第四脑室肿瘤的CT和MR诊断

第四脑室肿瘤的组织来源主要为室管膜和脉络膜组织,病理学上以室管膜瘤、室管膜下室管膜瘤和脉络丛乳头状瘤多见,少见的肿瘤有表皮样囊肿、皮样囊肿、成血管细胞瘤、脑膜瘤、转移瘤等.临床上还包括从邻近组织生长突入第四脑室内的肿瘤,如髓母细胞瘤、星形细胞瘤和血管母细胞瘤等[1].本文简述了第四脑室常见和少见肿瘤的CT、MR表现和鉴别诊断等.     

第四脑室脉络丛乳头状瘤1例

<正>病人,女,40岁,已婚。6年前开始出现间断性头痛,发作无明显规律,行走时加重,平卧休息时不能缓解。于当地医院就诊,未给出明确诊断(具体情况不详)。8 d前,患者骑自行车摔倒,头部着地,枕部疼痛较重,呈胀痛,伴有双眼胀痛。于当地医院行头颅CT(2012年9月15日)示:第四脑室占位。为求进一步诊治,遂来我院,门诊以"第四脑室肿瘤"收住我科。入院查体:体温36.2℃,脉搏     

四脑室区肿瘤的CT和MRI诊断

本文收集了１９８８～１９９３年间经华山医院手术和病理证实的四脑室区肿瘤共４９例。作者分析讨论了其ＣＴ和ＭＲＩ特征，以及与肿瘤来源和病人年龄的关系，结果表明，四脑室区肿瘤的诊断须结合ＣＴ和ＭＲＩ表现、肿瘤来源及病人年龄综合判断，其中肿瘤来源对诊断尤为重要。     

四脑室区肿瘤的CT和MRI诊断

目的探讨四脑室区肿瘤的CT和MRI诊断价值.材料和方法分析31例经手术、病理证实的四脑室区肿瘤的CT和MRI好发年龄、部位和图像特征.结果检出髓母细胞瘤9例,室管膜瘤8例,表皮样囊肿4例,脉络丛乳头状瘤3例,血管母细胞瘤2例,室管膜囊肿1例,海绵状血管瘤1例,生殖细胞瘤1例.结果提示(1)不同的四脑室区肿瘤各具其影像学特征;(2)四脑室区常见肿瘤具有年龄特征;(3)肿瘤来源的判断可帮助肿瘤定性的诊断.结论CT和MRI检查对四脑室区肿瘤的诊断和鉴别诊断有主要价值,以MRI为首选方法.     

第四脑室肿瘤的MRI诊断（附12例报告）

本文分析了１２例经手术证实的第四脑室肿瘤的ＭＲＩ表现，认为ＭＲＩ确定肿瘤的起源、大小及其与周围正常解剖结构的关系非常可靠，第四脑室扩大，肿瘤周围有脑脊液包绕以及四叠体向后上方移位是四脑室肿瘤的可靠征象。单凭ＭＲＩ信号诊断四脑室肿瘤是不全面的。     

第四脑室菊形团形成型胶质神经元肿瘤1例

1 病例简介 患者男,22岁,因"头痛头晕、视物有重影、恶心呕吐10d"入院.体格检查:意识清楚,语言流利,肢体活动正常,肌张力V级,无感觉障碍,病理征阴性.MRI示小脑蚓部囊实性肿块,呈长T1长T2混杂信号,FLAIR为混杂信号,大小约3.8 cm×3.7 cm×4.2 cm,增强扫描后不均匀强化(图1A～D).MRI诊断:小脑髓母细胞瘤.术中见肿瘤主要位于小脑蚓部,紧贴第四脑室前壁,质地软,部分呈胶冻状,血供较丰富.术后病理镜下见小圆核瘤细胞散在分布或围绕神经毡样基质内血管形成的假菊形团结构(图1E、F).免疫组化:神经胶质纤维酸性蛋白(+),突触素(+),神经元核抗原(-).病理诊断:第四脑室菊形团形成型胶质神经元肿瘤(rosette-forming glioneuronal tumor of the fourth ventricle,RGNT),WHO Ⅰ级.     

