Traumatic axonal injury: Relationships between lesions in the early phase and diffusion tensor imaging parameters in the chronic phase of traumatic brain injury

This prospective study of traumatic brain injury (TBI) patients investigates fractional anisotropy (FA) from chronic diffusion tensor imaging (DTI) in areas corresponding to persistent and transient traumatic axonal injury (TAI) lesions detected in clinical MRI from the early phase. Thirty‐eight patients (mean 24.7 [range 13–63] years of age) with moderate‐to‐severe TBI and 42 age‐ and sex‐matched healthy controls were included. Patients underwent 1.5‐T clinical MRI in the early phase (median 7 days), including fluid‐attenuated inversion recovery (FLAIR) and T2* gradient echo (T2*GRE) sequences. TAI lesions from the early phase were characterized as nonhemorrhagic or microhemorrhagic. In the chronic phase (median 3 years), patients and controls were imaged at 3 T with FLAIR, T2*GRE, T1, and DTI sequences. TAI lesions were classified as transient or persistent. The FLAIR/T2*GRE images from the early phase were linearly registered to the FA images from the chronic phase and lesions manually segmented on the FA‐registered FLAIR/T2*GRE images. For regions of interest (ROIs) from both nonhemorrhagic and microhemorrhagic lesion, we found a significant linear trend of lower mean FA from ROIs in healthy controls to ROIs in patients without either nonhemorrhagic or microhemorrhagic lesions and further to transient and finally persistent lesion ROIs (P < 0.001). Histogram analyses showed lower FA in persistent compared with transient nonhemorrhagic lesion ROIs (P < 0.001), but this was not found in microhemorrhagic lesion ROIs (P = 0.08–0.55). The demonstrated linear trend of lower FA values from healthy controls to persistent lesion ROIs was found in both nonhemorrhagic and microhemorrhagic lesions and indicates a gradual increasing disruption of the microstructure. Lower FA values in persistent compared with transient lesions were found only in nonhemorrhagic lesions. Thus, clinical MRI techniques are able to depict important aspects of white matter pathology across the stages of TBI. © 2016 Wiley Periodicals, Inc.     

Magnetic resonance outcome of new enhancing lesions in patients with relapsing-remitting multiple sclerosis

The aim of the study was to monitor the natural history of new enhancing lesions in multiple sclerosis (MS) by means of serial gadolinium-enhanced magnetic resonance imaging (MRI). Out of the 63 new enhancing lesions seen on the baseline scan, belonging to 26 relapsing-remitting MS patients, 26 (40%), nine (14%) and four (6%) lesions showed persisting enhancement at first, second and third follow-up scan, respectively. At the end of 5 months of follow-up, 58 (92%) of the new enhancing lesions were detected as T2 hyperintensities, 24 (38%) as T1 hypointensities ('black holes'), and five lesions (8%) disappeared in both T2 and T1 weighted images. Duration of gadolinium enhancement of at least two consecutive scans significantly influenced the development of 'black holes'. No significant correlation was observed between volume, location, configuration of enhancement at baseline and final outcome of the lesion. In individual cases, different evolution of new enhancing lesions was observed at the same time.In conclusion, this study documented that different outcomes of new lesions are unrelated either to the individual patient or to the baseline MRI characteristics. However, prolonged blood-brain-barrier disruption as shown by persisting enhancement significantly influences the lesion outcome.     

Longitudial observation of dynamic changes in cortical function and white matter fibrous structure of patients with visual pathway lesions by blood oxygenation level dependent-functional magnetic resonance imaging combined with diffusion tensor imaging

