高血压脑出血凝血酶与脑水肿的临床研究

目的研究凝血酶与高血压脑出血脑水肿形成的关系。方法62例出血量在35～50ml之间的急性高血压脑出血患者分为3组,高血压对照组、常规治疗组和微创治疗组。常规治疗组分别在起病1d、3d、5d和7d测定血清凝血酶浓度、神经功能缺损程度评分以及影像学的脑水肿比值。微创治疗组分别在起病1d、3d、5d和7d测定外周血和血肿液中所测得凝血酶浓度、神经功能缺损程度评分以及影像学的脑水肿比值。高血压对照组测定血清凝血酶浓度。结果血肿凝血酶浓度和脑水肿比值呈正相关(r=0.663,P<0.05);血清凝血酶浓度和脑水肿比值呈正相关(r=0.702,P<0.05);血肿局部凝血酶和神经功能缺损评分呈正相关(r=0.553,P<0.05)。结论凝血酶有可能导致脑出血患者脑水肿形成;微创治疗不能完全缓解脑出血患者早期(≤3d)血肿内凝血酶所诱导的脑水肿形成;微创治疗能改善脑出血后期(>3d)的脑水肿及神经功能缺损评分。     

252例老年颅内肿瘤术后并发症的相关因素分析

目的分析与老年颅内肿瘤术后并发症相关的因素。方法对北京天坛医院2005年1月至2007年12月252例手术治疗的老年颅内肿瘤相关资料进行回顾性研究。分析诸多临床因素与老年颅内肿瘤患者术后发生并发症的关系。应用SPSS 13.0软件进行单因素分析和多因素Logistic回归分析。结果单因素分析显示,术前患者卡氏评分(KPS)、肿瘤部位、术中出血量、麻醉时间、手术时间等与术后并发症的发生有关。多因素分析显示,术前患者KPS评分和肿瘤部位是术后并发症的主要影响因素。结论术前KPS小于90分和肿瘤位于幕下等是术后并发症的主要影响因素。术中出血量、麻醉时间以及手术时间等因素也与术后并发症发生率有一定相关。而年龄、性别、肿瘤切除程度和术前美国麻醉师协会评分(ASA)等在本研究中显示不是术后并发症的主要影响因素。     

磁共振血管造影及其原始图像、磁共振成像诊断脑动脉瘤

目的:回顾性分析了24例颅内动脉瘤病人的磁共振血管造影(MRA)及其原始图像,磁共振成像(MRI),数字减影血管造影(DSA)图像,评价其应用的价值和不足。方法:从各图像分析显示动脉瘤及其并发症信息的数量和质量,载瘤动脉、瘤颈、瘤腔的图像质量计分后统计处理。结果:检出率:DSA(95％)>MRA(87.5％)>MRI(68％),ERA 原始图像 MRI联合应用提高至92％,与DSA无明显差异;MRA有伪影,载瘤动脉细分支动脉和大瘤腔无信号;原始图像可发现小的和巨大动脉瘤,显示瘤腔、瘤壁、瘤体、占位效应准确,其瘤颈、瘤腔的信号多高于MRA;MRI显示瘤腔、瘤壁、瘤体、占位效应、出血、脑积水、脑水肿满意。结论:MRA及其原始图像联合应用相互验证同一信息,去除伪影,提高质量;信息全面,优于DSA;由于无创伤,无危险,对诊断动脉瘤有很高的实用价值。     

Developmental changes in cerebral grey and white matter volume from infancy to adulthood

In order to quantify human brain development in vivo, high resolution magnetic resonance images of 158 normal subjects from infancy to young adulthood were studied (age range 3 months–30 years, 71 males, 87 females). Data were analysed using algorithms based on voxel-based morphometry (VBM) (an objective whole brain processing technique) to generate global volume measures of whole brain, grey matter (GM) and white matter (GM). Gender-specific development of WM and GM volumes is characterised using a piecewise polynomial growth curve model to account for the non-linear nature of human brain development, implemented using Markov chain Monte Carlo simulation.     