第四脑室囊虫病的影像学诊断

脑室内囊虫病是因猪绦虫的幼虫随血运经脉络丛至脑室内寄生形成。以第四脑室囊虫病最常见。因虫体漂浮阻塞中脑导水管开口处或第四脑室正中孔处而出现症状，但往往随体位改变症状可缓解。随着囊肿逐渐增大，可出现高颅压症状及小脑、脑干受压症状。     

中国汉族正常成人第四脑室容积的高分辨率MRI测量

目的 测量中国汉族正常成人第四脑室容积的正常值,为建立中国标准脑提供基础数据.方法 采用全国多中心临床研究形式,选取18～70岁健康中国成年志愿者1000名,按照年龄18～30、31～40、41～50、51～60、61～70岁进行分组,分别定义为A、B、C、D、E年龄段组,每组男、女均为100名,对所有受试者均行3D磁化强度预备梯度回波序列T1WI,对3D数据重组后于矢状面通过软件自动追踪结合手工勾绘第四脑室边界测量其容积,对不同性别、不同年龄组统计分析分别采用独立样本t检验、方差分析,对年龄和容积作Pearson相关分析.结果 男、女性第四脑窒容积分别为(2.2±0.9)、(1.9±0.6)ml,性别间差异有统计学意义(t=5.573,P=0.000),男性第四脑室容积大于女性.男性A、B、C、D、E组第四脑室容积分别为(2.1±0.9)、(2.1±0.8)、(2.2±0.8)、(2.1±1.0)、(2.4±0.8)ml,5组间差异有统计学意义(F=2.639,P=0.033),E组与A、B、C、D组分别比较差异均有统计学意义(P值均<0.05);女性分别为(2.0±0.7)、(1.9±0.6)、(1.8±0.6)、(1.9±0.7)、(2.0±0.6)ml,各组间差异无统计学意义(F=1.788,P=0.130).男性容积和年龄有相关,但相关性不强(r=0.119,P=0.008);女性容积和年龄不相关(r=0.041,P=0.360).结论 正常中国成人第四脑窜容积大小存在性别差异;男女性第四脑室容积随年龄变化情况存在不同.     

第四脑室室管膜瘤的CT、MRI影像表现

目的探讨第四脑室室管膜瘤的CT、MRI特征,以提高对该病的诊断和鉴别诊断水平。方法搜集2008年4月至2011年7月在北京天坛医院经手术病理证实的33例第四脑室室管膜瘤患者资料,男20例,女13例,年龄2～68岁,回顾性分析其CT和(或)MRI表现。结果 33例中有12例同时行CT、MRI,8例单独行CT检查,13例单独行MRI。20例CT检查中,病灶密度以等/略高/略低密度为主,CT值范围21～48 HU,有10例发现点片状钙化,有13例发现"浇注"现象,术前CT准确诊断本病者3例。25例行MRI常规平扫加Gd-DTPA增强扫描,病灶大部分呈T1WI稍低信号、T2WI稍高信号,25例均可发现不同程度的"浇注"现象,21例肿块呈不均匀轻中度强化,3例中重度强化,1例无明显强化,23例MRI术前确诊。33例中共有22例肿块内有囊变区,12例肿块与脑干分界欠清晰,29例继发脑积水,3例重度脑积水,15例伴有室旁间质水肿,19例肿块几乎占满第四脑室。结论第四脑室室管膜瘤的CT、MRI表现有一定特征性,MRI是目前诊断该病的最佳方法,综合分析CT、MRI表现,可提高诊断准确率。     

