoma and the group of other types of osteosarcoma.In addition, nonparametrie test was used to assess the difference of ADC values between the chondrosareoma and the chondroblastic osteosarcoma.P value less than 0.05 was considered to represent a statistical significance.Results For 14 eases of ehondroid matrix-forming sarcomas, peripheral enhancement was found in all cases, septonodular enhancement was identified in 12 cases.While 13 eases of other types of osteosarcowas demonstrated heterogeneous enhancement.The mean ADC value of chondroid matrix-forming sarcomas [(2.56 ±0.35) × 10 -3 mm2/s] was significantly higher than that of other types of osteosarcoma [( 1.16±0.20) × 10-3 mm2/s] (t = 12.704,P <0.O1 ).There was no significant difference in the ADC value between the chondrosarcoma and the chondroblastie osteesarcama(Z =0.507 ,P =0.959).Conclusion Contrast-enhanced MRI and DWI can improve differentiation between chondroid matrix-forming sarcomas and other types of osteosarcomas.     

含软骨基质型肉瘤的MR钆喷替酸葡甲胺增强和扩散加权成像特点

Objective To study the Gadolinium-enhanced MRI and diffusion weighted imaging (DWI) characteristics of the chondroid matrix-forming sarcomas.Methods Contrast-enhanced MRI and DWI were performed in 14 eases of chondroid matrix-forming sarcomas (10 chondrosarcomas,4 chondroblastic esteosarcomas) and 13 cases of other types of osteosarcomas.DWI was obtained with a single-shot echo-planar imaging (EPI) sequence using a 1.5 T MR imager with two different b values of 0 and 700 s/mm2.The apparent diffusion coefficient (ADC) values were obtained in GE Functiontool software.The contrast-enhancement pattern was evaluated and the ADC values of ehondroid matrix-forming sarcomas was compared with that of other types of asteosarcoma.Independent sample t-test was performed to evaluate the difference of ADC values between the group of chondroid matrix-forming sarcoma and the group of other types of osteosarcoma.In addition, nonparametrie test was used to assess the difference of ADC values between the chondrosareoma and the chondroblastic osteosarcoma.P value less than 0.05 was considered to represent a statistical significance.Results For 14 eases of ehondroid matrix-forming sarcomas, peripheral enhancement was found in all cases, septonodular enhancement was identified in 12 cases.While 13 eases of other types of osteosarcowas demonstrated heterogeneous enhancement.The mean ADC value of chondroid matrix-forming sarcomas [(2.56 ±0.35) × 10 -3 mm2/s] was significantly higher than that of other types of osteosarcoma [( 1.16±0.20) × 10-3 mm2/s] (t = 12.704,P <0.O1 ).There was no significant difference in the ADC value between the chondrosarcoma and the chondroblastie osteesarcama(Z =0.507 ,P =0.959).Conclusion Contrast-enhanced MRI and DWI can improve differentiation between chondroid matrix-forming sarcomas and other types of osteosarcomas.     

Management of breast magnetic resonance imaging-detected lesions

Breast magnetic resonance imaging (MRI) has become an essential component of breast imaging. Whether it is used as a problem-solving tool or a screening test or for staging patients with breast cancer, it detects many lesions in the breast. The challenge for the radiologist is to distinguish significant from insignificant lesions and to direct their management. A brief summary of the terminology according to the American College of Radiologists lexicon will be provided. This review article will cover the differential diagnosis of enhancing lesions, including masses and nonmass enhancement, from benign and malignant causes. Some of the specific morphologic and kinetic features that help to differentiate benign from malignant lesions will be illustrated, and positive predictive values of these features will be reviewed. The various methods of investigating enhancing lesions of the breast will be discussed, including second-look ultrasound, ultrasound-guided biopsy, stereotactic biopsy, and MRI-guided biopsy. A practical approach to the management of MRI-detected lesions will include timing of follow-up, when to biopsy and when to ignore enhancing lesions in the breast.     

