贝伐珠单抗治疗放射性脑损伤的疗效研究

目的 评估贝伐珠单抗单药治疗放射性脑损伤的疗效及安全性。方法 对23例确诊放射性脑损伤并接受贝伐珠单抗单药治疗的患者进行回顾性分析。贝伐珠单抗治疗方案为静脉滴注（每次5 mg/kg,每两周1次,共4次）。分别在给药前及疗程结束后2周行头颅MRI检查、LENT-SOMA量表和MoCA量表评分,并记录治疗期间的不良事件。结果 2例患者在第1个疗程时出现鼻衄,随即终止治疗。其余21例患者在完成相应疗程的贝伐珠单抗治疗后临床症状明显改善,与基线水平相比,治疗后MRI T2相水肿体积明显缩小[平均缩小（53.9±22.13）%,Z=-5.645,P<0.05]。治疗后MOCA评分较治疗前增高（t=3.166,P<0.05）,其中1例患者虽然在完成两个疗程后MRI上表现为病灶范围轻度增加,但是在4次治疗结束后病情明显改善。在所有完成4次治疗的患者中,1例患者出现皮疹,2例患者出现高血压,另有1例有轻度颅内出血,无3到5级不良反应事件。结论 贝伐珠单抗单药治疗放射性脑损伤有较好的疗效和安全性。     

贝伐单抗治疗放射性脑坏死的疗效分析

目的 评估贝伐单抗治疗放射性脑坏死的疗效。方法 收集本院2011年6月至2013年2月期间行射波刀立体定向放疗后,影像学诊断为放射性脑坏死患者14例。应用贝伐单抗治疗,剂量5 mg/kg,每3周1次,至少连用3次。以治疗前后脑坏死症状变化、颅内水肿体积、脑坏死体积、脑坏死MRI信号变化为第1观察点。以贝伐单抗治疗的不良反应为第2观察点。结果 治疗后贝伐单抗治疗脑坏死病灶前后水肿指数、脑坏死体积、核磁信号比分别为7.05±6.48、（55.96±32.91）ml、2.70±4.78和3.59±4.74、（26.99±31.40）ml、1.82±0.53,结果差异均有统计学意义（t=3.946、3.952、4.507,P<0.01）。贝伐单抗不良反应较轻,未见2级以上不良反应。结论 贝伐单抗治疗放射性脑坏死安全、有效,值得进一步研究。     

鼻咽癌放射治疗后放射性脑损伤的影像学表现

目的 探讨鼻咽癌放射治疗(简称放疗)后放射性脑损伤的CT、MRI、正电子发射计算机体层摄影术(PET)的影像学以及组织病理学特征。方法 回顾分析鼻咽癌(NPC)放疗后放射性脑损伤71例患者的临床、CT、MRI、PET以及手术病理学资料。结果 病变位于颞叶、脑干或小脑，其CT表现为均匀或不均匀的低密度，位于颞叶者，呈“指状”低密度。23例患者(29个病灶)行CT增强扫描，86．2％(25／29)的病灶无强化。MRI示损伤脑组织的T1、T2弛豫时间延长，可呈不均匀信号改变。20例患者(29个病灶)行MR增强扫描，65．5％(19／29)的病灶呈“花环状”强化。2例病人行PET扫描，1例与CT及MRI所示病变相符合。3例患者颞叶手术切除术及组织病理学检查均为放射性脑坏死。结论 (1)MR平扫或增强扫描发现病变的敏感度均高于CT和PET。(2)T1WI和T2WI显示的不均匀信号提示为坏死，且均位于照射野内。(3)增强MRI所示的“花环状”强化，是放射性脑坏死的特征。(4)PET在放射性脑损伤诊断中可作为CT或MRI的补充。     