中国汉族正常成人第四脑室容积的高分辨率MRI测量

Objective To explore the normal range of the fourth ventricle volume of Chinese adults of the Han nationality and provide morphological data for the construction of database for Chinese Standard Brain.Methods This is a clinical multi-center study.One thousand Chinese healthy volunteers (age range= 18 to 70) recruited from 15 hospitals were divided into 5 groups, i.e., Group A (age range = 18 to 30),B (age range =31 to 40), C (age range =41 to 50), D (age range =51 to 60), and E (age range =61 to 70).Each group contained 100 males and 100 females.All of the volunteers were scanned by MR using T1 weighted three-dimensional magnetization prepared rapid acquisition gradient echo sequence.After three dimension data reconstruction, the volumes of the fourth ventricle were measured at sagittal view by automatic trace of Midobl.2 combined with manual outlining.The difference of volumes of the fourth ventricle between male and female were analyzed by independent sample t test, and among age groups by ANOVA.Pearson's correlation coeffcient was used to characterize the relationship between volumes of the fourth ventricle and age.Results The fourth ventricle volumes of Group A-E were (2.1±0.9), (2.1±0.8), (2.2±0.8), (2.1±1.0) and (2.4±0.8) ml respectively for male; those for female were(2.0±0.7), (1.9±0.6), (18±0.6), (1.9±0.7) and (2.0±0.6) ml respectively.The fourth ventricle volumes of males were significantly larger than those of females ( t = 5.573, P =0.000 ) ; there were no significant differences among the female groups ( F = 1.788, P = 0.130 ) ; there were significant differences among the male groups ( F = 2.639, P = 0.033 ) and multiple comparison found that the 60 years old was the watershed with significant difference ( P < 0.05 ).Correlation between the change of males' volumes and the ages was not strong (r = 0.119, P = 0.008 ), and the females' volumes did not correlated with their ages ( r = 0.041,P = 0.360 ).Conclusion There are gender differences in the fourth ventricle volumes of normal Chinese adults, and changes of the fourth ventricle volume with aging are different between males and females.     

肾交感神经射频消融术对高血压犬去甲肾上腺素溢出率及交感神经活性的影响

目的评价肾交感神经射频消融术(RSD)治疗腹主动脉缩窄型高血压犬的有效性和作用机制。方法成年健康杂种犬20只,采用腹主动脉缩窄法建立高血压模型。模型建立后,随机分为治疗组(n=10)和对照组(n=10)。治疗组犬于建模后1个月行双侧肾交感神经射频消融术。分别于建立模型前和建立模型后1、2、3个月,测定犬前上臂血压、交感神经活性及去甲肾上腺素溢出率并观察其变化趋势。结果建模后1个月,对照组前上臂收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP)与建模前比较均明显升高(P<0.05),肾交感神经活性冲动明显增强,去甲肾上腺素溢出率水平明显增高(P<0.05)。治疗组RSD手术即刻肾交感神经活性明显下降,至消融后2个月略有增高;去甲肾上腺素溢出率水平在建模后1个月显著增高(P<0.05),消融后显著降低并一直持续至实验结束(P<0.05)。与对照组比较,治疗组消融后1个月、2个月去甲肾上腺素溢出率水平显著降低(P<0.05)。结论 RSD对于高血压犬去甲肾上腺素溢出率及交感神经活性均有明显抑制作用。     