BACKGROUND: Functional magnetic resonance imaging (fMRI) is initially used for visual cortex location. However, the application of fMRI in investigating the development of visual pathway lesions needs to be further observed. OBJECTIVE: This study is to longitudially observe the dynamic changes in cortical function and white matter fibrous structure of patients with visual pathway lesions by blood oxygenation level dependent-functional magnetic resonance imaging (BOLD-fMRI) combined with diffusion tensor imaging (DTI), and to analyze the characteristics of brain function and structural recombination at convalescent period of lesions. DESIGN: Randomized controlled observation. SETTING: Department of Radiology, the General Hospital of Nanjing Military Area Command of Chinese PLA. PARTICIPANTS: Eight patients with unilateral or bilateral visual disorder caused by visual pathway lesions, who admitted to Department of Radiology, the General Hospital of Nanjing Military Area Command of Chinese PLA from January to September 2006 were involved, and served as experimental subjects. The patients, 6 males and 2 females, were aged 16–67 years. They had visual disorder confirmed by clinical examination, i.e. visual pathway lesion, which was further diagnosed by MR or CT. Another 12 subjects generally matching to those patients of experimental group in gender, age and sight, who received health examination in synchronization were involved and served as controls. The subjects had no history of eye diseases. Their binocular visual acuity (or corrected visual acuity) was over 1.0. Both routine examination of ophthalmology and examination of fundus were normal. Informed consents of detected items were obtained from all the subjects. METHODS: Signa Excite HD 1.5T magnetic resonance imaging system with 16 passages (GE Company, USA) and coil with 8 passages were used; brain functional stimulus apparatus (SAV-8800. Meide Company) was used for showing experimental mission. At the early stage and convalescent period of lesions, the patients with visual pathway lesion were examined by BOLD-fMRI combined with DTI, respectively, and brain activation volume, optic radiation anatomical structure and fractional anisotropy (FA) value were compared before and after symptomatic treatment under the stimulation to both eyes. The above-mentioned indexes were observed and compared between experimental and control groups. MAIN OUTCOME MEASURES: BOLD-fMRI and DTI manifestations before and after treatment in the experimental group and control group. RESULTS: All the 8 patients and 12 healthy subjects participated in the final analysis. ①BOLD-fMRI manifestation: Bilateral occipital lobes and calcarine gyri of control subjects were obviously activated. The activation volume of striate cortex under the stimulation to two eyes was obviously reduced in the experimental subjects than in the control subjects (P < 0.05). After treatment, the amount of activated pixel in the stimulated cortex was increased, and the activation area was expanded. ② DTI results: Bilateral optic radiation of healthy controls could be traced in the subcortex. Complete optic radiation of patients with visual pathway lesion could be shown. There was no significant difference in optic radiation between experimental subjects and healthy controls. No significant difference in optic radiation was found before and after observation, either (P > 0.05). In 4 patients with occipital lobe and optical center lesions, optic radial fiber was partially interrupted and tenuous, displacement could be found, and FA value was obviously decreased; After treatment, optic radial fiber bundle recovered to some extent, and FA value was also increased. CONCLUSION: BOLD-fMRI and DTI explain the development of lesion from the aspect of cortical function and fibrous anatomy. It has important significance for investigating the recombination of cortical function area following visual pathway lesion.     

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.     

One-year MRI scan predicts clinical response to interferon beta in multiple sclerosis

Background and purpose:  To define the predictive value of clinical and magnetic resonance imaging (MRI) characteristics in identifying relapsing-remitting multiple sclerosis (RR-MS) patients with sustained disability progression during interferon beta (IFNB) treatment.
Methods:  All patients receiving treatment with one of the available IFNB formulations for at least 1 year were included in this single-centre, prospective and post-marketing study. Demographic, clinical and MRI data were collected at IFNB start and at 1 year of therapy; patients were followed-up at least yearly. Poor clinical response was defined as the occurrence of a sustained disability progression of ≥1 point in the Expanded Disability Status Scale (EDSS) during the follow-up period.
Results:  Out of 454 RR-MS patients starting IFNB therapy, data coming from 394 patients with a mean follow-up of 4.8 (2.4) years were analysed. Sixty patients were excluded because of too short follow-up. Less than 1/3 (30.4%) of the patients satisfied the criterion of 'poor responders'. Patients presenting new lesions on T2-weighted MRI scan after 1 year of therapy (compared with baseline) had a higher risk of being poor responder to treatment with IFNB during the follow-up period (HR 16.8, 95% CI 7.6–37.1, P  < 0.001). An augmented risk increasing the number of lesions was observed, with a 10-fold increase for each new lesion.
Conclusions:  Developing new T2-hyperintense lesions during IFNB treatment was the best predictor of long-term poor response to therapy. MRI scans performed after 1 year of IFNB treatment may be useful in contributing to early identification of poor responders.     