鼻咽癌放射治疗后颞叶放射性脑病低场MR诊断

目的分析鼻咽癌(NPC)放疗后颞叶放射性脑病(REP)的低场强MRI表现,探讨其影像学特征性改变。方法分析25例鼻咽癌放疗后诊断为颞叶放射性脑病(REP)患者MRI表现和临床资料及随诊观察。结果 25例REP中累及单侧颞叶9例,累及双侧颞叶16例。表现为局限性脑水肿并局灶性坏死:病灶为斑片状或不规则形,T1WI呈低信号或等信号;T2WI呈高信号或等高混杂信号。T1WI+Gd-DTPA增强扫描可见脑回状或不规则环形强化。12例经治疗后行MRI复查,2例症状改善,MRI异常信号明显减少,9例病灶无变化,其中3例症状有改善,6例症状体征无变化,1例病灶增大。结论鼻咽癌放射治疗后REP的MRI表现有一定的特征性,可作为REP诊断的主要方法。     

贝伐珠单抗与奥沙利铂联合雷替曲塞治疗晚期结直肠癌临床效果观察

目的 探讨贝伐珠单抗与奥沙利铂联合雷替曲塞治疗晚期结直肠癌的临床效果.方法 选取池州市人民医院自2016年1月至2020年1月收治的63例晚期结直肠癌患者为研究对象.根据不同的治疗方式将其分为A组(n=28)与B组(n=35).A组患者采用贝伐珠单抗+奥沙利铂+卡培他滨治疗,B组患者采用贝伐珠单抗+奥沙利铂+雷替曲塞治...     

FLASH及FLAIR序列在脑弥漫性轴索损伤中的诊断价值

目的 探讨MR快速小角度激发梯度回波(FLASH)序列及液体衰减反转恢复(FLAIR)序列在脑弥漫性轴索损伤(DAI)中的诊断价值.资料与方法 回顾性分析40例经临床诊断的DAI患者的MR影像资料,所有患者均行T1WI、T2WI、FLAIR及FLASH序列扫描.比较各序列脑内病灶的显示率,分析其信号特征.结果 FLASH序列显示病灶最多、最敏感,病灶主要分布在皮髓交界区、基底节、胼胝体、脑干及小脑等区域,呈散在针尖状、斑点状、结节状、小片状中央显著低信号,周围薄环状高信号,FLAIR序列只有部分病灶显示,为结节状、斑片状高信号,且病灶越小显示越不敏感,常规T2WI较FLAIR序列敏感性差,常规T1WI显示率最低,显示者T2WI为高信号,T1WI为低信号.结论 对DAI病灶检出率FLASH、FLAIR序列较常规T2阢、T1WI高,可为DAI早期诊断、早期治疗提供科学、客观的影像学资料,对临床疑有DAI患者FLASH、FLAIR序列应作为MR检查的常规序列,FLASH序列为首选序列.     

小儿手足口病合并脑干脑炎的MRI特征与临床预后评估

目的:探讨MRI对小儿手足口病合并脑干脑炎的诊断、预后评估价值及临床指导意义。方法:回顾性分析42例小儿手足口病合并脑干脑炎的临床及影像资料,对比分析其入院及出院时的MRI表现及临床治疗效果。结果:根据入院时MRI表现,将患儿分为2组:31例病灶边界模糊型和11例病灶边界清晰型。边界模糊型病灶MRI表现为脑干背侧不同厚度T1WI呈等或稍低信号,T2WI稍高信号;出院时复查MRI均表现正常,30例临床完全康复,1例遗留眼球运动障碍。边界清晰型MRI表现为脑干内斑片状或对称性斑点状、条状T1WI低信号,T2WI高信号;出院复查MRI,7例表现正常,6例临床完全康复,4例遗留不同程度后遗症,其中,2例遗留桥脑延髓交界区病灶,1例遗留延髓病灶,1例遗留脊髓前角病灶,1例死亡。结论:小儿手足口病边界模糊型明显比边界清晰型预后好,以MRI表现进行分型有助于临床预后判断。     