Baroreflex and muscle metaboreflex: control of muscle sympathetic nerve activity

During heavy exercise, the arterial baroreflex and the reflexes evoked by the activation of those afferent nerve endings in the working skeletal muscles that are sensitive to metabolic changes (the so-called muscle metaboreflex) are hypothesized to be activated and, moreover, to interact in ways that lead to the modulation of the primary cardiovascular reflex responses. For the past few years, our group has been investigating the interaction between the arterial baroreflex and the muscle metaboreflex. We have focused our efforts in identifying the effects of muscle metaboreflex activation on the arterial baroreflex regulation of the cardiovascular hemodynamics and muscle sympathetic nerve activity (MSNA) in humans. In a series of studies, we have found that during muscle metaboreflex activation, dynamic carotid baroreflex responses are modulated, as exemplified by the augmentation of the MSNA, leg vascular conductance and blood pressure responses to carotid baroreflex unloading and the shorter suppression period of MSNA, diminished vasodilation, and reduced blood pressure response to carotid baroreflex stimulation. Furthermore, we have found that the modification of the arterial baroreflex-mediated beat-to-beat control of MSNA, which is seen during activation of the muscle metaboreflex (i.e., resetting and an increase in sensitivity), could be a consequence of the alteration in the arterial baroreflex control of both the occurrence and strength of the MSNA burst. In addition, we have demonstrated that the arterial baroreflex beat-to-beat control of MSNA is time-dependently modulated during isometric exercise. We suggest that the modulation of arterial baroreflex function during the activation of muscle metaboreflex is one of the mechanisms for increasing, or maintaining, blood pressure at the required pressure and thereby contributes to the regulation of the cardiovascular system during exercise.     

四脑室区舌下神经鞘瘤1例

患者女,23岁.无明显诱因下出现走路不稳半年,走路时易向右侧倾倒,间断性头痛1年,饮水易呛咳,吞咽困难半年,同时出现进行性双手麻木.体检:双眼球左视时水平性震颤,右侧上肢、左手指浅感觉减退,吞咽减退,双侧咽反射迟钝,左侧舌头萎缩,Rombergsign(+).头颅MRI示四脑室区占位,遂收入本院治疗.     

Arterial and venous signs of tumors within the fourth ventricle

Summary A positive diagnosis of tumors located within the fourth ventricle should be based on specific signs therby excluding other space occupying lesions in the posterior fossa. These are a typical omega form of the hemispheric cerebellar branches on the lateral projection, and an also typical inverted 3 form of the PICA in the semiaxial projection. Alteration of the veins of the lateral recess of the fourth ventricle and of the precentral cerebellar vein are important venous signs. Indirect signs are found in the absence of tonsillar herniation with arterial and venous signs of AP stretching of the cerebellar tonsils.     

Effects of perindopril on cardiac sympathetic nerve activity in patients with congestive heart failure: comparison with enalapril

Purpose The production of aldosterone in the heart is suppressed by the angiotensin-converting enzyme (ACE) inhibitor perindopril in patients with congestive heart failure (CHF). Moreover, perindopril has been reported to have more cardioprotective effects than enalapril.Materials and methods Forty patients with CHF [left ventricular ejection fraction (LVEF) <45%; mean 33±7%] were randomly assigned to perindopril (2 mg/day; n=20) or enalapril (5 mg/day; n=20). All patients were also treated with diuretics. The delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS) and washout rate (WR) were determined from ¹²³I-meta-iodobenzylguanidine (MIBG) images, and plasma brain natriuretic peptide (BNP) concentrations were measured before and 6 months after treatment. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and LVEF were also determined by echocardiography.Results After treatment, in patients receiving perindopril, TDS decreased from 39±10 to 34±9 (P<0.01), H/M ratios increased from 1.62±0.27 to 1.76±0.29 (P<0.01), WR decreased from 50±14% to 42±14% (P<0.05) and plasma BNP concentrations decreased from 226±155 to 141±90 pg/ml (P<0.0005). In addition, the LVEDV decreased from 180±30 to 161±30 ml (P<0.05) and the LVESV decreased from 122±35 to 105±36 ml (P<0.05). Although the LVEF tended to increase, the change was not statistically significant (from 33±8% to 36±12%; P=NS). On the other hand, there were no significant changes in these parameters in patients receiving enalapril.Conclusion Plasma BNP concentrations, ¹²³I-MIBG scintigraphic and echocardiographic parameters improved after 6 months of perindopril treatment. These findings indicate that perindopril treatment can ameliorate the cardiac sympathetic nerve activity and the left ventricular performance in patients with CHF.     

