颅内脑外型海绵状血管瘤MRI表现与误诊分析

目的分析颅内脑外型海绵状血管瘤(ECMs)的MRI表现及误诊原因,以提高术前诊断准确率。方法回顾性分析9例经手术病理确诊ECMs患者的MRI表现,观察病变部位、信号特点,结合病理特点,进行误诊分析。结果本组9例病例中,多发病灶2例,即内听道并脑内型海绵状血管瘤,单发病灶7例,其中病变位于海绵窦区3例,颅中窝、侧脑室后角、第四脑室、窦汇区各1例。周围组织水肿1例,无水肿8例。信号不均匀者5例,均匀者4例,以T1WI呈等信号、T2WI与FLAIR呈高信号为主,增强后早期明显强化,强化程度同血管样强化。4例SWI呈等、低、高混杂信号,2例呈等信号。DWI呈稍低信号3例,1例呈等低混杂信号,ADC图呈稍高信号4例。MRS中Cho、NAA峰位于基线水平者3例,发现Lac1例。PWI提示低灌注1例。结论 ECMs以T2WI、FLAIR高信号为主、常见"环铁征"、低灌注的脑组织外血管畸形病变,少见周围组织水肿。利用SWI、MRS及PWI等影像新技术,提高ECMs的诊断准确性,为临床治疗提供全面、准确的信息。     

软组织海绵状血管瘤的MRI表现

本回顾性分析了9例经病理证实的软组织深部海绵状血管瘤的MRI所见，着重探讨其信号特点及形态学改变。     

颅内巨大海绵状血管瘤误诊脑膜瘤1例

目的为加深对颅内海绵状血管瘤的认识,增强临床诊断能力,防止类似疾病再次出现误诊误治。方法对临床1例误诊为颅内脑膜瘤的巨大海绵状血管瘤的诊治过程加以分析,并讨论出现误诊的原因,以及对临床救治带来的相应后果。结果因为临床表现不典型,加之急性发病,病情不允许进一步明确诊断,从而导致误诊,并因此造成术中无法将肿瘤全切除。作为急诊手术,治疗已起到缓解颅高压,稳定生命体征作用,为进一步诊治争取了机会。结论临床医生应当充分认识到疾病表现的多样性、复杂性,急诊手术前应尽可能完善各项术前检查,并做好应对术中各种突发情况的准备。     

MRI新技术在中枢神经系统疾病中的临床应用

磁共振的技术进步已经取得了解剖结构的高分辨率成像,并且提供了评价组织的生理和功能的方法.磁共振成像提供了无创、无辐射的研究人类大脑生理学的方式.利用这些新的成像方法,我们可以对疾病作出更具体的诊断,以及预测和评估疾病治疗后的反应.本文对磁共振较新的技术DWI、MRS、SWI在中枢神经系统疾病中的应用作一综述.     

磁共振不同序列诊断颅内毛细血管扩张症的价值

目的探讨磁共振成像不同序列对颅内毛细血管扩张症的影像诊断价值。方法应用磁共振磁敏感加权成像(SWI)和梯度回波T2*WI及SET1WI、T2WI对11例颅内毛细血管扩张症患者进行扫描,分析MR不同序列图像的特征,比较检出病灶数目。结果 11例患者中,在SET1WI发现毛细血管扩张症病灶3个,T2WI未发现病灶;T2*WI发现病灶74个,SWI发现112个。结论在显示颅内毛细血管扩张症病灶方面,SWI序列最敏感,其次为T2*WI序列。     

氢质子磁共振波谱成像联合磁敏感成像评价弥漫性轴索损伤

目的探讨评价氢质子磁共振波谱（^1H—MRS）和磁敏感成像技术（susceptibility weighted imaging,SWI）在弥漫性轴索损伤（diffuse axonal injury,DAI）的早期诊断治疗中的价值。方法选择2009年9月至2010年8月收治DAI患者24例,分别在伤后1周、1个月行^1H—MRS和SWI检查,再随机选择20例健康成年人作为对照组。比较各组胼胝体压部和基底节N一乙酰天冬氨酸（N—acetylaspartate,NAA）／肌酸和磷酸肌酸（creatine compound,Cr）、胆碱复合物（choline—containing compounds,Cho）／Cr、肌醇（mlNs）／Cr以及谷氨酸和谷氨酰胺（Glx）／Cr等指标的差异。观察T：序列对DAI组病例的检出率;SWI序列观察微出血像素数目及微出血灶检出数。结果与对照组相比,DAI伤后1周、1个月组胼胝体压部NAA／Cr、Cho／Cr、mlNs／Cr、GLx／Cr、基底节区NAA／Cr、Cho／Cr的差异有统计学意义。T2及SWI对轴索病灶的检测率明显提高。24例DAI患者均有微出血。SWI序列及T2序列在微出血像素数及微出血灶数比较差异有统计学意义。结论磁共振波谱技术可反映弥漫性轴索损伤不同时间段局部组织代谢变化,SWI则可检测到微小出血灶,两者结合可更早明确弥漫性轴素损伤的诊断。     