弥散张量成像在颅内环形强化病变中的诊断价值

目的 探讨弥散张量成像(diffusion tensor imaging,DTI)对颅内环形强化病变的诊断价值.方法 53例颅内单发环形强化病例术前行DTI扫描,分别测量病变坏死区、灶周水肿区及对侧正常脑实质的平均弥散系数(MD)值及各向异性分数(FA)值.并通过弥散张量纤维束成像(diffusiontensor tracking,DTT)观察病灶与白质纤维束的关系.结果 脑脓肿坏死区的MD值为(0.60±0.13)×10-3 mm2/s,FA值为0.18±0.03,高级别星形细胞瘤MD值为(2.76±0.26)×10-3mm2/s,FA值为0.07±0.02,脑转移瘤MD为(2.82±0.29)×10-3mm2/s,FA值为0.06±0.02,前者与后两者间差异有统计学意义(P<0.01).高级别星形细胞瘤水肿区的FA值(0.23±0.06)与脑转移瘤(0.17±0.06)和脑脓肿(0.15±0.03)两者水肿区FA值差异有统计学意义(P<0.01).DTT可以较准确地反映病灶与白质纤维束的关系,为手术治疗及评估预后提供依据.结论 坏死区MD值及FA值有助于脑脓肿与环形强化脑肿瘤的鉴别;水肿区FA值有助于脑星形细胞瘤与转移瘤、脑脓肿的鉴别;DTT能够为优化手术方案及评估预后提供一定帮助.     

高血糖症脑损害的临床及影像学表现

目的探讨血糖急剧增高所致脑损害的临床表现及影像学特征。方法对6例血糖急剧增高所致脑损害的临床表现及影像学特征进行回顾性分析。结果6例患者均为老年,急性发病,发病时血糖水平为21．9～43．2mmol/L,酮体检测阴性,临床表现为舞蹈症、癫痫、认知功能障碍等。CT显示为尾状核豆状核高密度影。MRI T1WI呈高信号,T2WI呈低信号。采用降低血糖治疗及对症症状好转。结论高血糖脑损害与其CT、MRI表现可能构成一临床综合征。     

Fetal MRI: normal gestational landmarks for cerebral biometry, gyration and myelination

Purpose Up until the last 10 years, normal cerebral gestational landmarks were assessed by ultrasonographic and fetopathologic studies. The purpose of this paper is to display the possibilities provided by fetal MRI in the evaluation of fetal cerebral biometry, normal sulcation and myelination.Methods Two hundred and twenty-five fetuses (with a normal brain) were studied prospectively using a standardised method. The gestational age ranged from 22 to 38 weeks. The main data concerning biometry of various cerebral structures at those terms are given .Discussion In contrast to ultrasound, MRI allows measurements of brain (and not skull), which are available independently of the position of the fetal head. The timing of the appearance of the different sulci is also available using MRI. It is considered to be a good marker of fetal brain maturation. The biochemical modifications contemporary to myelination make it possible to evaluate this phenomenon in the fetal brain using MRI.     

FLAIR和DWI在急性脑梗死诊断中的应用

目的 比较液体衰减翻转恢复(FLAIR)序列和弥散加权成像(DWI)序列在急性脑梗死中的应用。方法 15例急性脑梗死患者(10例椎基底动脉系统脑梗死，5例颈内动脉系统脑梗死)接受FLAIR和DWI检查，评价病变的显示范围、边界、与周围组织的对比度、检出病灶的数目及病灶的大小。结果 FLAIR和DWI对病变的显示范围、与周围组织的对比均优于常规T2W，除小脑梗死外，发病时间＜24h的，以DWI对病变显示更佳；＞24h的，FALIR及DWI显示病灶大小无明显差异。结论 FLAIR和DWI在急性脑梗死诊断中均优于常规T2W序列，发病时间＜24h的，以DWI显示病灶最好，对靠近颅底的急性病变，FLAIR要优于DWI。     