Resting muscle sympathetic nerve activity,cardiac metaiodobenzylguanidine uptake,and exercise tolerance in patients with left ventricular dysfunction

Background  Sympathetic nerve overactivity and reduced exercise tolerance are characteristic features of patients with heart failure. However, to what extent sympathetic nerve overactivity contributes to limiting exercise tolerance has not been clearly defined. Methods  Myocardial iodine 123-metaiodobenzylguanidine (MIBG) scintigraphy, muscle sympathetic nerve activity (MSNA), and cardiopulmonary exercise testing were performed within 3 days in 30 patients with left ventricular dysfunction (LVD). Cardiac sympathetic nerve activity was estimated using H/M ratio and washout rate (WR) of 123I-MIBG imaging. MSNA was recorded by microneurography. Results  The patients with peak VO₂ < 20 mL/minute/kg (group II, n = 15) had significantly higher MSNA and WR, and lower H/M ratio than those with peak VO₂ ≧ 20 mL/minute/kg (group I, n = 15) (P < .05). Peak VO₂ had negative correlations with MSNA and WR (r = 0.58, 0.56), and positive correlations with early H/M ratio and delayed H/M ratio (r = 0.71, 0.75) in group II. Moreover, MSNA had negative correlations with early H/M ratio and delayed H/M ratio (r = 0.78, 0.66), and a positive correlation with WR (r = 0.79) in group II. However, similar relations were not found in group I. Conclusions  A link between cardiac and peripheral sympathetic nerve activities contributed to limiting exercise tolerance in patients with LVD patients and reduced exercise tolerance. See related editorial, doi:     

膈神经移位术中应用生物膜防止神经黏连的临床研究

目的 研究生物膜在膈神经加移植神经移位至肌皮神经主干的术式中防止神经黏连的作用.方法 回顾性地对行两种术式病例的长期随访资料进行统计学分析.有效随访资料者58例,其中使用生物膜(实验组)27例;不使用生物膜(对照组)31例.总结两者的恢复有效率、优良率、恢复时间,进行两组问比较的统计学分析.结果 实验组优14例、良8例、差5例,有效率81.48%,优良率达51.85%.恢复时间(8.7±2.1)个月.对照组优8例、良16例、差7例,有效率77.42%,优良率达25.81%.恢复时间(11.8±1.8)个月.结论 膈神经移位术中使用生物膜处理神经吻合口能有效地防止周围神经黏连,促进周围神经再生,提高手术疗效,缩短恢复时间.适宜在临床工作中推广应用.     

Technical aspects of the pneumoencephalographic and ventriculographic examination of the fourth ventricle

Summary The introduction of new equipment for encephalography and ventriculography which allows the easy and rapid use of tomography has brought about a considerable improvement in the visualization of the anatomical structures of the posterior fossa and especially of the fourth ventricle. In order to have a satisfactory idea of the anatomical details of the fourth ventricle at pneumography two main prerequisites have to be fulfilled: the fourth ventricle must be completely filled with air and the beam direction must be chosen to depict the relevant structures, the latter being especially critical in the PA projections. The position of the head that is most effective for the exchange of ventricular CSF with air obviously cannot be the most suitable position for keeping the air within the fourth ventricle and aqueduct. To obtain complete filling of the fourth ventricle special measures have to be taken during pneumoencephalography and ventriculography. The second prerequisite, a suitable beam direction, is of importance not only in taking plain films but also for tomography. In this context the advantages and disadvantages of different patterns of tomographic movements and angles are discussed.