经皮射频治疗肝海绵状血管瘤的疗效与安全性分析

目的评价经皮射频(percutaneous radiofrequency ablation, PRFA)微创治疗肝脏海绵状血管瘤(hepatic cavernous hemangiomas,HCHs)的有效性和安全性. 方法应用RF-2000射频仪和10电极LeVeen射频针在超声引导下施行PRFA治疗HCHs 26例39个病灶直径2.5～11.0 cm,其中直径＞3.0 cm者予分层多点或多次叠合消融.局部麻醉,配合全身镇痛处理. 结果 26例均成功实施PRFA.反应期2～5天,包括局部疼痛不适、发热、ALT升高等,无胆漏、出血等并发症.23例随访1～5年,平均2年8个月,经一次治疗完全缓解(CR)22例,部分缓解(PR)1例,缓解率(CR PR)100%;HCHs直径平均缩小68.8%(41.2%～81.5%). 结论在掌握好适应证和操作技巧的前提下,PRFA可发挥微创、安全、有效之优势,可作为治疗HCHs的一种理想选择方法.     

单纯腰骶椎管内硬膜外血管瘤的诊断与治疗

海绵状血管瘤虽然是一种常见的良性肿瘤,可以发生在人体的各个器官和组织,但单纯发生在椎管内硬膜外腔的十分少见,而发生在腰骶部者更为罕见,而且术前确诊十分困难[1~5]。尽管MRI是目前评估椎管内病变的最好方法,但对于单纯椎管内硬膜外血管瘤的诊断,误诊仍极易发生。为此,我们     

MRI诊断与治疗肢体血管瘤的价值

目的 探讨MRI对血管瘤诊断和治疗的指导价值.方法 对15例肢体血管瘤患者,使用Siemens 1.5T超导型磁共振扫描仪.行矢状、冠状T1加权和T2加权扫描,然后注射Gd-DTPA进行增强.并对8例患者行CEIRI增强血管成像.15例中10例患者进行了手术治疗,并与术前MR/检查结果进行比对.结果 所有患者T1WI显示为不均匀的混杂信号,以低信号为主,边界不清楚.T2WI亦显示为不均匀的混杂信号,而以高信号为主.Gd-DTPA增强后,肿瘤影像明显强化,可清楚显示其与周围组织的关系.CEMRI血管成像,可见肿瘤组织内成团的血管畸形图像.10例患者术中所见与MRI影像显示完全一致.结论 MRI对血管瘤的定性及准确的定位诊断、血管瘤的侵犯范围以及对术后疗效的评价均有重要的指导意义.     

肝脏上皮样血管平滑肌脂肪瘤MRI影像学特征及误诊分析

目的 探讨肝脏上皮样血管平滑肌脂肪瘤（HEAML）MRI影像学特征表现及误诊分析。方法 收集并回顾性分析2012年5月至2019年11月复旦大学附属中山医院经病理确诊的8例HEAML患者临床与影像资料,总结其MRI影像学特征,主要包括：平扫信号、DWI与ADC信号、化学位移成像、强化特点、是否含有供血动脉与引流静脉。结果 8例HEAML均为单发,术前诊断正确5例,2例误诊为肝腺瘤,1例误诊为肝细胞肝癌。T2WI多为高或高低混杂信号,T1WI多为低信号,DWI高或稍高信号,ADC多为等信号;化学位移成像6例有信号差异;增强动脉期多为明显强化,5例呈“快进慢出”,3例“快进快出”,3例渐进性强化并趋于均匀信号;4例见包膜,其中3例持续强化,1例延迟强化;3例见供血动脉,4例见引流静脉,2例见静脉早显。结论 MRI多序列综合分析有助于提高术前诊断准确率,HEAML具有化学位移成像中反相位较正相位见局灶性低信号,假包膜持续强化,供血动脉、引流静脉及静脉早显等MRI影像学特征。     

