脑型血吸虫病的诊断与外科治疗

目的探讨脑型血吸虫病的诊断和治疗方法选择。方法回顾性分析研究同济医院1992年10月～2003年12月诊治9例脑型血吸虫病的临床资料。结果9例病人中1例行保守治疗，8例行手术治疗，术后除1例病人出现暂时性运动性失语外，其他均恢复良好，无严重手术并发症及手术死亡。结论头颅CT和MRI检查对脑型血吸虫病诊断有重要价值，对有明显颅内压增高和占位效应或药物治疗无效可考虑手术治疗。     

慢性脑型血吸虫病的诊断与治疗(附26例报告)

目的探讨慢性脑型血吸虫病的临床特征、诊断和治疗方法;方法对收治的26例慢性脑型血吸虫病患者的临床资料、影像学特点、诊断及治疗方法进行回顾性分析;结果26例患者根据临床表现和影像学结果,结合血吸虫抗体检测阳性确诊12例(4例经病理证实),术后病理确诊10例,诊断性治疗确诊4例。12例行药物治疗,均治愈;14例行开颅手术,术后均行抗血吸虫治疗,13例恢复良好,1例遗留肢体轻瘫,无死亡病例;结论颅脑MRI检查和免疫学检测对慢性脑型血吸虫病的诊断有重要价值,严重的颅高压、顽固性癫痫及药物治疗无效者需手术治疗,其余病例选用药物治疗。     

颅内海绵状血管瘤的CT和MRI诊断

目的探讨颅内海绵状血管瘤的CT和MRI表现及诊断价值。方法搜集60例颅内海绵状血管瘤的CT和MRI影像资料，CT检查37例，MRI检查53例，CT和MRI检查30例，其中脑内型海绵状血管瘤57例，经手术病理证实42例，影像资料典型15例，经伽玛刀治疗随访证实；脑外型海绵状血管瘤3例，均经手术病理治疗证实。结果脑内型海绵状血管瘤可位于脑内任何部位，单发病灶多见，无明显占位效应，周围无或轻度水肿。CT检查的全部病例呈稍高及混杂密度影32例，增强扫描大都无强化；MRI检查T2WI表现为“桑葚状”混杂高信号，周围有云絮状低信号环，增强后病灶仅少数轻度强化。脑外型病灶位于中颅窝、鞍旁，MRI呈类似哑铃形或类圆形较均匀的稍长T1、明显长T2信号，增强扫描呈明显均匀强化。结论脑内与脑外型海绵状血管瘤的CT和MRI表现具有一定特征，MRI优于CT像，特别是MRI的T2WI像有助于明确诊断。     

脑血吸虫病的影像学特点及诊断治疗

目的分析脑血吸虫病的影像学特点，提出诊断要点和治疗方法选择。方法回顾性分析大坪医院1998年11月至2007年7月诊治21例脑血吸虫病的临床资料，全部行了CT和MRI检查，免疫学检查确诊20例，病理确诊1例。结果病灶位于皮层或皮层下，周围指套样水肿及占位效应，MPd增强表现为：脑皮质或皮层下线状强化影，多发或单发大小不等强化结节，呈簇状聚集围绕成团，部分邻近脑膜呈炎性改变。全部经吡喹酮及糖皮质激素治疗治愈，包括手术切除1例。结论头颅CT和MPd检查见成簇状堆积的结节状强化伴脑膜炎性改变，提示颅内寄生虫感染，需行免疫学确诊，大多可经吡喹酮化疗和糖皮质激素治愈。     

脑血吸虫病的临床及影像学特点

目的探讨脑血吸虫病的临床及CT、MRI特点.方法对收治的11例脑血吸虫病患者的临床资料、实验室检查、CT、MRI结果进行回顾性分析.结果所有病例均为慢性脑血吸虫病,其中癫痫型5例,脑瘤型5例,脑卒中型1例,5例脑瘤型曾误诊为"胶质瘤";脑血吸虫病的CT、MRI表现具有特征性.结论脑血吸虫病临床表现多样,误诊率高,应结合实验室及影像学检查综合分析.     

