急性孤立性脑桥梗死病灶模式与病因学机制的相关性

目的 探讨急性孤立性脑桥梗死病灶模式与病因学机制的相关性.方法 回顾性收集急性孤立性脑桥梗死患者的临床资料,应用弥散加权成像(diffusion-weighted imaging,DWI)确定病灶分布模式,分析病灶模式与病因学分型之间的相关性.结果 总共纳入146例急性孤立性脑桥梗死患者,单侧梗死138例,双侧梗死8例.DWI病灶模式分析显示,旁正中梗死98例,前外侧梗死11例,被盖部梗死18例,多发性梗死19例;在各病因学分型中,基底动脉分支病变(basilar artery branch disease,BABD)所占比例最高(72例,49.3%),其次是大动脉闭塞性疾病(32例,21.9%)、小动脉闭塞性疾病(25例,17.1%)和其他病因/病因不明(12例,8.2%),心源性栓塞最少(5例,3.4%).急性孤立性脑桥梗死的DWI病灶分布模式与病因学分型存在显著相关性(C=0.516,P<0.001).其中,60例旁正中梗死(χ2=16.915,P<0.001)、1例前外侧梗死(χ2=7.701,P=0.006)、1例被盖部梗死(χ2=17.401,P<0.001)与BABD显著相关;9例旁正中梗死(χ2=12.534,P<0.001)、6例前外侧梗死(χ2=24.365,P<0.001)、10例被盖部梗死(χ2=18.312,P<0.001)与小动脉闭塞性疾病有关.结论 急性孤立性脑桥梗死病灶模式与其病因学机制存在显著相关性,早期可通过DWI显示的梗死灶分布特征来预测急性孤立性脑桥梗死的病因.     

孤立性脑桥梗死的临床和影像学特征:脑桥旁正中梗死与脑桥腔隙性梗死的比较

目的 探讨孤立性脑桥梗死的临床和影像学特征以及早期运动障碍进展(progessive motor deficits,PMD)和短期预后的影响因素.方法 对初次发病24 h内入院的86例孤立性脑桥梗死患者进行回顾性分析,根据梗死灶最大直径和部位分为脑桥旁正中梗死(paramedian pontine infarction,PPI)和脑桥腔隙性梗死(lacunar pontine infarction,LPI),根据早期PMD情况分为PMD组和无PMD组,根据出院时改良Rankin量表(modified Rankin Scale,mRS)评分分为转归不良组(mRS评分＞2分)和转归良好组(mRS评分≤2分),对不同病例组的临床和影像学特征进行比较.结果 PPI组(n=35)高脂血症(57.14％对33.33％;x2=4.80,P=0.028)、偏瘫(97.14％对72.55％;x2=8.718,P=0.003)、基底动脉狭窄(45.71％对17.65％;x2=7.930,P=0.005)和出院时转归不良(54.29％对31.37％;x2=4.515,P=0.034)患者构成比以及基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分[(6.00 ±2.39)分对(4.61 ±3.41)分;t=2.087,P=0.040]均显著性高于LPI组(n＝ 51).PMD组(n=22)基线舒张压水平[(97.82±15.61)mm Hg对(89.55±12.23)mm Hg,1 mm Hg=0.133 kPa;t =2.258,P=0.031]以及PPI(63.64％对32.81％;x2=6.445,P＝0.011)和基底动脉狭窄(59.10％对18.75％;x2=12.922,P=0.000)的构成比均显著性高于无PMD组(n＝64).转归不良组(n＝ 35)基线NIHSS评分[(6.80±2.63)分对(3.73 ±2.55)分;t＝5.426,P＝0.000]和空腹血糖水平[(9.40±5.15) mmol/L对(6.56 ±2.69) mmol/L;t =2.985,P=0.004]以及PPI患者构成比(54.29％对31.37％;x2 =4.515,P＝0.034)均显著性高于转归良好组(n=51).多变量logistic回归分析显示,基底动脉狭窄是PPI发病[优势比(odds ratio,OR)3.801,95％可信区间(confidence interval,CI)1.357～10.646;P=0.011]和孤立性脑桥梗死早期PMD(OR 4.571,95％ CI1.214～17.214;P=0.025)的独立危险因素,基线NIHSS评分≥5分是其短期转归不良的独立预测因素(OR4.277,95％ CI 1.505 ～ 12.151;P=0.006).结论 PPI主要与基底动脉分支病变有关,基线NIHSS评分≥5分可能是孤立性脑桥梗死短期转归不良的独立预测因素,其早期PMD和短期转归不良均可能与基底动脉病变有关.     

孤立性脑桥梗死早期进展的临床研究

目的分析急性孤立性脑桥梗死早期临床神经功能缺损进展的影响因素。方法选择2015年3月~2017年3月北京市中关村医院神经内科收治的经头颅MRI确诊的急性孤立性脑桥梗死患者146例,根据美国国立卫生研究院卒中量表(NIHSS)评分改变情况分为进展组30例和非进展组116例,分析2组临床及影像学特点。结果进展组与非进展组在就诊时间、脑梗死灶大小、脑梗死灶累及层面≥2个比例(76.6%vs 37.9%)、基底动脉狭窄发生率(30.0%vs 7.7%)、基底动脉轻度狭窄(46.6%vs 6.0%)及合并颅内其他血管中重度狭窄比例(50.0%vs21.5%)、出院NIHSS评分、出院改良Rankin量表评分≥3分比例(80.0%vs 15.5%)比较,差异有统计学意义(P0.05,P0.01)。结论孤立性脑桥梗死患者的进展与脑梗死灶较大、累及多个层面、合并基底动脉狭窄、合并颅内其他血管中重度狭窄相关,早期评估脑血管对于判断其预后有重要意义。     

