磁共振检查病案精选(十八) (神经系统)

分水脑梗塞,即血液动力性脑梗塞,是一种较少见类型脑梗塞,约占脑梗塞的10%。常发生于两支主要脑动脉的末梢供血交界区,包括大脑前、中、后动脉末梢交界区,深穿支动脉末梢邻接区,小脑上动脉与下后动脉末梢邻近区等。上述交界区血供灌注玉低,侧支循环差。当有脑动脉狭窄或痉挛时,在全身血压下降(如心功能不全、休克等)后,遂可造成此交界区脑组织发生缺血性脑梗塞。磁共振表现,分水脑梗塞好发于额叶凸面矢状带、侧室后边缘、枕顶叶三角区、皮质下弯曲带以及小脑半球皮质边缘,显示为斑片状、带状或楔形影。急性期,Ｔ1加权呈低信号,Ｔ2加权呈…     

MRI及CT对脑血管病36例诊断特点分析

目的：介绍ＭＲＩ及ＣＴ在脑血管疾病诊断中的特点。方法：对３６例脑血管疾病患在治疗前及治疗２～４个月后复查ＭＲＩ及ＣＴ。结果：３６例患中脑血肿１８例和脑梗塞１２例均获得满意的诊断。６例蛛网膜下腔出血患在ＭＲＩ对脑血与ＣＴ检查比较,ＣＴ扫描优于ＭＲＩ检查。ＭＲＩ对脑血肿亚急性期和脑梗塞早期诊断明确。对蛛网膜下腔出血７ｄ之内的病灶,在ＭＲＩＴ１和Ｔ２加权像中信号显示不敏感,而在ＣＴ扫描显示颅内纵裂     

颈静脉鼓室球瘤的MRI 诊断

本文收集了天坛医院 1992年 1月至 1994年 10月所收治的 11例颈静脉鼓室球瘤的ＭＲ、ＣＴ及血管造影和临床、病理资料 ,并结合文献进行了分析和讨论 ,以进一步提高对该病的ＭＲ表现的认识。1　材料和方法使用超导型ＭＲ机 (ＧＥＳｉｇｎａｌ 1 5Ｔ) ,应用快速自旋回波序列 (ＦＳＥＴＲ/ＴＥ =2 6 0 0 / 85ｍｓ)Ｔ2 加权像 ,自旋回波序列(ＳＥＴＲ/ＴＥ =6 0 0 / 16ｍｓ)Ｔ1加权图像 ,取矢、冠、轴位进行平扫 ,然后静脉注射顺磁性对比剂Ｇｄ ＤＴＰＡ (0 2ｍｌ/ｋｇ)重复Ｔ1加权像扫描 ,增强扫描时加用化学位移抑制脂肪的干扰 ,4例加做ＭＲ…     

von hippel-lindau综合征1例

患者男 ,4 0岁。头晕 ,头痛进行性加重半年 ,伴右耳鸣 5个月。体检 :右侧鼻唇沟浅 ,站立不稳。眼底乳头边缘不清。右眼底片状出血。颅脑ＭＲＩ:右侧桥小脑脚及右侧小脑半球内可见一“葫芦状”异常混杂信号区 ,以稍长Ｔ1长Ｔ2信号为主 ,其内部可见小片状短Ｔ1高信号及短Ｔ2低信号区 ,病灶边界不清 ,周围可见片状稍长Ｔ2信号水肿区。增强扫描病灶呈显著异常对比增强 ,其后方可见一纡曲的血管影 (图 1～ 3 )。腹部ＭＲ、ＣＴ及Ｂ超 :双肾多发大小不等的囊性及实性病变 ,ＭＲ及ＣＴ增强扫描可见实性部分呈明显不均匀强化。胰腺内也可见多发囊性…     

肺癌幕下脑转移瘤与血供关系的研究

目的：研究肺癌幕下脑转移瘤的MRI分布特征与血供的相关性。材料和方法：搜集经病理或临床证实的肿瘤幕下脑转移MRI资料20例,以脑血供解剖范围为基础,从断层像上观察确定瘤灶在幕下小脑和脑干对应脑血供区分布的规律性。结果：20例肺癌中,11例为病理证实,4例为非小细胞肺癌,7例为小细胞肺癌;9例为临床诊治过程证实。20例肺癌幕下脑转移瘤单发7例,多发13例,共有55个瘤灶,即小脑半球47个,脑干4个,小脑上蚓部3个．小脑下蚓部1个,行分属于小脑上动脉供血区13个(23．6％),小脑前下动脉供血区20个(36．4％),小脑后下动脉供血区16个(29．1％)．基底动脉脑干分支供血区4个(7．3％),小脑动脉均有的混合供血区2个(3．6％)。20例中伴幕上多发转移瘤15例(75.0％)。结沦：肺癌单独幕下脑转移瘤较少,多伴有幕上多发脑转移;幕下脑转移以小脑半球多见,依次分布于小脑前下和后下动脉以及小脑上动脉供血区,但三者之间无统计学差别。研究表明幕下瘤灶分布与脑血供有一定相关性。     