脑囊虫病诊断方法的探讨

为进一步探讨脑囊虫病的诊断方法,对43例具有中枢神经系统症状和体征的病人进行了脑部CT、血清和CSF囊虫抗体检查（ELISA法）,32例CT无典型脑囊虫病改变的患者做了脑MRI检查。结果11例（25．6％）CT表现为多发圆形低密度灶,部分间有点状钙化,为脑囊虫病的典型改变,余32例改变不典型或无异常改变。血清囊虫抗体阳性37例（86．0％）,CSF囊虫抗体阳性32例（74．0％）。27例（84．4％）脑MRI可见典型脑囊虫病改变,5例为非特异性改变。认为脑囊虫病的诊断应结合临床表现、免疫学检查结果和影像学改变综合分析,MRI对脑囊虫病的诊断价值优于CT。     

血、脑脊液囊尾蚴抗体、颅脑CT及MRI对脑囊虫病诊断价值的比较

近年来，笔者在临床实践中发现脑囊虫病有增加趋势，多数病例不能询及明确食米猪肉史及捧绦史，故诊断多依赖免疫学诊断、颅脑CT或颅脑MRI检查。本研究通过24例脑囊虫病患者的血、脑脊液囊尾蚴抗体、颅脑CT及颅脑MRI检查结果，对脑囊虫病的诊断价值进行比较。     

颅内海绵状血管瘤的CT和MRI诊断

目的探讨颅内海绵状血管瘤的CT和MRI表现及诊断价值。方法搜集60例颅内海绵状血管瘤的CT和MRI影像资料,CT检查37例,MRI检查53例,CT和MRI检查30例,其中脑内型海绵状血管瘤57例,经手术病理证实42例,影像资料典型15例,经伽玛刀治疗随访证实;脑外型海绵状血管瘤3例,均经手术病理治疗证实。结果脑内型海绵状血管瘤可位于脑内任何部位,单发病灶多见,无明显占位效应,周围无或轻度水肿。CT检查的全部病例呈稍高及混杂密度影32例,增强扫描大都无强化;MRI检查T2WI表现为"桑葚状"混杂高信号,周围有云絮状低信号环,增强后病灶仅少数轻度强化。脑外型病灶位于中颅窝、鞍旁,MRI呈类似哑铃形或类圆形较均匀的稍长T1、明显长T2信号,增强扫描呈明显均匀强化。结论脑内与脑外型海绵状血管瘤的CT和MRI表现具有一定特征,MRI优于CT像,特别是MRI的T2WI像有助于明确诊断。     

脑型血吸虫病87例临床分析

目的 介绍脑型血吸虫病的诊断及治疗。方法 选择87例脑型血吸虫病，对其临床资料进行回顾性研究。结果 47例行保守治疗，均痊愈出院。40例行手术治疗。28例术后恢复良好，无手术死亡。结论 头颅CT检查对脑型血吸虫病的诊断有很重要的价值。脑型血吸虫病的治疗以药物治疗为主。对有明显的颅内高压表现或药物治疗无效者则考虑手术治疗。     

貌似脑瘤的脑型血吸虫病15例临床分析

目的 探讨脑瘤型脑血吸虫病的临床及MRI的特点.方法 对收治的15例脑瘤型脑血吸虫病的临床资料、实验室检查及MRI资料进行回顾性分析.结果 均为慢性脑型血吸虫病肉芽肿型,表现为脑瘤型.脑瘤型脑血吸虫病的MRI表现具有特征性.结论 脑瘤型脑血吸虫病的MRI易误诊为肿瘤,应结合实验室及影像学检查综合分析.     

Correlations between clinical and magnetic resonance imaging findings in multiple sclerosis

40 patients with multiple sclerosis were investigated by magnetic resonance imaging (MRI) and computer tomography (CT). Additionally, cerebrospinal fluid (CSF) findings and evoked potentials (EPs; visual, brainstem) were evaluated. MRI findings were abnormal in 85% of the patients, whilst CT scan showed pathological changes in only 23%. The sensitivity for detecting lesions was significantly higher for MRI than CT. 86% of 23 patients with a duration of disease of more than 1 year had pathological MRI findings, and MRI was abnormal in 82% of 17 patients with a duration of symptoms up to 1 year. All patients with abnormal MRI had at least one other pathological laboratory finding. CT revealed only large lesions, and in patients with abnormal CT MRI visualized lesions more extensively. Additionally, brainstem lesions could be verified in 6 patients and spinal cord lesions in 3 cases. CSF was abnormal in 86%, and positive MRI findings occurred in 26 of 31 patients with abnormal CSF. Abnormalities of EPs were found in 76%, and MRI was positive in 24 of 33 patients with abnormal EPs.     