Sensitivity of delayed gadolinium-enhanced MRI in multiple sclerosis

Introduction - We performed this study to define the sensitivity of delayed gadolinium-enhanced magnetic resonance imaging (MRI) in detecting active lesions in the brains of patients with multiple sclerosis (MS). Material and methods - T₁weighted images were obtained in 27 patients with relapsing-remitting or secondary progressive MS before, 5–7 min and 20–30 min after the injection of 0.1 mmol/kg gadolinium-DTPA. Results - One-hundred-and-three enhancing lesions were found on the early and 110 on the delayed scans (increase = 6.4%). Six patients had 8 additional lesions in the delayed scans, while 1 patient had 1 more lesion on the early scan. Two of the 12 (17%) patients with no enhancing lesions on the early scans had 2 enhancing lesions on the delayed scans. The average increase of enhancing lesion detection with delayed scanning was 14.5% for those patients who already had enhancing lesions on the early post-contrast scans. A significant increase of the enhancing lesion volume was found with delayed scanning (P=:0.004). Conclusion - These data indicate that it is possible to increase MRI sensitivity in detecting MS active lesions by delaying the scanning after gadolinium injection.     

The influence of clinical relapses and steroid therapy on the development of Gd-enhancing lesions: a longitudinal MRI study in relapsing—remitting multiple sclerosis patients

Fifty-three patients with relapsing-remitting multiple sclerosis who had monthly Gd (gadolinium) enhanced MRI (Magnetic Resonance Imaging) and clinical evaluation, were divided into two subgroups: 1) patients with a clinical relapse, treated with IVMP (intravenous methylprednisolone) and at least one enhancing lesion on MRI. 2) patients who did not have a clinical relapse but with at least one enhancing lesion on MRI. In group 1, we evaluated the number and volume of enhancing lesions on the scan before and three scans after IVMP therapy; in group 2, we considered the first scan with enhancing lesions and the subsequent three scans. The mean number and volume of enhancing lesions on the first scan was significantly higher in patients with clinical relapse compared to patients without clinical relapse. In group 1, we found a consistent reduction in the first scan following steroid treatment which returned to initial levels at the following scan. Both volumetric and numerical evaluation are appropiate MRI outcome measures in monitoring therapeutic trials.     

Neuroimaging Characteristics in Subgroup of GBMs with p53 Overexpression

Glioblastoma multiforme (GBM) is a heterogeneous group of tumors, and neuroimaging characteristics have not been well-defined in molecular subgroups. Eighty-five patients with GBM were analyzed regarding imaging characteristics and correlation to p53 expression. The p53 positivity was graded according to percentage of positive cells (Grade 0, for < 10%; Grade 1, for <25%; Grade 2, for 26-50%; Grade 3, for >50% labeled cells). Imaging characteristics evaluated in the preoperative MRI were location and number of lesions, dimensions of enhancing lesion and of surrounding edema, mass effect, tumor borders, enhancement pattern after intravenous contrast administration, and tumor necrosis. Eighteen tumors had p53 expression >50% in immunohistochemical staining. Preoperative MRI of patients harboring those tumors with high p53 positivity revealed typical lesions with ring enhancement pattern and well-defined borders in T1-weighted images with contrast, and they were significantly different from other groups of p53 expression. There was no difference in terms of location and number of the lesions, dimensions of enhancing lesion and surrounding edema, mass effect, and the tumor necrosis between four different groups of p53 expression. A special subgroup of GBMs with p53 overexpression has ring enhancement pattern and well-defined border on MRI that may be influential in preoperative planning and postoperative management of adjunct therapy.     

Focal epilepsy in India with special reference to lesions showing ring or disc-like enhancement on contrast computed tomography.