Surgical management of brain-stem cavernous malformations: report of 137 cases

BACKGROUND: With the improvement in neuroimaging and microsurgical techniques, brain stem cavernous malformations are no longer considered inoperable. Surgical indications for brainstem cavernoma are evolving, with better understanding of its natural history and decreasing surgical complications. METHODS: During 1986 through 1998, a series of 137 patients (4 patients each with two brain stem lesions, total number of lesions, 141) with brain stem cavernous malformations were treated microsurgically at Beijing Neurosurgery Institute. The age distribution, lesion location, and clinical presentations were analyzed. The bleeding rate, surgical indications and microsurgical techniques were also discussed. RESULTS: In our series, 92 of 137 cases (67.2%) suffered more than one hemorrhage. Female patients had a higher risk of recurrent hemorrhage than that of male patients. Unlike cavernomas malformations from other locations, repeated hemorrhages from brain stem malformations are much more common and usually lead to new neurologic deficits. Among all 137 surgically treated patients, there was no operative mortality. Ninety-nine patients (72.3%) either improved or remained clinically stable postoperatively. The size of the cavernoma/hematoma does not necessarily correlate with the surgical result. While the acute hematoma can facilitate the surgical dissection, longer clinical history with multiple hemorrhages often makes total surgical resection difficult, partially because of the firmer capsule that may not shrink or collapse after hematoma is released. Pathologically those capsules were associated with more hyaline degeneration, fibrous proliferation and even calcifications. During the follow-up period between 0.5 to 11 years in 129 cases, 115 patients (89.2%) have been working, studying, or doing house work. Three patients (2.3%) suffered recurrent hemorrhages. CONCLUSIONS: Surgical indications of brain stem cavernoma include (1) progressive neurologic deficits; (2) overt acute or subacute hemorrhage on MRI either inside or outside cavernous malformations with mass effect; (3) cavernoma/hematoma reaching brainstem surface (<2 mm brain tissue between cavernoma /hematoma and pial surface). Grave clinical presentations like coma, respiratory, or cardiac instability are not surgical contraindications. Emergent surgical evacuation may lead to satisfactory outcome. Repeated hemorrhages will worsen the pre-existing neurologic deficits and possibly make the surgical dissections more difficult. Patients with minimum, stable neurologic deficits and lesion/hematoma that has not reached the brain stem surface should be followed conservatively.     

肝局灶性结节增生的CT和MRI表现及误诊分析

目的 探讨肝局灶性结节增生（FNH）的CT和MRI表现,提高诊断准确性。方法 回顾性分析2013年9月至2019年1月温州市中心医院经病理学检查明确为肝FNH的32例患者影像学资料,行CT检查32例,MRI检查21例。结果 32例共计36个病灶,单发29例,多发3例。CT平扫呈略低密度20例,等密度12例,增强扫描动脉期均见明显强化,门脉期强化不同程度减低,呈高密度26例,等密度6例;延迟期呈稍高密度5例,等密度21例,低密度6例。MRI平扫T1WI等信号13例,低信号8例;T2WI均呈稍高信号;DWI呈稍高信号15例,高信号6例;增强扫描动脉期均明显强化,门脉期呈稍高信号18例,等信号3例;延迟期呈稍高信号6例。CT检出病灶有中心瘢痕14例,增粗迂曲的供血动脉11例,假包膜5例。MRI检出病灶有中心瘢痕12例,增粗迂曲的供血动脉7例,假包膜4例。32例中2例误诊为肝癌,1例误诊为肝腺瘤。结论 对于典型的肝FNH,根据CT和MRI图像一般能做出正确诊断,对于不典型肝FNH需要加强认识、 注意鉴别。     

Intramedullary spinal cord cavernous malformations: report of ten new cases

Spinal cord cavernous malformations (SCCM), once thought to be extremely rare, have been diagnosed more frequently since the advent of MRI. In addition to the six personal cases surgically treated between 1992 and 1993 and already described in the literature, the authors report here a further ten cases operated on between April 1993 and January 2001. These involved five males and five females whose ages at operation ranged from 12 to 69 years. The SCCM were thoracic in five patients and cervical in five. In seven cases, the malformations bulged on the surface of the pia mater, while in the other three there was subpial discoloration due to the presence of hemosiderin. Removal was total in all cases. After surgery, two patients presented transient worsening of preoperative paraparesis. At follow-up ranging from 2.2 to 9.2 years (mean 5.7), nine patients had made complete motor recovery while one, in whom preoperative paraparesis had been severe, remained stationary. At least one follow-up MRI investigation was performed in each patient 6 to 12 months after operation. As previously reported, the authors confirm that the treatment of choice for symptomatic SCCM is total surgical excision in order to avoid recurrences and the possibility of further hemorrhage. Surgical outcome combines low mortality with a high probability of functional recovery, especially when paraparesis is not severe and of relatively recent onset.     