Comparison of MR spectroscopy and MR imaging with contrast agent in children with cerebral astrocytomas

We studied 33 patients with astrocytomas of different grades (68 examinations) by magnetic resonance imaging (MRI) and proton MR spectroscopy (¹H-MRS). We found that in 80% of the spectra, the presence of signals in the area of 0.8–1.5 ppm, assigned to lipids/lactate in ¹H-MR spectra, correlated with signal enhancement after Gd-DTPA administration. We suggest that visibility of lipid/lactate signals could be due to blood–brain barrier damage, which is characterized by contrast agent enhancement. Received: 16 November 1998     

Detection and characterization of neurotoxicity in cancer patients using proton MR spectroscopy

OBJECTIVE: The study objective was to detect abnormalities and identify relationships between brain metabolic ratios determined by proton magnetic resonance spectroscopic imaging ((1)H-MRSI) and neuropsychological (NP) function in cancer patients at risk for neurotoxicity. METHODS: Thirty-two patients received (1)H-MRSI using a multi-slice, multi-voxel technique on a 1.5T magnet. Cho/NAA, NAA/Cr, and Cho/Cr ratios were identified in seven pre-determined sites without tumor involvement. A battery of age-appropriate NP tests was administered within 7 days of imaging. Relationships were examined between test scores and metabolite ratios. CONCLUSIONS: This study identifies relationships between brain metabolite ratios and cognitive functioning in cancer patients. (1)H-MRSI may be useful in early detection of neurotoxic effects, but prospective longitudinal studies in a homogeneous population are recommended to determine the prognostic value.     

Surgical management of epilepsy due to cerebral cavernomas using neuronavigation and intraoperative MR imaging

Abstract

Objectives:

Cure from seizures due to cavernomas might be surgically achieved dependent on both, the complete removal of the cavernoma as well as its surrounding hemosiderin rim. High field intraoperative MRI imaging (iopMRI) and neuronavigation might play a crucial role to achieve both goals. We retrospectively investigated the long-term results and impact of intraoperative 1·5T MRI (iopMRI) and neuronavigation on the completeness of surgical removal of a cavernous malformation (CM) and its perilesional hemosiderin rim as well as reduction of surgical morbidity.

Methods:

26 patients (14 female, 12 male, mean age 39·1 years, range: 17–63 years) with CM related epilepsy were identified. Eighteen patients suffered from drug resistant epilepsy (69·2%). Mean duration of epilepsy was 11·9 years in subjects with drug resistant epilepsy (n = 18) and 0·3 years in subjects presenting with first-time seizures (n = 8). We performed 24 lesionectomies and two lesionectomies combined with extended temporal resections. Seven lesions were located extratemporally.

Results:

Complete CM removal was documented by postsurgical MRI in all patients. As direct consequence of iopMRI, refined surgery was necessary in 11·5% of patients to achieve complete cavernoma removal and in another 11·5% for complete resection of additional adjacent epileptogenic cortex. Removal of the hemosiderin rim was confirmed by iopMRI in 92% of patients. Two patients suffered from mild (7·7%) and one from moderate (3·8%) visual field deficits. Complete seizure control (Engel class 1A) was achieved in 80·8% of patients with a mean follow-up period of 47·7 months.

Discussion:

We report excellent long-term seizure control with minimal surgical morbidity after complete resection of CM using our multimodal approach.     

基底动脉弯曲度与年龄及基底动脉供血区脑梗死发生的关系

目的 初步研究成年人基底动脉的扭曲系数(TC)值,并评价后循环脑梗死TC值的变化.方法 前瞻性分析135名健康体检者(19～80岁,男90名,女45名)及42例后循环脑梗死患者(51～70岁,男28例,女14例)的磁共振血管成像上基底动脉的TC值,并探究脑梗死患者TC值与后循环脑梗死发生的相关性.结果 除31～50岁与51～70岁组外,其他不同年龄组间TC值比较,差异均有统计学意义;脑梗死患者的TC值(2.497±1.200)明显大于健康对照组(1.939±0.850,t=2.39,P=0.0195).结论 (1)基底动脉弯曲度与年龄呈正相关,可间接反映动脉硬化的程度;(2)后循环脑梗死患者的基底动脉弯曲度明显增大.     