鼻咽癌放射治疗后放射性脑病的影像学诊断

目的：探讨放射性脑病的删表现及CT灌注表现，并分析其影像诊断价值。方法：回顾性分析经手术病理临床综合诊断证实的鼻咽癌放射治疗后放射性脑病的46例MRI、6例CT灌注检查资料。结果：82．4％(56/68)放射性脑病病灶分布在颞叶底部，13．2％(9/68)位于脑干，4．4％(3/68)位于额叶及小脑。其典型的加MRI表现为：①83．8％(57/68)的病灶T1WI呈低信号，T2WI呈高信号，增强后呈花环状、不规则斑片状强化，强化灶位于照射野内。②13．2％(9/68)的病灶T1WI、T2WI皆呈等信号，增强后呈结节状均匀强化。该类型部分病例经治疗可缩小或消失。③2．9％(2／68)的病灶囊变，信号均匀，T1WI、T2WI信号程度同脑脊液相仿，增强后未见明显强化。放射性脑病可有占位效应，其程度小于转移瘤的占位程度。MR动态观察可显示放射性脑病的大小变化。CT灌注示放射性脑病呈明显低灌注，脑相对血流量明显减少。手术切除及组织病理学检查显示血管内皮损伤、脑组织坏死。结论：鼻咽癌放射治疗后放射性脑病的MRI表现有一定的特征性，动态影像学观察及CT灌注对鉴别诊断有一定的帮助。CT灌注及手术病理支持放射性脑病的血管损伤学说。     

小儿手足口病合并脑干脑炎、脊髓炎的MRI表现

目的 探讨小儿手足口病(hand-foot-mouth disease,HFMD)合并脑干脑炎、脊髓炎MRI表现特征,以提高对本病的认识.资料与方法回顾性分析7例有阳性影像学表现的小儿HFMD合并脑干脑炎、脊髓炎患者的MRI特征性表现.结果 4例病灶以桥脑、延脑交界部为主,1例位于桥脑,呈略长T1、长T2斑片状信号.2例病灶在横断位上表现为对称性小斑片状信号.2例病灶均位于脊髓圆锥,呈长条形略长T1、长T2信号,病灶在横断位上表现为对称性小斑片状信号.结论 HFMD合并脑干脑炎、脊髓炎MRI表现有一定特征性.MRI能真实地显示HFMD脑干脑炎、脊髓炎脑部、脊髓受损情况,可对临床治疗提供可靠的影像学依据.     

IgG4相关疾病的影像特征及疗效监测

目的：探讨IgG4相关疾病的影像学特征及激素治疗后疗效的评估。方法收集13例经病理证实的IgG4相关疾病的影像资料,均行CT检查,其中5例同时行MR检查,6例患者有治疗前及治疗后3~6月的完整影像资料。分析病灶的形态、分布、影像特征以及治疗后影像变化。结果13例中1例病灶位于泪腺,1例位于颌下腺,1例位于胆道,3例位于胰腺,4例位于肾脏,2例位于腹膜后,1例位于肺。其中2例病变累及多部位,包括腹膜后、胰腺及肾脏等。所有受累脏器呈弥漫性肿胀或局部软组织肿块,CT平扫呈低密度,T2WI上呈低信号,增强后轻度均匀性强化。6例患者经激素治疗后病灶缩小,T2WI信号有增高表现。结论受累脏器肿胀,CT平扫低密度以及T2WI低信号,轻度均匀强化是IgG4相关疾病的影像学特征,CT及MR在疾病的诊断及激素治疗后疗效的评估方面具有重要的临床应用价值。     

High intensity focused ultrasound treatment of adenomyosis: The relationship between the features of magnetic resonance imaging on T2 weighted images and the therapeutic efficacy