---

Technische Aspekte der pneumoencephalographischen und ventriculographischen Untersuchung des I V. Ventrikels

Zusammenfassung Die vorliegende Arbeit beschäftigt sich ausführlich mit der Darstellung des IV. Ventrikels (sowohl mittels Übersichtsaufnahmen als auch mittels Tomographie) in 2 Ebenen. Dabei kommt es besonders auf die Haltung des Kopfes bei der Luftfüllung an, da nur bei einer kompletten Luftfüllung des IV. Ventrikels und bei einer korrekten Einstellung des Zentralstrahls eine genügende Darstellung des IV. Ventrikels in allen Abschnitten erreicht werden kann.

---

Aspects techniques de l'examen pneumoencéphalographique et ventriculographique du I Ve ventricule

Résumé L'introduction de nouveaux équipements pour l'encéphalographie et la ventriculographie permettant l'utilisation facile et rapide de la tomographie a apporté une amélioration considérable dans la visualisation des structures anatomiques de la fosse postérieure et plus spécialement du IVe ventricule. — Afin d'obtenir une vue satisfaisante des détails anatomiques du IVe ventricule en pneumographie, duex conditions principales doivent être remplies: — le IVe ventricule doit être complètement insufflé et le faisceau doit être centré sur les structures intéressées, celles-ci étant particulièrement délicates sur les projections postéro-antérieures. La position de la tête la plus adéquate pour l'échange entre le liquide céphalo-rachidien ventriculaire et l'air n'est évidemment pas la meilleure position pour garder l'air dans le IVe ventricule et l'aqueduc. Afin d'obtenir une insufflation complète du IVe ventricule il est nécessaire de recourir à des mesures spéciales au cours de la pneumoencéphalographie. — La deuxième condition, c'est-à-dire une direction adéquate du faisceau, est importante non seulement lors de la prise de clichés conventionnels mais aussi pour la tomographie. Dans ce travail l'auteur discute les avantages et les inconvénients de différents types de mouvements et d'angles tomographiques.

     

Effects of nicorandil on cardiac sympathetic nerve activity after reperfusion therapy in patients with first anterior acute myocardial infarction

Purpose Ischaemic preconditioning (PC) is a cardioprotective phenomenon in which short periods of myocardial ischaemia result in resistance to decreased contractile dysfunction during a subsequent period of sustained ischaemia. Nicorandil, an ATP-sensitive potassium channel opener, can induce PC effects on sympathetic nerves during myocardial ischaemia. However, its effects on cardiac sympathetic nerve activity (CSNA) and left ventricular remodelling have not been determined. In this study, we sought to determine whether nicorandil administration improves CSNA in patients with acute myocardial infarction (AMI).Methods We studied 58 patients with first anterior AMI, who were randomly assigned to receive nicorandil (group A) or isosorbide dinitrate (group B) after primary coronary angioplasty. The nicorandil or isosorbide dinitrate was continuously infused for >48 h. The extent score (ES) was determined from ^99mTc-pyrophosphate scintigraphy, and the total defect score (TDS) was determined from ²⁰¹Tl scintigraphy 3–5 days after primary angioplasty. The left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were determined by left ventriculography 2 weeks later. The delayed heart/mediastinum count (H/M) ratio, delayed TDS and washout rate (WR) were determined from ¹²³I-meta-iodobenzylguanidine (MIBG) images 3 weeks later. The left ventriculography results were re-examined 6 months after treatment.Results Fifty patients originally enrolled in the trial completed the entire protocol. After treatment, no significant differences were observed in ES or left ventricular parameters between the two groups. However, in group A (n=25), the TDSs determined from ²⁰¹Tl and ¹²³I-MIBG were significantly lower (26±6 vs 30±5, P<0.01, and 32±8 vs 40±6, P<0.0001, respectively), the H/M ratio significantly higher (1.99±0.16 vs 1.77±0.30, P<0.005) and the WR significantly lower (36%±8% vs 44%±12%, P<0.005) than in group B (n=25). Moreover, 6 months after treatment, LVEDV and LVEF were better in group A than in group B.Conclusion These findings indicate that nicorandil can have beneficial effects on CSNA and left ventricular remodelling in patients with first anterior AMI.