高凝状态相关性非单一动脉供血区多发急性脑梗死的临床特点和微栓子监测

目的 研究高凝状态相关性非单一动脉供血区多发急性脑梗死的临床和影像学特点、微栓子监测,探讨其可能的发病机制。方法 收集就诊于我院神经内科的高凝状态相关性非单一动脉供血区多发急性脑梗死患者的临床资料、实验室检查、头MRI、TCD微栓子监测,总结分析其特点。结果 共收集22例患者。均以局灶性神经功能缺损急性起病,包括偏瘫、失语、偏身感觉障碍、构音障碍、偏盲、皮质盲。高凝状态相关性基础疾病如下:系统性恶性肿瘤10例,高同型半胱氨酸血症(中重度,HCY50μmol/L)5例,肾病综合征2例,抗磷脂综合征2例,溃疡性结肠炎1例,真性红细胞增多症1例,阵发性睡眠性血红蛋白尿症1例。18例在卒中发病后高凝状态相关性基础疾病才被首次确诊。DWI示多发急性梗死灶,不符合单一动脉供血区,累及双侧前循环或前后循环,病灶累及大脑半球脑叶皮层/皮层下22例,深部12例,小脑10例,脑干2例。22例行微栓子监测者10例阳性。结论 对于非单一动脉供血区多发急性脑梗死,要注意筛查高凝状态相关性基础疾病,高凝状态和微栓塞可能都参与其发病机制。     

The clinical utility of multimodal MR image-guided needle biopsy in cerebral gliomas

Purpose: Our aim was to evaluate the diagnostic value of multimodal Magnetic Resonance (MR) Image in the stereotactic biopsy of cerebral gliomas, and investigate its implications. Materials and Methods: Twenty-four patients with cerebral gliomas underwent ¹H Magnetic Resonance Spectroscopy (¹H-MRS)- and intraoperative Magnetic Resonance Imaging (iMRI)-supported stereotactic biopsy, and 23 patients underwent only the preoperative MRI-guided biopsy. The diagnostic yield, morbidity and mortality rates were analyzed. In addition, 20 patients underwent subsequent tumor resection, thus the diagnostic accuracy of the biopsy was further evaluated. Results: The diagnostic accuracies of biopsies evaluated by tumor resection in the trial groups were better than control groups (92.3% and 42.9%, respectively, p = 0.031). The diagnostic yield in the trial groups was better than the control groups, but the difference was not statistically significant (100% and 82.6%, respectively, p = 0.05). The morbidity and mortality rates were similar in both groups. Conclusions: Multimodal MR image-guided glioma biopsy is practical and valuable. This technique can increase the diagnostic accuracy in the stereotactic biopsy of cerebral gliomas. Besides, it is likely to increase the diagnostic yield but requires further validation.     

颅内脑膜瘤的临床病理分析

本文报道颅内脑膜瘤1999例,男性占44.6％、女性占55.4％,平均年龄43±13岁,主要发生在大脑凸面、矢状窦旁、大脑镰旁、蝶骨嵴等部位。后期的1313例脑膜瘤中良性占87.6％、恶性占12.4％,良性脑膜瘤中内皮型占53.8％,纤维型占32.0％,过渡型6.8％、混合型0.8％,分型不详6.6％。天幕上的脑膜瘤以内皮型多见,天幕和后颅窝脑膜瘤以纤维型多见;恶性脑膜瘤中血管母细胞型占73.8％。脑膜肉瘤和良性脑膜瘤恶性变者占26.2％。恶性脑膜瘤好发于矢状窦旁、大脑镰旁、中颅窝和天幕,其发生率男性高于女性。     

Hypoyelination in I-cell disease; MRI, MR spectroscopy and neuropathological correlation