三维动脉自旋标记脑血流灌注加权成像在交叉性小脑神经机能联系不能的应用价值

目的利用3T磁共振的三维动脉自旋标记灌注加权成像(3D ASL)方法,通过观察全脑脑血流灌注情况,评价3D ASL在诊断交叉性小脑神经机能联系不能(CCD)的作用,并了解原发脑组织病变与CCD的关系。方法收集幕上单侧大脑中动脉供血区脑组织病变合并对侧小脑半球低灌注患者58例,利用3D ASL可定量测量脑组织的脑血流量(CBF)方法,测量双侧小脑半球脑组织的CBF的灌注情况,计算小脑不对称指数(AI),依据AI大于10%时诊断为CCD,并分析幕上病变与CCD之间的相关性。结果 58例幕上单侧大脑中动脉供血区脑组织病变导致幕下对侧小脑半球低灌注区,以小脑半球下部明显;幕上单侧脑组织病变中55例均为脑梗死,脑外伤3例,脑梗死病变占绝大部分。幕上病灶均累及皮质-桥脑-小脑束的放射冠及以上的白质纤维走行通道;其中幕上脑组织的CBF值越低、其对侧小脑半球CBF测值越低,呈明显正相关性;幕上脑组织低灌注面积与CCD的发生无明显相关性。4例患者做了2次ASL检查,2例患者做了3次3D ASL检查,其CCD病变区小脑半球的血流量变化不明显。发出CCD的病程最短为1d,最长为1年2个月CCD小脑半球低灌注区以小脑下部明显,其CCD产生与幕上脑组织病变发生部位呈明显相关,与发病时间及病程无明显相关性。结论 3D ASL作为一种新的灌注方法,能够无创的评价CCD的发生,其具有很好的诊断价值及能定量评估小脑半球低灌注程度,3D ASL为进一步研究CCD的发生机制提供广泛发展空间。     

脑静脉血管瘤的MR诊断及其评价

目的探讨脑静脉血管瘤的ＭＲ表现并评价其诊断价值。方法本组搜集１５例ＭＲ诊断为脑表脉血管瘤的病例,对其ＭＲ表现进行分析（其中６例行ＤＳＡ检查）。结果１５例均能在ＭＲ上显示典型的“水母头”状形态,而增强扫描显示的更清楚,且能显示其静脉引流方向,同时ＭＲ能显示其它合并症。１５例中位于幕上１０例,小脑半球４例,１例多发,分别位于小脑及丘脑。结论ＭＲＩ是确诊脑静脉血管瘤的首选检查方法,并有助于指导临床治疗。     

脑胶质瘤合并血管畸形1例

男 ,49岁 ,8个月前突发右侧肢体乏力 ,逐渐加重 ,伴头痛、恶心、呕吐 ,癫痫大发作 1次 ,ＣＴ扫描示右顶脑内血肿 ,经保守治疗后右侧肢体无力好转 ,行ＭＲＡ扫描示左顶叶动静脉畸形 ,行γ刀治疗 ,3个月后复查ＣＴ示 :病灶囊性变。右侧肢体肌力较左侧差 ,间断脱水治疗。 1天前因头痛伴呕吐入院 ,ＭＲＩ示 :左顶叶有一 4 5× 4 0× 4 2ｃｍ2囊性灶 ,囊分隔处见不均匀斑点状强化影。查体 :神清 ,右侧肢体肌力Ⅳ 级 ,余 (- )。术中见三个大小不等被分隔囊性病灶 ,囊分隔处实质病变呈褐红色 ,血供丰富 ,一条供血动脉和一条引流至矢状窦粗大静脉 ,…     

脑动静脉畸形的影像学诊断

目的：分析脑ＡＶＭ的影像学表现，探讨不同成像手段的诊断价值。材料与方法：报告１４例经ＤＳＡ或临床确诊的ＡＶＭ，行ＣＴ、ＭＲＩ及磁共振血管造影（ＭＲＡ）检查。结果：５例ＣＴ提示ＡＶＭ，ＭＲＩ不能显示供血动脉及引流静脉；ＭＲＡ可显示ＡＶＭ的供血动脉，部分显示引流静脉，有利于观察病变的内部细节。结论：ＭＲＡ是一种无创性血管显像技术，对于制订ＡＶＭ的治疗方案及估计预后具有指导意义，优于ＣＴ及ＭＲＩ。     

磁共振T1 加权像在急性闭塞性脑血管病诊断中的价值

目的 评价磁共振Ｔ１加权像在急性闭塞性脑血管病诊断中的价值。方法 急性闭塞性脑务管病１５例,其中急性脑皮层动脉闭塞９例,急性脑静脉窦闭塞６例。结果 ９例急性脑皮层动脉闭塞,Ｔ１加权像上ＭＲ信号强度正常,但可见梗死区脑肿胀征象;Ｔ２加权像时,病变区信号强度无异常发现。６例急性脑静脉窦闭塞中,横窦和乙状窦闭塞４例,上矢状窦后１／３处闭塞２例。Ｔ１加权像见闭塞的静脉窦血管流空影消失,静脉窦呈稍高信号强度     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.