In 150 consecutive cases of simple partial epilepsy significant CT abnormalities were found in 68%. The commonest lesion noted was a hypodense lesion on unenhanced scan, with a ring or disc-like enhancement on contrast scan, and surrounding hypodensity. This lesion was seen in 39 cases and was more common in patients below the age of 15 years and in those with shorter duration of fits (less than 6 months). Nineteen of these cases had focal signs, 16 showed focal slow activity on EEG and 17/39 had neither signs nor focal slowing on EEG. Ten cases with a ring or disc enhancing lesion had evidence of tuberculosis elsewhere in the body, three more had a past history of tuberculosis and four others had a history of close contact with a case of tuberculosis. After 3 months of antitubercular treatment, 23 out of 25 patients who were rescanned showed clearing of the lesion. The two who did not were operated upon, and the lesion was shown histologically to be a tuberculoma. Ten other cases have done well, but have not been rescanned. Only one case was not treated with antitubercular therapy. She developed fits, altered consciousness, and meningitis and recovered from this serious illness after starting antitubercular therapy. Though not histologically verified, it seems justified to conclude that in India a ring or disc enhancing lesion is the commonest accompaniment of focal epilepsy, and that at least one third (and probably more) of these lesions are tuberculomas.     

Anti-Ma2 associated paraneoplastic neurological syndrome presenting as encephalitis and progressive muscular atrophy

A 36 year old man with a history of testicular germ cell tumour presented six months after bilateral orchidectomy with progressive amnesia, irritability, vertical gaze palsy, and generalised seizures. Eight months after initial onset of symptoms, he demonstrated a head drop with muscular atrophy of the upper limbs, shoulder girdle, and posterior neck. He reported no sensory disturbances and his sensory examination was normal. The overall clinical presentation was consistent with motor neurone disease. Cerebrospinal fluid analysis revealed mild pleocytosis and increased protein concentration. Serum and cerebrospinal fluid were positive for the anti-Ma2 antibody by western blot analysis and immunostaining. Abnormal high signal in the grey matter was noted in the cervical spinal cord and brain by T2 weighted magnetic resonance imaging (MRI). The patient was treated with corticosteroids, intravenous immunoglobulin, and antiepileptic medication. The patient improved clinically and symptom progression ceased after initiation of treatment. There was complete resolution of the abnormal brain MRI lesions; however, the cervical spinal cord MRI lesion and muscular atrophy remained unchanged. It is suggested that the anti-Ma2 antibody is involved not only in encephalitis, but may also play a role in the cervical spinal cord lesions resulting in a motor neurone disease-like presentation.     

Diverging lesion and connectivity patterns influence early and late swallowing recovery after hemispheric stroke

Knowledge about the recovery of oral intake after hemispheric stroke is important to guide therapeutic decisions, including the administration of enteral tube feeding and the choice of the appropriate feeding route. They aimed to determine the localization and connectivity of lesions in impaired recovery versus recovered swallowing after initially dysphagic stroke. Sixty‐two acute ischemic hemispheric stroke patients with impaired oral intake were included in a prospective observational cohort study. Voxel‐based lesion‐symptom mapping and probabilistic tractography were used to determine the association of lesion location and connectivity with impaired recovery of oral intake ≥7 days (indication for early tube feeding) and ≥4 weeks (indication for percutaneous endoscopic gastrostomy feeding) after stroke. Two distinct patterns influencing recovery of swallowing were recognized. Firstly, impaired recovery of oral intake after ≥7 days was significantly associated with lesions of the superior corona radiata (65% of statistical map, P < 0.05). The affected fibers were connected with the thalamus, primary motor, and supplemental motor areas and the basal ganglia. Secondly, impaired recovery of oral intake after ≥4 weeks significantly correlated with lesions of the anterior insula (54% of statistical map, P < 0.05), which was connected to adjacent operculo‐insular areas of deglutition. These findings indicate that early swallowing recovery is influenced by white matter lesions disrupting thalamic and corticobulbar projection fibers. Late recovery is determined by specific cortical lesions affecting association fibers. This knowledge may help clinicians to identify patients at risk of prolonged swallowing problems that would benefit from enteral tube feeding. Hum Brain Mapp 38:2165–2176, 2017. © 2017 Wiley Periodicals, Inc.     