MRI of a female patient with genetically diagnosed I-cell disease at 2weeks, 4 and 8months revealed delayed myelination or hypomyelination with decreased choline on MR spectroscopy. Brain autopsy was performed 2h after death at 14-month-old. Immunoreactivities for myelin basic protein and proteolipid proteins, markers for mature myelin sheath, were reduced in the myelinated fibers and oligodendrocytes in the white matter, indicating the hypomyelination in the central nervous system. I-Cell disease should be added to the list of delayed or hypomyelination conditions, and this neuroimaging finding could be a key for differentiating I-cell disease from the clinically similar disorder of Hurler syndrome characterized by perivascular lacunation.     

急性脑梗死患者伴脑内微出血的临床研究

目的探讨急性脑梗死合并脑内微出血(CMBs)的发生率、分布、演变的规律、出血转换的关系。方法采用回顾性的方法,对2005～2007年1039例患者进行研究,其中脑梗死患者678例(其中梗死后出血者27例),对照组361例。采用1.5 T Philips MRI对全部研究对象进行MR I自旋回波序列(SE)、快速自旋回波序列(FSE)、场回波序列(FE)、梯度回波(GRE)扫描。结果比较4种序列检查阳性率,证实CMBs在MRI-T2WI序列显影率最高,CMBs发生率在对照组、梗死组、梗死后出血组中依次为11%、22.6%、40.7%,差异有统计学意义(χ2=216.695,P=0.000),CMBs灶以皮质-皮质下、基底节区分布较多,幕下结构分布相对较少,但3组间比较分布差异无统计学意义(χ2=6.530,P=0.163)。脑梗死患者合并高血压病与非高血压分组,与对照组相比CMBs检出率未见明显差别(χ2=0.417,P=0.792).,CMBs分布规律与急性脑梗死分布区域不一致,两侧半球灶分布无明显差别(χ2=4.811,P=0.683);脑梗死患者与对照组的CMBs分级均以轻度为主,中重度发病相对较少,差异无统计学意义(P=0.181),梗死组中对36例CMBs患者动态观察发现:再梗死患者的新发微出血的比例高于无再梗死者(60.9%:23.1%,χ2=4.760,P=0.029)。结论通过MRI的GRE序列扫描发现急性脑梗死、再发脑梗死和梗死后出血患者微出血发生率高,但CMBs分布与梗死部位和梗死的严重的程度无关,推论CMBs发生可能与急性脑梗死发病时,在应激和缺血、缺氧的状态下出现的脑内广泛微血管病变有关。     

Changed patterns of cerebral activation related to clinically normal hand movement in cervical dystonia

OBJECTIVES: The relief of cervical dystonia by sensory tricks points at complex sensorimotor interaction. The relation between such stimulus-induced normalization of posture and parietal activation [Naumann M, Magyar-Lehmann S, Reiners K, Erbguth F, Leenders KL. Sensory tricks in cervical dystonia: perceptual dysbalance of parietal cortex modulates frontal motor programming. Ann Neurol 2000;47:322-8] further supports the idea of disturbed higher-order motor control and suggests that the organization of movement is affected beyond the level of a local output channel. Dysbalance beyond a restricted output channel is also supported by the spread of focal dystonia to adjacent body parts. In this fMRI study, we aimed to determine whether cervical dystonia patients have indeed different patterns of cerebral activation during clinically normal hand performance. PATIENTS AND METHODS: By means of statistical parametric mapping (SPM) of 3T fMRI results, task-related cerebral activations measured in eight cervical dystonia patients were compared to data of nine healthy volunteers. RESULTS: Compared to controls, the patient group showed a relative reduction of activations in bilateral parietal, left premotor and cingulate cortex regions during imagining of movement, while activation of right (ipsilateral) putamen, insula and cingulate cortex was impaired during movement execution. CONCLUSION: Cervical dystonia appears to concern a general disorganization of cerebral motor control, which indicates a pre-dystonic state of clinically normal hand movements. The latter may imply an increased vulnerability for deteriorating triggers such as minor accidents.