急性胆红素脑病常规MRI及1H-MR波谱表现

Objective To investigate the characterized imaging in conventional MRI, get information about the metabolites in basal ganglia from proton MR Spectroscopy(1H-MRS) of acute bilirubin encephalopathy(ABE) and find out the relationship between those changes and bilirubin levels. Methods Twenty-eight patients with acute bilirubin encephalopathy and 15 normal neonates underwent MR and 1H-MRS examinations T1 WI, T2WI and DWI were collected via conventional MRI scanning of all neonates. All patients underwent multi-voxels scanning and 15 of them had single voxel scanning. 1H-MRS used point resolved spectroscopy (PRESS) both in multi-voxels and single voxel scanning. The data of them were acquired from the ROIs placed in basal ganglia and globus pallidus, respectively. The metabolites including NAA choline, Lactate, glutamate and glutamine, myoinositol and creatine were quantitatively analyzed to compare them between the control group and the case group. Equality of variance between patient data and normal values were tested by using the two-tailed t test. The case group was divided into three groups of 342.0 μmol/L < TSB ≤ 427. 5 μmol/L,427.5 μmol/L < TSB ≤ 513.0 μmol/L, TSB > 513.0 μmol/L including 8,9,11 patients, respectively. Analysis of variance was used for statistics. Results Conventional magnetic resonance imaging showed symmetrical high signal of T1WI in globus pallidus of 23 patients. The case group and the control group were significantly different. Single voxel 1H-MRS revealed that the relative concentrations of Glx/Gr and mI/Cr in the control group were 0.95±0.23, 0.57±0.20, respectively, While those in case group were 1.45±0.37, 0.74±0.23, respectively. There were significant differences between two groups (t =2. 13,4. 40,P =0.04,0.00 respectively). Multi-voxels scanning 1H-MRS revealed that Glx / Cr were 0.51±0.36 in case group and 0.29±0.18 in control group. There was also a significant difference between two groups (t =2.17,P =0.03). And the values of Cho/Cr, NAA/Cr and Lac/Cr were not significantly different. The results were same in multi-voxels 1H-MRS. Total bilirubin level and the concentration of metabolites in the brain do not have obvious correlation. Conclusions ABE has a characteristic signature which is symmetrical high signal of T1 WI in globus pallidus on conventional MBI; The values of mI/Cr and Glx/Cr remarkably increase as detected by 1H-MRS, which is generally in agreement with what has been known about bilirubin pathology.     

自闭症的常规MRI和1H-MRS表现

目的 探讨常规MR成像和1H MR波谱(MRS)在自闭症诊断中的价值.资料与方法 回顾性分析12例自闭症患者的全脑常规MR扫描及其中8例患者额叶和海马的多体素2D 1H MR波谱扫描表现.结果 常规MR扫描发现3例患者的顶叶白质在FLAIR上出现斑片状高信号.1H MRS分析发现5例患者额叶的NAA/Cho明显下降(NAA/Cho<1),其中1例患者的左侧额叶出现Lac峰;另外有2例患者海马的NAA/Cho出现下降(NAA/Cho<1).结论 常规MR成像和1H MRS可发现部分自闭症患者脑组织异常.     

Biomedical implants and devices: assessment of magnetic field interactions with a 3.0-Tesla MR system

PURPOSE: To evaluate magnetic field interactions for 109 different biomedical implants and devices in association with exposure to a 3.0-Tesla magnetic resonance (MR) system. MATERIALS AND METHODS: A total of 109 implants and devices (aneurysm clips, 32; clips, fasteners, and staples, 10; coils and stents, 10; heart valve prostheses and annuloplasty rings, 12; orthopedic implants, five; suture materials, 13; vascular access ports and accessories, 13; miscellaneous implants and devices, 14) were tested for magnetic field interactions at 3.0-Tesla using previously-described, standardized techniques to assess magnetic field translational attraction and torque. RESULTS: The deflection angles and torque measurements ranged, respectively, from 0 to 16 degrees and 0 to +2 for the aneurysm clips; 0 to 90 degrees and 0 to +4 for the clips, fasteners, and staples; 0 to 47 degrees and 0 to +4 for the coils and stents; 0 to 4 degrees and 0 to +1 for the heart valve prostheses and annuloplasty rings; 0 to 12 degrees and 0 to +2 for the orthopedic implants; 0 to 13 degrees and 0 to +2 for the suture materials; 0 to 52 degrees and 0 to +4 for the vascular access ports and accessories; and 0 to 28 degrees and 0 to +3 for the miscellaneous implants and devices. CONCLUSION: Of the 109 implants and devices assessed for magnetic field interactions at 3.0-Tesla, four (4%) are potentially unsafe based on deflection angle criteria. The implications of these results for patients undergoing MR procedures at 3.0-Tesla is discussed. Notably, these results are specific to the 3.0-Tesla MR system used for this evaluation.     