胰腺腺泡细胞癌的CT及MRI影像学分析

目的 分析胰腺腺泡细胞癌（ACC）的CT和MRI特征,提高对该病影像学表现的认识。方法 回顾性分析2007年1月至2016年1月在我院经手术病理或穿刺活检证实的7例ACC患者的CT及MRI影像学资料,其中3例行CT平扫及增强扫描,4例行MRI平扫及增强扫描,观察其影像学表现。结果 男4例,女3例,平均年龄51岁;7例均为单发,病灶位于胰体尾部5例,胰头2例;最大直径约2~13 cm,平均直径5.2 cm,边界较清楚;CT平扫为略低密度,病灶内见不规则更低密度区,未见明显钙化。MRI扫描示病灶T1WI上为混杂稍低信号、T2WI上为混杂稍高信号。CT、MRI增强扫描均见瘤内实性成分动脉期轻度强化,门脉期呈渐进性强化,强化程度低于正常胰腺组织。7例中1例肝转移,1例侵犯临近脾脏,2例显示胰管侵犯并扩张,3例出现腹膜后淋巴结转移。结论 胰腺腺泡细胞癌CT、MRI表现具有一定特征性。     

临床及影像学评价硬化治疗静脉畸形效果研究进展

静脉畸形（VM）为最常见先天性脉管畸形,其临床表现取决于病灶范围及位置,包括疼痛、肿胀、活动受限及出血等;治疗VM方法包括硬化治疗、手术治疗及激光治疗等,硬化为一线治疗方案。目前对于评价硬化治疗VM效果尚未建立统一标准。本文围绕临床及影像学评价硬化治疗静脉畸形效果进展进行综述。     

Extradural spinal cavernous angiomas: report of seven cases

The authors describe seven cases of extradural spinal cavernous angioma. Although cavernoma itself is not rare, the extradural spinal localization is uncommon and makes preoperative differential diagnosis difficult. Routine MRI investigation has aided neurosurgeons in evaluating the true incidence of these vascular malformations, which was understimated in the past. The data published so far have not entirely clarified the treatment of choice for these lesions. Considering their rarity in this site, their presenting symptoms and the difficulties involved in neuroradiological diagnosis, the authors discuss the role of surgery as the principal form of treatment and review the relevant literature. Seven patients (4 male, 3 female) were admitted to our Institute of Neurosurgery between 1992 and 2004, with a 5–6 month history (range=2–365 days) of low back pain or radicular pain, sometimes associated with paresthesia. All patients had a CT scan, as well as MRI with gadolinium when possible, which detected an extradural roundish lesion: differential diagnosis was very difficult, especially between neurinoma and cavernoma. Treatment was always surgical and resection of the lesion radical. Postoperatively, all patients presented complete regression of clinical symptoms. In all cases histological diagnosis was cavernous angioma. Postoperative MRI with gadolinium or CT scan with IV contrast, performed before discharge, confirmed radical removal of the vascular malformation in all cases. Our experience confirms that surgery should be the treatment of choice for these lesions, in view of both their tendency to bleed and their straightforward surgical removal.     

基于MRI影像组学及临床特征预测肿块型肝内胆管细胞癌的术后生存时间

目的 探讨影响肿块型肝内胆管细胞癌（mass-forming intrahepatic cholangiocarcinoma,MFICC）患者手术切除预后的相关因素。方法 回顾性收集2015年10月至2017年5月杭州市第三人民医院行外科手术切除治疗的MF-ICC患者42 例,均经病理学检查证实为MF-ICC。所有患者术前1 个月内行肝脏MRI平扫+增强检查,应用GE-AK软件标注MRI增强平衡期（magnetic resonance-equilibrium phase,MREP）图像上肿瘤病灶并提取9个量化的一阶影像组学特征,纳入临床特征10个指标。电话随访并记录患者术后生存时间,行Cox回归模型分析。结果 MRI影像组学特征及临床特征与MF-ICC患者术后生存具有明显相关性,大血管侵犯（HR 1.532,95%CI 2.245～9.328,P=0.025）、淋巴结肿大（HR 1.273,95%CI 1.352～5.463,P=0.042）和均匀度（HR 2.475,95%CI 3.226～12.001,P=0.002）是影响MF-ICC患者术后生存的不良预后因素。结论 MRI影像组学特征（均匀度）和临床特征（大血管侵犯和淋巴结肿大）是与MF-ICC患者术后总生存时间相关的独立危险因素,提示影像组学特征（均匀度）是具有临床应用前景的生物学特征。