Thickening of Multiple Cranial Nerves in a Patient with Extranodal Peripheral T-cell Lymphoma

A 57-year-old male became aware of a subcutaneous tumor in March 2001. Histopathological examination showed peripheral T-cell lymphoma. He achieved complete remission after chemotherapy. Later the lymphoma relapsed in the subcutaneous lesion and chemotherapy was performed again. In April 2003, he developed diplopia, dysarthria, and dysphagia. Abnormal lymphoid cells were found in the cerebrospinal fluid. An immunophenotypical study disclosed that CD2, CD3, CD5, and CD8 were positive. Rearrangement of TCR was detected by Southern blotting. Cranial magnetic resonance imaging did not detect any intraparenchymal lesions, but thickening of multiple cranial nerves was detected. These nerves were homogeneously enhanced by gadolinium-DTPA. After intrathecal chemotherapy, atypical cells disappeared from the cerebrospinal fluid and thickening of the cranial nerves was resolved. Finally, lymphoma spread to the bone marrow, and the patient died in July 2003.     

磁共振DWI对脑脓肿与坏死囊变性胶质瘤的鉴别诊断价值

目的评价磁共振弥散加权成像(DWI)及表观弥散系数(ADC)值在脑脓肿与坏死囊变性胶质瘤鉴别诊断中的作用。方法8例脑脓肿和15例坏死囊变性胶质瘤,均行常规磁共振T1WI、T2WI和DWI检查。观察病变区信号强度,并分别测量脑脓肿、胶质瘤坏死囊变区、周围水肿、对侧正常脑白质及脑脊液的ADC值。结果DWI上所有脑脓肿均呈高信号,而胶质瘤坏死、囊变部分均呈低信号。脑脓肿与胶质瘤坏死囊变区ADC值之间,脑脓肿周围水肿与胶质瘤周围水肿的ADC值之间均有统计学差异。结论DWI与ADC值测量能有效反映脑脓肿与坏死、囊变性胶质瘤的不同液态性质,对其鉴别诊断有重要作用。     

Magnetic Resonance Imaging of Multiple Sclerosis

Although conventional magnetic resonance imaging (cMRI) is widely used for diagnosing multiple sclerosis (MS) and monitoring disease activity and evolution, the correlation between cMRI and clinical findings is far from strict. Among the reasons for this "clinical-MRI paradox," a major role has been attributed to the limited specificity of cMRI to the heterogeneous pathological substrates of MS and to its inability to quantify the extent of damage in the normal-appearing tissue. Modern quantitative MRI techniques have the potential to overcome some of the limitations of cMRI. Metrics derived from magnetization transfer and diffusion-weighted MRI enable one to quantify the extent of structural changes occurring within and outside macroscopic MS lesions with increased pathological specificity over cMRI. Magnetic resonance spectroscopy can add information on the biochemical nature of such changes, with the potential to improve significantly our ability to monitor inflammatory demyelination and axonal injury. Finally, functional MRI might provide new insights into the role of cortical adaptive changes in limiting the clinical consequences of white-matter structural damage. This review outlines the major contributions given by MRI-based techniques to the diagnostic work-up of MS patients, to the understanding of the pathobiology of the disease, and to the assessment of the effects of new experimental treatments.     

垂体脓肿的诊断和治疗(附2例报告及文献复习)

目的探讨垂体脓肿的临床、影像学特点及治疗,提高对垂体脓肿的认识和诊治水平。方法回顾性分析2例垂体脓肿患者的临床表现、影像学特征、诊断和治疗经过,并结合相关文献分析垂体脓肿的诊断和鉴别诊断。结果 2例中年女性患者,主要临床症状为头痛、发热、视觉障碍、多饮多尿、闭经和全身乏力。MRI增强扫描示垂体病灶环形强化伴垂体柄明显强化。例1患者经额下入路清除脓肿,术后使用抗生素和对症治疗,恢复良好。例2患者经鼻蝶入路清除脓肿,术后2个月复发,再次经鼻蝶入路清除脓肿,术后恢复良好。结论垂体脓肿术前诊断困难,早期出现视力和视野改变、尿崩,以及影像学检查出现鞍区环形强化的囊性病灶应考虑垂体脓肿的可能性。早诊断、围手术期合理应用抗生素、及时手术和适当的对症治疗是治疗的关键。     

Unusual Presentation of Sarcoidosis: Solitary Intracranial Mass Lesion Mimicking a Glioma

We present a patient with sarcoidosis with an isolated intraparenchymal mass lesion that was similar to a glioma on magnetic resonance imaging. On fluid‐attenuated inversion recovery images, a small hyperintense signal change in the right uncus was observed. Three months later, enlargement of the abnormal signal lesion was observed. An initial diagnosis of glioma was made. A biopsy of the temporal lobe tumor was done. On histology, a noncaseating granulomatous inflammation consistent with neurosarcoidosis was diagnosed. Albeit rarely, we should consider the possibility of neurosarcoidosis in the differential diagnosis of isolated intraparenchymal mass lesion, when the mass is located beside the pia mater.     