常规MRI和1H-MRS在职业性锰暴露致中枢神经损害中的应用价值

Objective MRI and MR hydrogen proton spectroscopy (1H-MRS) were used to detect the abnormal signal and alteration of metabolites, in order to explore the efficacy of these method in evaluating the damages of central nervous system (CNS) induced by occupational manganese exposure.Methods Eighteen workers exposed to manganese without any manganism symptoms, 12 workers with slightly chronic manganese poisoning, and 19 healthy workers were scanned using routine MRI sequence and 1H-MRS.The blood manganese concentration was also collected for each subject.On cerebral axial T1 WI,the signal intensities of ipsilateral globus pallidus and frontal white matter were measured in the visually brightest area (try to select the signal homogeneous region), and the globus pallidus index (PI) was then calculated.The 1H-MRS data was calculated to get the values of the peak height of N-acetylaspartate (NAA), choline (Cho), inositol (mI) and creatine (Cr) and the ratios of NAA/Cr, Cho/Cr, and mL/Cr were also calculated.One way ANOVA was used to compare the values of PI, NAA/Cr, Cho/Cr, mI/Cr and MnB among the three groups, and the correlations between PI and the time span of manganese exposure or blood manganese concentration were analyzed by Pearson correlation analysis.Eight workers exposed to manganese were followed up one year, and their PI , NAA/Cr before and after follow-up were compared by t test.Results Fourteen of 18 cases exposed to manganese without any manganism symptoms showed symmetrically high intensity signal on T1 WI, while the T2 WI were normal.No high signal intensity was observed on T1WI in any of the healthy workers or manganese poisoning workers.We found that the average PI in manganese exposed group (1.16 ±0.09) was significantly higher (F =24.79 ,P =0.O00)than those of the poisoning ( 1.05 ± 0.07 ) and control groups ( 1.01 ± 0.05 ).The blood manganese concentration in manganese exposed group, the poisoning group and the control group were (0.051 ±0.024), (0.047 ±0.018 ), ( 0.043 ± 0.020 ) μg/ml respectively, which was not significantly different ( F = O.623, P =0.541 ) and did not exceed the upper limit of normal reference value ( < 0.10 μg/ml ).There was a significantly correlation between PI and the time span of manganese exposure ( r = 0.67, P = 0.002 ),however, there was no correlation between PI and blood manganese concentration ( r = 0.20, P = 0.427 ).Furthermore, the NAA/Cr ratio decreased variously in the manganese poisoning group ( 1.22 ± 0.07 ) which was significantly lower( F = 4.120, P = 0.023 ) than those of the poisoning( 1.33 ± 0.13 ) and control groups ( 1.31 ±0.13).No statistical significanees were found in the ratios of Cho/Cr and mI/Cr among these three groups(P>0.05).No obvious changes of the PI and NAA/Cr were found in the 8 manganese exposed workers after 1 year follow-up.Conclusion Manganese exposure could lead to the high intensity signal on T1 WI, therefore the increased PI may be the biomarkers of central nerve system damages caused by the occupational manganese exposure.     

恶性胶质瘤的二维氢质子磁共振波谱研究

研究脑恶性胶质瘤的二维氢质子磁共振波谱(2D1H -MRS)特征及其代谢物变化规律。材料和方法 :经病理学证实的恶性胶质瘤14例(男性8例 ,女性6例 ,年龄19～72岁) ,年龄相近正常对照组15例 ,使用1.5TMRI成像仪 ,PRESS序列 ,TR/TE=1000ms/144ms ,多体素相位矩阵 :16×16 ,FOV :24cm。完成扫描后用随机软件包FuncTool进行分析 ,观察正常对照组(作为外参照)、病例组病灶周边、病变区及对侧正常区(内参照)各主要代谢物变化情况。结果 :14例胶质瘤按WHO标准分类Ⅲ级6例 ,Ⅳ级8例 ,肿瘤实体区NAA/Cho、NAA/Cr、NAA/(Cho +Cr)分别为0.39±0.11 ,1.09±0.38 ,0.28±0.06 ,较正常参照区降低且具显著性差异(p<0.05) ;Cho/Cr和Lac/Cr分别为3.05±1.44 ,0.35±0.59 ,均较参照区升高 ,前者p<0.05 ,后者无统计学差异(p>0.05) ;结合多体素波谱图观察提示恶性胶质瘤Cho升高、NAA下降和出现异常Lac峰 ,同时可显示肿瘤周边区域的Cho升高等异常。结论 :Cho升高、NAA下降和出现异常Lac峰是恶性胶质瘤的主要波谱表现。2D 1H -MRS可检测胶质瘤MRI所示病灶以外区域的代谢异常 ,此对鉴别诊断、立体定向活检和制定治疗方案等有较高临床应用价值     