ObjectivesTo investigate the relationship between the features of magnetic resonance imaging (MRI) on T2 weighted images (T2WI) and the therapeutic efficacy of high intensity focused ultrasound (HIFU) on adenomyosis.Materials and methodsFrom January 2011 to November 2015, four hundred and twenty-eight patients with symptomatic adenomyosis were treated with HIFU. Based on the signal intensity and the number of hyperintense foci in the adenomyotic lesions on T2WI, the patients were classified into groups. The day after HIFU ablation patients underwent contrast-enhanced MRI and a comparison was made of non-perfused volume (NPV) ratio, energy efficiency factor (EEF), treatment time, sonication time, and adverse effects.ResultsNo significant difference in terms of HIFU treatment settings and results was observed between the group of patients with hypointense adenomyotic lesions and the group with isointense adenomyotic lesions (P > 0.05). However, the sonication time and EEF were significantly higher in the group with multiple hyperintense foci compared to the group with few hyperintense foci. The NPV ratio achieved in the lesions with multiple hyperintenese foci was significantly lower than that in the lesions with few hyperintense foci (P < 0.05). No significant difference was observed in the rate of adverse effects between the two groups.ConclusionsBased on our results, the response of the adenomyotic lesions to HIFU treatment is not related to the signal intensity of adenomyotic lesions on T2WI. However, the number of the high signal intensity foci in the adenomyotic lesions on T2WI can be considered as a predictive factor to help select patients for HIFU treatment.     

垂体腺瘤MRI与病理对照研究

目的分析垂体腺瘤的MRI表现与手术、病理关系.材料与方法对242例垂体腺瘤的MRI特征性表现进行分析,并与手术病理对照.结果大腺瘤(高度＞10 mm)161例,MRI平扫T1WI等信号101例,略低信号21例,混合信号39例,T2WI等信号112例,高信号11例,混合信号38例,增强后肿瘤实质部分均有强化,出血、囊变、坏死和钙化区无强化,微腺瘤(高度＜10mm)81例,MRI平扫表现为T1WI略低信号53例,等信号28例,T2WI等信号42例,高信号39例,注射Gd-DTPA后立即成像,77例呈相对低信号,4例呈等信号.手术和病理发现,T1WI等或略低信号区为肿瘤实质,T1WI低信号、T2WI高信号区为坏死或囊变区,T1WI、T2WI均呈高信号区为出血,手术和病理发现钙化6例,术前MRI未发现.结论MRI能清晰显示垂体瘤的大小、形态、轮廓和与周围结构的关系,可为制定手术方案提供重要依据.     

布氏杆菌性脊椎炎的MRI表现

目的探讨MRI对布氏杆菌性脊椎炎的诊断价值。资料与方法 16例经临床或手术病理证实的布氏杆菌性脊椎炎行T1WI、T2WI、STIR及增强检查,分析其形态及信号特点。结果病变累及腰椎最多。椎体形态多无明显变化,椎体边缘可见小的骨质破坏及骨质增生。病变椎体T1WI呈低信号,T2WI呈低等或等高信号或低等高混杂信号。STIR呈高信号。增强扫描病变椎体明显强化,与周围正常增强的椎体信号类似或更高。椎间盘7例变窄,信号变化不显著,呈等T1、等T2信号(与邻近椎间盘比较),只有2例T2WI呈高信号。16例均有椎管外软组织受累,呈不均匀长T1、长T2信号,边界模糊,STIR呈混杂高信号,内可见多发大小不等的脓腔,增强扫描显示脓腔壁厚薄不均不规则强化。10例有不同程度椎管内硬膜外脓肿,呈长T1、长T2信号,STIR呈高信号。增强扫描显示脓壁厚薄不均明显强化。脓肿范围较小,一般不超过病变椎体节段。结论布氏杆菌性脊椎炎MRI表现有一定的特征性,MRI对布氏杆菌性脊椎炎诊断及鉴别诊断有重要价值。     

脑静脉窦血栓的磁共振诊断

目的 探讨磁共振的常规扫描序列和三维相位对比法MR静脉造影(3D-PC法MRV)对脑静脉窦血栓的诊断价值.方法 共收集34例临床确诊的脑静脉窦血栓病例,男15例,女19例.年龄1～71岁,中位年龄38岁.所有病例均行常规MR序列,3D-PC法MRV扫描;急性期(1～5天)脑静脉窦血栓7例;亚急性期(6～21天)18例,慢性期(＞21天)9例.结果 急性期脑静脉窦血栓信号T1WI以等低信号为主,T2WI以低信号为主;亚急性期T1 WI以高信号为主,T2WI呈低或高信号;慢性期T1WI表现为等或低信号,T2 WI以高信号或流空信号.3D-PC法MRV主要表现为脑静脉窦的闭塞或充盈缺损.同时14例患者合并有脑实质异常,出血9例,缺血水肿5例.结论 常规MR序列与3D-PC法MRV显示脑静脉窦血栓具特征性,可做为理想的检查手段.     