9例原发性中枢神经系统血管炎临床、影像及病理特点研究

目的  总结原发性中枢神经系统血管炎临床、磁共振成像（magnetic resonance imaging,MRI）和病理学特点。 方法  收集2012年3月～2014年12月首都医科大学附属北京天坛医院神经病学中心收治的原发性中枢神经系统血管炎患者资料,采用描述性方法对其临床表现、MRI及病理学特点进行分析。 结果  共收集9例患者,其中男性5例（55.56%）,女性4例（44.44%）,年龄范围10～47岁,中位年龄30岁。痫性发作4例（44.44%）,行为认知异常3例（33.33%）,局灶性感觉运动异常5例（55.56%）,头晕2例（22.22%）,钝性头痛2例（22.22%）,面部疼痛1例（11.11%）,视物模糊1例（11.11%）,行走不稳1例（11.11%）。腰穿异常4例（44.44%）。MRI表现为双侧病灶6例（66.67%）,单侧病灶3例（33.33%）,其中受累部位分别为额叶9例（100%）,顶叶5例（55.56%）,颞枕叶4例（44.44%）,合并皮层下白质受累6例（66.67%）,合并脑膜/脊膜受累3例（33.33%）,合并基底节受累1例（11.11%）,合并脊髓受累1例（11.11%）;病变边界不清8例（88.89%）,边界清1例（11.11%）;皮层萎缩伴脑室扩大3例（33.33%）;病灶及脑脊膜强化6例（66.67%）;7例患者行磁共振T2*或磁敏感加权序列（susceptibility weighted  imaging,SWI）,其中病灶表现低信号4例（57.14%）。2例行脑病理学检查,表现为脑实质水肿,血管周围炎性细胞浸润,血管壁坏死和胶质增生。 结论  原发性中枢神经系统血管炎临床表现及影像学多样,病灶合并脑膜和（或）脊膜强化,以及磁共振T2*或SWI序列低信号是其重要影像学特征,脑活检仍是目前重要的确诊手段。     

Latent cerebral artery stenoses on magnetic resonance angiography in a patient diagnosed as probable Alzheimer disease

Abstract A 65-year-old woman with hypertension developed slowly progressive memory disturbance and disorientation. She was diagnosed as having Alzheimer-type dementia according to clinical criteria. Later her cognitive deterioration was noted to fluctuate in parallel to her blood pressure. Magnetic resonance angiography and single photon emission computed tomography showed bilateral middle cerebral artery stenoses and middle cerebral artery watershed dominant hypoperfusion. It is postulated that the patient's cognitive disturbance may have originated from vascular lesions.     

MR imaging and CT of pituitary abscess: Case report and review

Abstract

Pituitary abscess is a rare disorder. However, preoperative diagnosis is important to prevent a cranial approach leading to severe meningitis. A case of a 55 year-old woman with pituitary abcess is reported. The patient was admitted with a several-week history of frontal headache and no signs of inflammation. Computed tomographic (CT) scan showed a slightly low-density suprasellar expanding mass lesion with an enhanced thin wall in the pituitary region. Magnetic resonance imaging showed a homogenous high- intensity signal relative to brain parenchyma on T1 -weighted images with an enhanced thin wall and a homogenous low-intensity signal on T2-weighted images. This was histologically shown to be a pituitary abscess. Our case and review of the available literature suggest that pituitary abscess generally shows a homogenous low-density on CT scan and a homogenous low- to iso- and high-intensity signals or homogenous high- and low-intensity signals on T1- and T2-weighted images, respectively, with a cystic appearance and enhanced smooth wall. [Neurol Res 1996; 18: 495-498]     

Transcranial Doppler Sonography Guided by Magnetic Resonance Angiography for Improved Monitoring of Intracranial Arteries