脑型血吸虫病临床特征与手术治疗

目的 探讨脑型血吸虫病临床特征与手术疗效。方法 回顾分析12例脑型吸虫病临床表现。实验室检查。影像学特征。手术方式，手术结果及预后。结果 12例均行CT扫描。6例加MRI扫描，表现为片状水肿无强化3例。片状水肿区内单个或多发散在结节状等或高密度强化灶9例。血吸虫酶联免疫吸附试验阳性8例。手术治疗10例，9例行病灶切除。1例行单侧颞肌下减压术，非手术治疗2例。9例术后病检为血吸虫肉芽肿，CT复查，病灶消失，结论 脑实质内片状或散片状水肿区伴单个或多发强化密度均匀结节灶。血吸虫酶联免疫吸附试验阳性可作为诊断地依据。单发或多发结节灶伴严重脑水肿，占位效应明显为手术指标。     

Cerebral schistosomiasis presenting as a brain tumor

A patient with cerebral Schistosoma mansoni schistosomiasis is described. The infection presented as a cerebral tumor, and the patient did not have the usual hepatic or intestinal symptoms of this disease. The computed tomography (CT) findings in histologically proven cerebral schistosomiasis are reported. The pathological CT findings developed at a late stage of the disease, and the CT scans were normal at a time when the EEG recordings were pathological.     

Multiple sclerosis: relations between MRI and CT findings, cerebrospinal fluid parameters and clinical features

Cerebral MRI and CT findings were compared with various cerebrospinal fluid (CSF) parameters and clinical features in 75 patients with multiple sclerosis (MS). There were positive correlations between CSF albumin as a parameter of blood-brain barrier function and morphological parameters, namely the number of nonperiventricular foci and periventricular involvement demonstrated by MRI and ventricular enlargement as shown by CT. Apart from positive correlations between the number of nonperiventricular foci and CSF levels of IgA and IgG, including the IgG synthetic rate, no other correlations were found between CSF parameters (leucocyte count and immunoglobulin concentrations) and morphological findings. The unremitting-progressive type of MS was distinguished from the relapsing-remitting form by a lower CSF leucocyte count and a higher degree of disability, but there was no difference between the morphological findings in the two forms. Positive correlations were found between degree of disability and both periventricular involvement in the MRI and CT evidence of ventricular enlargement. In terms of correlations with the duration of disease, cerebral MRI proved to be far superior to CSF evaluations.     

Spontaneous intracranial hypotension: correlation of imaging findings with clinical features

BACKGROUND: Spontaneous intracranial hypotension (SIH) is increasingly recognized as a clinically variable and likely underdiagnosed syndrome caused by non-traumatic CSF leaks. The aim of this study was to correlate the findings of imaging studies - magnetic resonance imaging (MRI), radionuclide cisternography - with clinical features and CSF pressure in SIH in order to improve the diagnostic yield and management in patients with SIH. METHODS: Clinical case study of 10 consecutive cases of SIH, MRI, radio-isotope cisternography. RESULTS: 5 out of 10 patients had unusual clinical symptoms of SIH(2 subdural haematomas, 1 gait ataxia, 1 tinnitus, 1 haemodialysis-associated headache). In 7 patients pachymeningeal gadolinium enhancement was detected in MRI accompanied by a reduced CSF opening pressure. In contrast, the 3 patients with normal MRI also had a normal CSF pressure. Radio-isotope cisternography was abnormal in all patients tested. There was no correlation between the severity of clinical symptoms and MRI or radionuclide cisternography findings. CONCLUSIONS: The spectrum of clinical symptoms and imaging findings in SIH is highly variable. There- fore the diagnosis of SIH is often delayed. Radio-isotope cisternography is an important additional diagnostic method to detect CSF leaks or pathological kinetics of radio-isotope movement particularly in cases with normal MRI findings.     

Magnetic resonance imaging and other techniques in the diagnosis of multiple sclerosis

We evaluated 35 patients with multiple sclerosis (MS) by magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, evoked potential testing, and computed tomographic (CT) scanning. As classified by the McAlpine et al and McDonald and Halliday criteria, 27 patients had definite MS, three had probable MS, and five had possible MS. All of the patients had multiple white matter lesions detectable by MRI that were evident predominantly in the periventricular areas but also in the cerebral or cerebellar white matter. The severity of the MRI abnormality, as judged by the number and size of the lesions, correlated with the likelihood of a positive CT scan but not with the duration of disease, the degree of disability, or positive CSF oligoclonal banding. Magnetic resonance imaging successfully demonstrated brain-stem lesions in 15 patients (none were seen on CT scans). Magnetic resonance imaging seems to be a sensitive indicator of MS lesions, but clinical assessment will continue to be crucial to the diagnosis of MS.