三叉神经节和Meckel''s腔原发性肿瘤的MRI表现

目的 研究三叉神经节和Meckel’s腔原发肿瘤的MRI表现。方法 对14例经病理证实的三叉神经节和Meckel’s腔原发肿瘤患包括4例三叉神经鞘瘤，5例脑膜瘤，1例脂肪瘤，以及4例表皮样囊肿的MRI表现进行了分析。结果 三叉神经鞘瘤在T1WI上呈均匀低信号，在T2WI上呈高信号。5例脑膜瘤中的3例在T1WI和T2WI上与周围脑组织信号一致，1例在T1WI上呈低信号，在T2WI上呈高信号，另1例在CT图像上有丰富的钙质沉着而在T1WI和T2WI上均呈低信号。脂肪瘤信号均匀且与眶内和皮下脂肪信号一致。4例表皮样囊肿的2例在T1WI和T2WI上呈非常高的信号，另外2例呈匍匐性生长并且占位效应较轻。肿瘤侵犯三叉神经能很好的显示其范围。结论 发生自三叉神经节和Meckel’s腔的不同原发肿瘤具有各自的信号特征，可通过MR成像予以鉴别。     

颞下窝原发肿瘤的CT及MR表现

目的：探讨颞下窝原发肿瘤CT及MRI表现。方法回顾性分析20例经病理证实的颞下窝原发肿瘤的CT及MR资料。结果颞下窝肿瘤形态多不规则。神经鞘瘤多边界清楚（5/6）,MR T1WI为等信号,T2WI为高信号肿物伴线状分隔样低信号,2例通过卵圆孔伸入中颅窝呈哑铃状生长。恶性外周神经鞘膜肿瘤边界多不清楚（4/5）,MR T1WI为等信号,T2WI为不均匀高信号,病变可侵犯邻近肌肉及骨质。横纹肌肉瘤MR T1WI为等信号,T2WI为高信号。孤立性纤维性肿瘤边界清楚,MR T1 WI等信号,T2 WI为混杂略高信号,增强后较明显强化。腺样囊性癌边界不清,沿神经浸润生长。侵袭性多形性腺瘤MR T1 WI为等、低信号,T2 WI为高信号,侵犯邻近肌肉。淋巴瘤形态不规则,边界清楚,MR T1WI为低信号,T2WI为中高信号,轻度强化,内有线样血管影穿行。结论熟悉颞下窝原发肿瘤CT及MRI表现,有助于提高该部位病变诊断及鉴别诊断水平。     

Intramedullary tuberculomas. MR findings in seven patients

Purpose: To describe the MR findings in intramedullary tuberculomas and to discuss the usefulness of MR in the management of this pathology.Material and Methods: A retrospective study of 7 patients from 21 to 60 years of age with clinical and radiological evidence of intramedullary tuberculomas was undertaken. Both T1- and T2-weighted images (WI) were obtained along with postcontrast T1WI. Signal intensities (SIs) of the granulomas were compared with SIs of the normal spinal cord.Results: Six patients showed focus of tuberculosis elsewhere in the body. Six out of 7 showed fusiform swelling of the cord. Ill-defined iso-intensity (in 4 patients) to hyperintensity (in 3 patients) was seen at the site of granuloma on T1WI. On T2WI, 2 patients revealed a hypointense area (with disc enhancement). An iso-hypointense rim was seen surrounding a hyperintense centre in 5 patients (with rim enhancement). Adjacent oedema was seen in all patients. In 2 patients meningeal enhancement was also seen. In 2 patients the histopathology following surgical biopsy confirmed the diagnosis. In the remaining 5 patients, another known focus of tuberculosis elsewhere in the body and a marked response to antitubercular treatment was considered confirmatory for tuberculomas.Conclusion: Hypo- or iso-intensity on T2WI within the spinal cord with surrounding hyperintense oedema is suggestive of intramedullary tuberculomas. Central hyperintensities are also detected at times due to a variable amount of caseous necrosis with liquefaction. On T1WI, fusiform swelling of the cord is seen along with iso- to hyperintense foci, surrounded by hypointense oedema of the cord. Such findings should prompt a contrast-enhanced study, which may show single or conglomerate disc- or ring-enhancing lesions. MR thus plays an important role not only in detection and diagnosis, but also in deciding the treatment options and in the follow-up of those patients.     