Transcranial Doppler (TCD) sonography combines the advantages of real–time hemodynamic information, cost–effectiveness, and bedside application. However, measurements can be difficult to reproduce because the spatial resolution and the determination of insonation angles are limited. The purpose of this study was to use the high anatomic resolution of threedimensional (3D) magnetic resonance angiography (MRA) images for the stereotactic guidance of TCD in order to improve the accuracy and reproducibility of TCD examinations. The MRA examinations were performed on a 1.5 T scanner using a 3D flow compensated gradient–echo sequence. A noninvasive stereotactic mask was used for image registration. The MRA data were then transferred to a personal computer. An infrared tracking system registered the position of the head and the ultrasound probe during TCD. This enabled the authors to superimpose a virtual ultrasound beam onto the MRA projections of the intracranial arteries displayed on the monitor of the personal computer. This allows the examiner to easily identify the insonated intracranial artery and displays the insonation angle. In volunteer examinations (n=1 0), the accuracy and reproducibility     

25例烟雾病临床影像特点观察

目的探讨烟雾病的临床特征、影像学特点。方法对25例烟雾病患者首发症状、临床表现及影像学结果进行分析。结果烟雾病发病平均年龄较轻,女性多于男性;少儿烟雾病患者以缺血改变为主(87.5%),成年烟雾病患者缺血改变(58.8%)与出血改变(41.2%)相当;临床以头痛、头晕、肢体无力或偏瘫或交替性瘫痪为主要表现,同时可伴失语、智能下降、视力下降、癫痫发作、小舞蹈发作等表现。14例行头CT检查仅示颅内病灶,均未提示烟雾病;25例均行MRI和MRA检查发现颅内病灶,显示颈内动脉虹吸末段和大脑前或中动脉近段狭窄或闭塞,并有脑基底部异常血管网及侧支循环形成,均被诊断为烟雾病。其中9例又行数字减影血管造影术(DSA),结果与其MRA相符。结论头颅MRI和MRA是诊断烟雾病理想的非介入性检查方法。     

Surface rendered three-dimensional MR imaging for the evaluation of trigeminal neuralgia and hemifacial spasm

Surface rendered three-dimensional (SR3D) magnetic resonance (MR) imaging was used to visualize the cerebellopontine angle nerves, blood vessels and brain stem and compared with the operative view in patients undergoing microvascular decompression. Thirty-one patients with 32 affected nerves manifesting as trigeminal neuralgia (TN, 16 cases), hemifacial spasm (HFS, 14 cases) and glossopharyngeal neuralgia (2 cases) underwent microvascular decompression at the Kanto Neurosurgical Hospital between February 2001 and July 2002. Preoperative MR imaging and MR angiography were performed in all patients. The SR3D MR image and the operative view correlated in 30 of the 31 patients. A very thin artery was not detected in one patient with TN. SR3D MR imaging can clearly demonstrate the three-dimensional relationship between the nerves and the offending vessel, so is very effective for the preoperative planning of microvascular decompression in cases of TN and HFS.     

24例原发性中枢神经系统血管炎患者的MRI表现

目的观察24例原发性中枢神经系统血管炎(PACNS)的磁共振成像(MRI)表现,探讨PACNS的MRI诊断价值。方法对急性期进行了MRI检查的24例经病理证实的PACNS的MRI特点进行了回顾性分析。结果 24例患者中,病灶以幕上多见[19例(79.2%)],最常累及颞叶、额叶、顶叶及基底节区(包括丘脑),分别为13例(54.2%)、10例(41.7%)、8例(33.3%)、8例(33.3%);大部分病灶累及双侧大脑半球[15例(72.5%)],灰质和白质均受累[21例(87.5%)]。MRI上病灶可多发或单发,均为12例(50%)。病灶形态大致可分为四种类型:斑片状、肿块样、脑回状和混合性,分别为12例(50%)、8例(33.3%)、2例(8.3%)和2例(8.3%)。MRI上所有病灶均呈长(稍长)T1WI、长(稍长)T2WI异常信号,增强扫描可见病灶均有强化,FLAIR上均呈高或稍高信号,9例(37.5%)病灶中心呈散点状短T1WI、短T2WI混杂信号。17例行DWI和ADC序列检查者中,9例(52.9%)在DWI上呈高(稍高)信号,ADC上呈等信号或混杂信号影,8例(47.1%)在DWI及ADC上呈等信号。11例行GRE序列检查者,8例(72.7%)可见病灶局部有点状低信号影或病灶周围血管影增粗,余3例未见异常。8例行MRA序列检查者,仅1例发现异常,可见病灶供血区相应血管局部有狭窄。结论本组24例PACNS患者急性期头MRI均有异常,表现多样,病灶以幕上多见,可累及各个脑区,病灶可多发或单发,多数灰白质均受累。其形态可表现为斑片状、肿块样、脑回状或混合性,增强扫描均可见强化,以斑片状或脑回样强化多见。头MRI上病灶多变、灰白质受累、斑片状或脑回样强化等表现对PACNS诊断有一定提示性。     