No difference in efficacy of two different doses of intravenous immunoglobulins in MS: clinical and MRI assessment

We performed a double-blind, placebo-controlled study to evaluate the efficacy of low and high dose of intravenous immunoglobulins (IVIG) in relapsing/remitting (RR) multiple sclerosis (MS). Patients (n = 49) with clinical definite RR MS were randomly allocated to three groups and treated with 0.2 g/kg (n = 17) or 0.4 g/kg (n = 15) once a month of IVIG and placebo (n = 17) for 12 months. Clinical data were assessed monthly and magnetic resonance imaging (MRI) was performed every 3 months during the study period. Annual relapse rate (ARR) and change of the mean Expanded Disability Status Scale (EDSS) and Neurological Rating Scale Score (NRSS) from baseline to study conclusion were used as the clinical end-points. For MRI activity total lesion volume on T2-weighted image (T2WI), new lesions and gadolinium (Gd)-enhanced lesions on T1WI were analysed. ARR in both IVIG groups (0.88 for 0.2 g/kg and 0.86 for 0.4 g/kg) was reduced compared with placebo (1.24) during treatment period. Neurological disability measured with EDSS decreased slightly in both the IVIG groups (0.029 and 0.066, respectively) and increased by 0.29 in placebo (P = 0.0117). The neurologic impairment measured by NRSS showed similar trend. The total lesion volume on T2WI increased by 13.56% in placebo whereas in the 0.4 g/kg IVIG group decreased by -3.95% and in the 0.2 g/kg IVIG group increased by 3.6%. The cumulative numbers of Gd-enhancing lesions and new T2WI lesions in the IVIG groups were reduced in comparison with the placebo group. Our findings suggest that the dose 0.2 g/kg of IVIG is equally effective as 0.4 g/kg in reducing MS activity.     

早期腔隙性脑梗死的临床与磁共振弥散加权成像

目的:从临床角度探讨磁共振弥散加权成像(diffusion weighted i maging,DWI)对早期腔隙性脑梗死(lacu-na cerebral infarction,LI)的诊断价值。方法:分析60例早期腔隙性脑梗死患者的临床资料,同时进行MRI常规序列及DWI序列检查,并由4位经验丰富的医师在不了解患者临床体征的情况下进行阅片,记录出病变所在的详细的神经解剖部位,对同一层面所有的磁共振像进行比较,重点分析信号强度和病灶大小。数据经统计学分析。结果:60例患者中高血压病45例(75%)、高脂血症21例(35%)、糖尿病18例(30%);常见临床类型为纯运动性轻偏瘫(PMH)及变异型20例,腔隙状态(LS)12例,无症状腔隙性梗死(ALI)10例,感觉运动性卒中(SMS)8例。病灶部位主要为尾状核(29.1%)、豆状核(23.3%)、放射冠(15.1%)、丘脑(10.5%)、内囊(7.0%)。60例患者中超急性期(≤6小时)20例,DWI扫描均检出病灶,常规MRI扫描均未检出病灶;急性期(7~24小时)患者22例,DWI扫描均检出病灶,DWI检出率为100%,而常规MRI共检出12例,检出率为55%(P<0.05)。DWI在超早期及急性期可显示T2加权像不能显示的病灶,并随时间延长显影范围逐渐增大。在T2加权像上可显示的病灶中,DWI可更清楚、更全面地显示病灶,大于T2病灶。结论:高血压病是LI的直接原因;腔隙病灶主要位于基底节,LS及ALI的检出率有上升趋势,DWI对早期LI的诊断显著优于常规MRI。DWI应作为早期LI的首选检查方法。     

磁共振成像T2*WI观察大鼠自发性脑出血含铁病灶的演变过程

目的:旨在研究用MRI T2*WI检测自发性脑出血后含铁病灶的演变过程.方法:大鼠脑内注射不同体积的自体动脉血(A组10μL;B组50μL;C组100μL).各组术后第1、3,7,14和30天行脑部MRI T2WI和T2*WI扫描,记录图像特征.由Image J软件进行图像分析.结果:大鼠脑内注射自体血后,MRI T2*WI图像较T2WI明显清晰;A、B组大鼠术后7和14 d含铁病灶体积T2*WI较T2WI所测得的体积更大(P<0.05); C组大鼠术后第7、14和30天,T2*WI比较T2WI测得的体积也更大(P<0.05).结论:在自发性脑出血后含铁病灶的检测中,MRI T2*WI较MRI T2WI更为清晰和敏感.     