常规MRI和1H-MRS在职业性锰暴露致中枢神经损害中的应用价值

Objective MRI and MR hydrogen proton spectroscopy (1H-MRS) were used to detect the abnormal signal and alteration of metabolites, in order to explore the efficacy of these method in evaluating the damages of central nervous system (CNS) induced by occupational manganese exposure.Methods Eighteen workers exposed to manganese without any manganism symptoms, 12 workers with slightly chronic manganese poisoning, and 19 healthy workers were scanned using routine MRI sequence and 1H-MRS.The blood manganese concentration was also collected for each subject.On cerebral axial T1 WI,the signal intensities of ipsilateral globus pallidus and frontal white matter were measured in the visually brightest area (try to select the signal homogeneous region), and the globus pallidus index (PI) was then calculated.The 1H-MRS data was calculated to get the values of the peak height of N-acetylaspartate (NAA), choline (Cho), inositol (mI) and creatine (Cr) and the ratios of NAA/Cr, Cho/Cr, and mL/Cr were also calculated.One way ANOVA was used to compare the values of PI, NAA/Cr, Cho/Cr, mI/Cr and MnB among the three groups, and the correlations between PI and the time span of manganese exposure or blood manganese concentration were analyzed by Pearson correlation analysis.Eight workers exposed to manganese were followed up one year, and their PI , NAA/Cr before and after follow-up were compared by t test.Results Fourteen of 18 cases exposed to manganese without any manganism symptoms showed symmetrically high intensity signal on T1 WI, while the T2 WI were normal.No high signal intensity was observed on T1WI in any of the healthy workers or manganese poisoning workers.We found that the average PI in manganese exposed group (1.16 ±0.09) was significantly higher (F =24.79 ,P =0.O00)than those of the poisoning ( 1.05 ± 0.07 ) and control groups ( 1.01 ± 0.05 ).The blood manganese concentration in manganese exposed group, the poisoning group and the control group were (0.051 ±0.024), (0.047 ±0.018 ), ( 0.043 ± 0.020 ) μg/ml respectively, which was not significantly different ( F = O.623, P =0.541 ) and did not exceed the upper limit of normal reference value ( < 0.10 μg/ml ).There was a significantly correlation between PI and the time span of manganese exposure ( r = 0.67, P = 0.002 ),however, there was no correlation between PI and blood manganese concentration ( r = 0.20, P = 0.427 ).Furthermore, the NAA/Cr ratio decreased variously in the manganese poisoning group ( 1.22 ± 0.07 ) which was significantly lower( F = 4.120, P = 0.023 ) than those of the poisoning( 1.33 ± 0.13 ) and control groups ( 1.31 ±0.13).No statistical significanees were found in the ratios of Cho/Cr and mI/Cr among these three groups(P>0.05).No obvious changes of the PI and NAA/Cr were found in the 8 manganese exposed workers after 1 year follow-up.Conclusion Manganese exposure could lead to the high intensity signal on T1 WI, therefore the increased PI may be the biomarkers of central nerve system damages caused by the occupational manganese exposure.     

线粒体脑肌病综合影像表现

目的:探讨多种影像技术对线粒体脑肌病(ME)的诊断价值.方法:回顾性分析7例线粒体脑肌病患者的影像资料,其中7例行常规MRI扫描,3例行MRA扫描,4例行MRS扫描,1例行DSA检查,6例行CT平扫.结果:6例病变主要累及两侧大脑皮层和皮层下,1例主要表现为白质内改变,均表现为长T1、长T2改变;MRA示2例未见明显改变,1例示病变处血管分支明显增粗;4例MRS在病变处检出乳酸双峰,1例在脑脊液中检出乳酸双峰.1例行DSA检查示病灶内血管分支增粗,血运加快.6例行CT检查病灶均呈低密度改变.结论:影像检查尤其是MRI检查对ME的诊断提供了丰富的信息,当年青患者出现非典型性脑梗死表现,MRS检出乳酸双峰时要考虑到线粒体脑肌病的可能.