Role of High-Resolution Magnetic Resonance Imaging in the Diagnosis of Primary Angiitis of the Central Nervous System

Background

Primary angiitis of the central nervous system (PACNS) is a rare disorder and is often difficult to diagnose due to the lack of a confirmatory test. PACNS can generally be diagnosed based on typical angiographic findings. We describe herein a patient diagnosed with PACNS despite the presence of normal findings on conventional angiography.

Case Report

A 44-year-old man with a recent history of ischemic stroke in the right posterior cerebral artery territory developed acute-onset vertigo. Diffusion-weighted imaging revealed an acute infarction within the left posterior inferior cerebellar artery. His medical history was unremarkable except for hyperlipidemia; the initial examination revealed mild gait imbalance. During the 10 days of hospital admission, the patient experienced four recurrent ischemic strokes within the posterior circulation territory (occipital lobe, pons, and cerebellum). He was diagnosed with recurrent cerebral infarctions due to PACNS. The basilar artery exhibited no demonstrable luminal stenosis, but there were direct imaging signs of central nervous system angiitis including wall thickening and contrast enhancement. High-dose intravenous steroid therapy followed by oral prednisolone was administered. There was no further stroke recurrence and follow-up imaging of the arterial walls showed normalization of their characteristics.

Conclusions

The present case emphasizes the importance of wall imaging in the diagnosis and treatment of PACNS.     

神经精神性狼疮的临床表现和MRI特点分析

目的分析神经精神性狼疮(NPSLE)患者常见的临床表现并探讨其头颅MRI的特点及应用价值。方法回顾性分析11例经临床确诊的NPSLE患者的临床资料及头颅MRI检查结果。结果 11例患者中表现为狼疮样头痛8例,癫痫发作4例,言语不利3例,精神症状、视物模糊和偏瘫各2例,意识障碍和共济失调各1例。10例行头颅MRI检查的患者中,有6例出现异常信号影,病灶累及脑叶(额顶枕叶)3例,基底节2例,白质(皮质下白质、脑室旁及半卵圆中心)5例。病灶性质包括腔隙性梗死(4例)、脑血栓形成(3例)和脑萎缩(2例)。结论 NPSLE临床表现复杂多样,以狼疮样头痛及癫痫发作最常见;头颅MRI可发现NPSLE患者脑内病灶的部位及性质,是较为敏感的检查方法,结合临床可以协助诊断。     

烟雾病的临床及影像研究

目的:研究烟雾病(moyamoya disease,MMD)的临床及影像学特征。方法:回顾性分析27例烟雾病,观察其临床及影像学特点。结果:本组病例多为儿童及青壮年起病,女性居多。病程为多发,主要有脑梗死、出血和短暂脑缺血发作等起病形式,临床表现为肢体麻木、无力、头痛、智力减退等症状;DSA在脑底动脉环发现血管闭塞、狭窄及烟雾状毛细血管网形成,MRA对本病有一定阳性发现。结论:对于儿童及青壮年反复发作的脑卒中患者要考虑MMD的可能,目前仍依靠数字减影血管造影确诊,MRA对本病有一定阳性发现。     

Multiple Liver Abscesses Associated with Ventriculoperitoneal Shunt Infection: Case Report and Review of the Literature

Liver abscess following ventriculoperitoneal (VP) shunting occurs very rarely. We report an unusual case of multiple liver abscesses caused by Staphylococcus capitis in a 50-year-old compromised woman due to a complicating VP shunt infection. We reviewed the nine cases of VP shunt complications reported in the English literature, and speculated that the most likely pathogenetic mechanism in our case is an infected peritoneal tip that migrated to and penetrated the liver, which subsequently caused the formation of multiple liver abscesses. The patient was successfully treated with percutaneous aspiration, drainage of the abscesses, intravenous antibiotics, and shunt revision. Awareness and vigilance of the possibility of liver abscess formation caused by VP shunt infection will help establish an early accurate diagnosis and therapeutic strategy.     