Dynamics of regional distribution of ischemic lesions in middle cerebral artery trunk occlusion relates to collateral circulation

We describe the regional distribution of acute perfusion, diffusion, and final infarct lesions in middle cerebral artery (MCA) trunk occlusion. A total of 31 patients with acute ischemic stroke and MCA trunk occlusion were studied by multiparametric magnetic resonance imaging. Probabilistic maps of lesion distribution were generated. The probability of initial and final infarcts was highest in the central MCA region with decreasing probability toward the periphery where the probability of the tissue at risk of infarction to be saved was highest. The probability of brain regions being involved in acute diffusion lesions and evolving into or escaping from the final infarct relates to the anatomy of arterial blood supply.     

Cerebral Cortex Involvement in Neuromyelitis Optica Spectrum Disorder

MethodsThe study enrolled 215 NMOSD patients who were seropositive for the anti-AQP4 antibody from 5 referral hospitals, and retrospectively analyzed their demographic, clinical, and MRI findings. Abnormal cerebral cortex lesions on brain MRI were identified by a neuroradiologist and two neurologists using consensus.ResultsMost of the 215 enrolled patients (87%) were female. The median age at onset was 22.5 years (range: 15–36 years) and the mean follow-up duration was 123 months. Brain lesions were found in 143 of 194 patients (74%) in whom MRI was performed during follow-up. Brain lesions involving the cerebral cortex were identified in 6 of these 194 patients (3.1%). Five of the patients were female, and the six patients together had a median age of 29 years (range: 15–36 years) at the time of lesion presentation. Three of them showed leptomeningeal enhancement in the lesions. At presentation of the cortex-involving lesions, five of these patients were not being treated at the time of presentation, while the sixth was being treated with interferon-beta.ConclusionsAlthough rare, cortical involvement occurs in NMOSD and is commonly combined with leptomeningeal enhancement. We speculate that this occurs only in patients who are not treated appropriately with immunosuppressant drugs.     

Intracranial, Intraaxial, Space-Occupying Lesions in Patients with Intractable Partial Seizures: An Anatomoclinical, Neuropsychological, and Surgical Correlation

Fifty of approximately 250 patients evaluated for intractable partial seizures were shown to have a space-occupying lesion detected with radiographs and/or neuroimaging. Twenty-eight males and 22 females had a mean age at seizure onset of 13 years and a mean duration of seizures of 11 years. All patients had closed-circuit television with EEG monitoring and complete neurologic and neuropsychological assessment. Findings were correlated with lesion location and surgical data. Twenty-seven lesions (54%) were located in the temporal lobe. Thirty-five lesions (70%) were neoplastic. All patients with temporal lobe lesions had complex partial seizures, as did 74% of patients with extratemporal lesions. A good correlation between clinical seizure characteristics and lesion localization was found with the temporal, occipital, and frontal lesions but not with the parietal lesions. Sixty-six percent of patients had focal interictal EEG findings. Lateralization corresponded to the side of the lesion in 64% and was localized to the region of the lesion in 30%. Lateralized ictal EEGs occurred in 58% of patients, corresponding with the side of the lesion in all but one patient. Abnormal findings on neuropsychological testing were congruent with lesion lateralization in 56% of patients and were localized to the region in 26%. Thirty-nine of 47 patients who underwent a subtotal lobectomy to include the lesion are seizure-free after greater than or equal to 1 year of follow-up, and five others are markedly improved.     