MR imaging of stereotactic thalamotomy using radiofrequency methods]

Sixty-eight stereotactic radiofrequency (rf) thalamic lesions in 57 patients with movement disorders were evaluated by magnetic resonance (MR) imaging. Postoperative periods ranged from 5 days to 4 years and 9 months. All 68 rf lesions were clearly detected on T2-weighted images (T2WI). Changes in signal intensity on T2WI were classified into five patterns, as follows: Pattern I: lesions with three concentric zones consisting of an inner hypointense, middle hyperintense and outer hypointense zone (31 lesions); Pattern II: lesions consisting of an inner hypointense and outer hyperintense zone (4 lesions); Pattern III: lesions consisting of an inner hyperintense and outer hypointense zone (27 lesion); Pattern IV: lesions of a hyperintense area alone (2 lesions); Pattern V: lesions of a hypointense area alone (4 lesions). The outer hypointense rim in Patterns I and III is thought to represent hemosiderin deposition. The abnormal signal intensity on T2WI caused by rf ranged from 2 to 12 mm in diameter, and lesions in the late phase were smaller than lesions in the early phase.     

Magnetic resonance imaging of typical polypoid adenomyoma of the uterus in 8 patients: correlation with pathological findings

OBJECTIVE: To study the magnetic resonance imaging findings of typical polypoid adenomyoma and correlate radiological findings with histopathologic findings. METHODS: Magnetic resonance imaging and histopathologic findings were retrospectively reviewed in 8 patients. The size, location, polyp's shape, and signal intensity of magnetic resonance imaging findings were evaluated. RESULTS: The polyp's shape of 8 cases is pedunculated in 7 and sessile in 1, and all 8 cases are well circumscribed. Four cases (50%) show an isointense mass relative to the myometrium with small or large hyperintense foci on T1-weighted imaging (T1WI) or T2-weighted imaging (T2WI), reflecting the fascicle of smooth muscle with islands of hemorrhagic endometrial tissue. One case forms a large hemorrhagic cavity, being hyperintense on T1WI and hypointense on T2WI. Three cases (37%) show almost homogeneous isointense or hyperintense mass on T2WI. CONCLUSIONS: When there is a well-defined polypoid mass protrusion into the uterine endometrial cavity that is isointense relative to the myometrium with small or large foci of high signal on T1WI or T2WI in a premenopausal woman, typical polypoid adenomyoma can be considered in the differential diagnosis.     

肝硬化结节与小肝癌的MRI研究

目的:回顾性分析肝硬化合并小肝癌、再生结节(RN)及肝不典型增生结节(DN)的MR表现,探讨其MR诊断与鉴别诊断。方法:收集50例结节性肝硬化病例MR检查资料,患者行正反相位T1WI、脂肪抑制T2WI、动态增强扫描和弥散加权(DWI)扫描,总结肝内结节的信号特点。结果:RN在T1WI脂肪抑制上多为等信号或稍高信号,T2WI多为低信号,增强后与周围正常肝组织强化相似或信号稍低;DN在T1WI多为较高信号,T2WI多为稍低或等信号,增强后强化不明显;癌结节T1WI多为稍低或等信号,偶有稍高信号,T2WI多为较高信号,DWI为高信号,强化多为动脉中晚期强化,门静脉期以后强化减退。结论:磁共振平扫加动态增强能对大多数RN、DN和小肝癌结节做出明确诊断和鉴别。