Multimodal biological brain age prediction using magnetic resonance imaging and angiography with the identification of predictive regions

Biological brain age predicted using machine learning models based on high‐resolution imaging data has been suggested as a potential biomarker for neurological and cerebrovascular diseases. In this work, we aimed to develop deep learning models to predict the biological brain age using structural magnetic resonance imaging and angiography datasets from a large database of 2074 adults (21–81 years). Since different imaging modalities can provide complementary information, combining them might allow to identify more complex aging patterns, with angiography data, for instance, showing vascular aging effects complementary to the atrophic brain tissue changes seen in T1‐weighted MRI sequences. We used saliency maps to investigate the contribution of cortical, subcortical, and arterial structures to the prediction. Our results show that combining T1‐weighted and angiography MR data led to a significantly improved brain age prediction accuracy, with a mean absolute error of 3.85 years comparing the predicted and chronological age. The most predictive brain regions included the lateral sulcus, the fourth ventricle, and the amygdala, while the brain arteries contributing the most to the prediction included the basilar artery, the middle cerebral artery M2 segments, and the left posterior cerebral artery. Our study proposes a framework for brain age prediction using multimodal imaging, which gives accurate predictions and allows identifying the most predictive regions for this task, which can serve as a surrogate for the brain regions that are most affected by aging.     

Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings

To evaluate and review the clinical spectrum of anterior cerebral artery (ACA) territory infarction, we studied 48 consecutive patients who admitted to our stroke unit over a 6-year period. We performed magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in all patients, and diffusion magnetic resonance imaging (DWI) in 21. In our stroke registry, patients with ACA infarction represented 1.3% of 3705 patients with ischemic stroke. The main risk factors of ACA infarcts was hypertension in 58% of patients, diabetes mellitus in 29%, hypercholesterolemia in 25%, cigarette smoking in 19%, atrial fibrillation in 19%, and myocardial infarct in 6%. Presumed causes of ACA infarct were large-artery disease and cardioembolism in 13 patients each, small-artery disease (SAD) in the territory of Heubner's artery in two and atherosclerosis of large-arteries (<50% stenosis) in 16. On clinico-radiologic analysis there were three main clinical patterns depending on lesion side; left-side infarction (30 patients) consisting of mutism, transcortical motor aphasia, and hemiparesis with lower limb predominance; right side infarction (16 patients) accompanied by acute confusional state, motor hemineglect and hemiparesis; bilateral infarction (two patients) presented with akinetic mutism, severe sphincter dysfunction, and dependent functional outcome. Our findings suggest that clinical and etiologic spectrum of ACA infarction may present similar features as that of middle cerebral artery infarction, but frontal dysfunctions and callosal syndromes can help to make a clinical differential diagnosis. Moreover, at the early phase of stroke, DWI is useful imaging method to locate and delineate the boundary of lesion in the territory of ACA.     

Magnetic Resonance Imaging Detection of a Lesion Compatible With Central Pontine Myelinolysis in a Pregnant Patient With Recurrent Vomiting and Confusion

The authors report a patient who presented with unexplained confusion. She was 15 weeks pregnant and had been having recurrent vomiting for several weeks. This was felt to possibly represent hyperemesis gravidarum, but she had several other possible contributing factors. Her serum sodium was 146 mmol/L, and her potassium was 2.6 mmol/L. She was alert but had disorientation, visual hallucinations, memory impairment, and confabulation despite being a college graduate with no history of illicit drug use or excessive alcohol consumption. Her initial magnetic resonance imaging (MRI) brain scan was interpreted as being normal. However, her follow-up MRI brain scan revealed typical findings of central pontine myelinolysis, which correlated with hyperreflexia and positive Babinski reflexes. This patient illustrates the constellation of signs and symptoms that can be seen with a demyelinating lesion of the pons. In addition, our case illustrates how this MRI scan finding can be quite nonspecific but may help to explain the clinical findings.     

磁共振管壁成像在颅内动脉夹层中的应用价值

颅内动脉夹层即颅内血管壁内血肿,是导致中青年缺血性或出血性卒中的重要病因,因血 管管径细小,走行迂曲,颅内动脉夹层诊断较困难。磁共振管壁成像作为一种无创性、无放射性检 查手段,可直接观察到动脉夹层所致的特征性壁内血肿信号,因而对颅内动脉夹层的诊断、鉴别诊断 及随访具有重要作用。本文将对磁共振管壁成像在颅内动脉夹层中的应用价值做一简要综述。