脑多发性硬化病灶和脑萎缩的MRI特点及其相关因素的研究

目的 探讨脑多发性硬化(MS)病灶和脑萎缩的MRI特点,并对其与脑萎缩的关系及其相关因素进行分析.方法 80例确诊的脑MS患者按照年龄分成两组;每例患者MRI检查时均进行5 mm层厚不间断横断面T1、T2加权像扫描;观察MS的病灶数目、信号和形态特点及分布规律;测量脑萎缩数据,并与正常对照组进行比较;对MS脑萎缩的相关因素进行分析.结果 (1)MRI显示脑MS病灶多呈卵圆形或类圆形,边界较清楚,典型病灶长轴与侧脑室切线垂直,病灶以等或稍长T1、长T2信号改变为主.(2)与健康对照组比较,脑MS患者脑室的测量径线明显增大,脑沟及外侧裂明显增宽,脑实质的测量径线明显缩小.(3)对MS患者脑萎缩的相关因素进行分析得出扩展残疾状态评分(EDSS)是脑萎缩的最主要预测因素.结论 脑MS的病灶多分布在侧脑室周围,以等或稍长T1、长T2信号为主,病灶形态多呈卵圆形或类圆形,边界较清楚;脑MS患者的病程、病灶的数目及直径以及EDSS得分均与脑萎缩明显相关;脑萎缩在脑MS患者中普遍存在并逐渐进展,其测量数据可作为临床监测MS进展的一个有用指标.     

多发性硬化脑内磁共振病灶分布及其特征(附203例2年MRI随访结果)

目的　为了解多发性硬化 ( multiple sclerosis,MS)的病灶特点 ,对确诊的 2 0 3例 MS患者进行系列磁共振 ( magnetic resonance,image,MRI)观察。方法　选择确诊的缓解 -复发型 MS患者 2 0 3例 ,每 6个月检查头颅MRI一次。结果　 ( 1 ) 2 0 3例 MS患者中 ,1 72 ( 84 .7% )例脑 MRI显示脱髓鞘病灶。其中有胼胝体病灶者 90例( 5 2 % ) ,有脑干病灶者 1 0 6例 ( 6 2 % ) ,有小脑病灶者 4 6例 ( 2 8% ) ,有与脑室连接的病灶者 1 5 7例 ( 91 % ) ,有典型的卵圆形病灶者 98例 ( 5 7% ) ,病灶长轴与侧脑室切线垂直的病灶占总病灶一半以上者 1 30例 ( 76 % )。( 2 ) 2 0 3例MS患者中 ,大脑半球内和脑内无病灶者分别为 4 1例 ( 2 0 % )和 31例 ( 1 5 % )。仅脑干有病灶者 6例 ( 3% ) ,仅小脑有病灶者 2例 ( 1 % ) ,脑干和小脑都有病灶者 2例 ( 1 % )。 ( 3) 2 0 3例共检查 82 7例次 MRI,有活动病灶者 77例( 4 1 % ) ,共有活动病灶 2 6 1个 ,分布在大脑、小脑和脑干者依次为 2 2 3、1 0和 2 8个。结论　 ( 1 )在确诊 MS患者中 ,多数 ( 85 % )脑 MRI有脱髓鞘病灶 ,与欧美资料相近。( 2 )脑内有病灶者中 ,小脑有病灶者占 2 8% ,较欧美报道为低。 ( 3) T2像发现活动病灶的机率不高 ,多次复查能提高病灶的检出率 ( 4 1     

Lesion development and reperfusion benefit in relation to vascular occlusion patterns after embolic stroke in rats

Vascular occlusion sites largely determine the pattern of cerebral tissue damage and likelihood of subsequent reperfusion after acute ischemic stroke. We aimed to elucidate relationships between flow obstruction in segments of the internal carotid artery (ICA) and middle cerebral artery (MCA), and (1) profiles of acute ischemic lesions and (2) probability of subsequent beneficial reperfusion. Embolic stroke was induced by unilateral intracarotid blood clot injection in normotensive (n=53) or spontaneously hypertensive (n=20) rats, followed within 2 hours by magnetic resonance (MR) angiography (MRA), diffusion- (DWI) and perfusion-weighted magnetic resonance imaging (MRI) (PWI). In a subset of animals (n=9), MRI was repeated after 24 and 168 hours to determine the predictive value of the occlusion pattern on benefit of reperfusion. The extent of cerebral perfusion and diffusion abnormality was related to the pattern of flow obstruction in ICA and MCA segments. Hypertensive animals displayed significantly larger cortical perfusion lesions. Acute perfusion-diffusion lesion mismatches were detected in all animals that subsequently benefitted from reperfusion. Yet, the presence of an angiography-diffusion mismatch was more specific in predicting reperfusion benefit. Combination of DWI, PWI, and MRA exclusively informs on the impact of arterial occlusion profiles after acute ischemic stroke, which may improve prognostication and subsequent treatment decisions.