急性皮质下脑梗死后进展性运动功能缺损的预测因素和发生机制：回顾性病例系列研究

目的探讨急性皮质下脑梗死后进展性运动功能缺损（progressive motor deficits,PMD）的预测因素和发生机制。方法连续纳入发病24h内的急性皮质下脑梗死患者,根据美国国立卫生研究院卒中量表运动项目评分变化分为PMD组（5d内增加I〉2分）和非PMD组,比较两组间人口统计学、影像学资料和相关危险因素的差异,筛选PMD的早期预测因素。对PMD组和部分非PMD组患者进行弥散加权成像复查,从影像学角度分析PMD的发生机制。结果共纳入117例发病24h内的急性皮质下脑梗死患者,其中PMD组26例,非PMD组91例。单变量分析显示,PMD组既往卒中或短暂性脑缺血发作史的患者构成比显著性低于非PMD组（11．5％对31．9％;X2=4．206,P=0．040）,糖基化血红蛋白（6．7％±2．0％对5．9％±1．7％;t=-2．206,P=0．029）和梗死层面数（3．7±1．4对3．0±1．6;t=-2．147,P=0．034）显著性高于非PMD组,放射冠部位梗死（73．1％对25．3％;X^2=20．081,P〈0．001）以及大脑中动脉（middle cerebral artery,MCA）狭窄或闭塞（76．9％对51．6％,X^2=5．279,P=0．022）的患者构成比显著性高于非PMD组。多变量logistic回归分析显示,放射冠梗死[优势比（oddsratio,OR）10．459,95％可信区间（confidence interval,CI）3．091～35．396;P〈0．001]与MCA狭窄或闭塞（OR4．036,95％CI 1．057～15．417;P=0．041）是急性皮质下脑梗死后PMD的独立预测因素。PMD组梗死灶扩大（50．0％对6．5％;X^2=13．830,P〈0．001）和梗死复发（38．5％对3．2％;X^2=11．273,P=0．001）的患者构成比显著性高于非PMD组,无任何改变（23．1％对90．3％扰。=26．566,P〈0．001）的患者构成比显著性低于非PMD组。结论放射冠部位梗死以及MCA狭窄或闭塞是急性皮质下脑梗死后PMD的重要独立预测因素,梗死灶扩大和梗死复发可能是PMD的主要发生机制。     

老年急性孤立性脑桥梗死患者早期运动功能缺损进展的相关危险因素分析

目的 探讨老年急性孤立性脑桥梗死患者早期运动功能缺损进展的预测因素.方法 选择郑州大学第二附属医院神经内科收治的资料完整的老年急性孤立性脑桥梗死患者95例,根据病情是否进展将患者分为进展性运动功能缺损(progressive motor deficits,PMD)组31例(32.6％)和未进展组64例.PMD为发病1周...     

穿支动脉区梗死扩散加权成像影像学滴水征与进展性运动缺损的关系

目的对比分析急性期进展性：和无进展性穿支动脉区梗死的临床特征,并探讨穿支动脉区梗死扩散加权成像（DWI）影像学模式与进展性运动缺损（PMD）的关系。方法回顾性分析经头磁共振及头颈部CT或MR血管造影成像证实的新发穿支动脉区梗死（脑桥或大脑中动脉深穿支供血区）患者75例,根据卒中发生后5d内动态的美国国立卫生研究院卒中评分（NIHSS）情况,分为PMD组30例,NPMD组45例。采用t或,检验比较两组的危险因素、神经功能缺损程度、临床表现、梗死灶影像学模式、基底动脉、颈内动脉及大脑中动脉病变情况。结果PMD组中病灶呈滴水征的比例[20／30（66．7％）]高于NPMD组[10／45（22．2％）,X2=14．8,P〈0．01]。PMD组患者平均人院时NIHSS评分（4．60±1．40）高于NPMD（3．75±1．20,t=2．81,P〈0．01）。经Logistic回归分析发现,穿支动脉区梗死DWI影像学滴水征与PMD呈正相关（OR3．0,95％CI1．25—7．17,P〈0．05）。结论DWI影像学滴水征是穿支动脉区梗死影像学模式特征之一,影像学滴水征或可作为进展性卒中或早期神经功能恶化的预测指标。     

脑桥梗死患者的临床特征与头颅磁共振影像对比分析

目的总结脑桥梗死的临床及影像特点,探讨不同类型脑桥梗死的发病机制。方法选取脑桥梗死患者45例(脑桥梗死组),行头颅磁共振平扫、弥散加权及磁共振血管造影,根据MRI所见责任病灶将脑桥梗死分型,对不同类型脑桥梗死合并基底动脉主干硬化、狭窄的比例进行分析。另取非脑梗死患者60例为对照组,采用logistic回归分析脑桥梗死危险因素。结果脑桥梗死高危因素logistic显示,高血压(P=0.029)、糖尿病(P=0.002)、颈动脉硬化(P=0.000)是脑桥梗死独立危险因素。脑桥梗死中旁正中动脉梗死(A型)和分水岭区梗死(D型)发病率最高,分别为19例(42.2%)和16例(35.6%)。主要临床表现为偏侧肢体无力(73.3%)、构音不良(55.6%)和偏侧肢体痛觉减退(28.9%)等。53.3%的患者缺乏脑干受损的表现,而类似大脑半球梗死。D型脑桥梗死合并基底动脉主干硬化、狭窄比例明显高于A型(P=0.004)。结论脑桥梗死主要以旁正中动脉和分水岭区梗死为主,仅根据临床表现定位易发生偏差,需行头颅MRI加以辨识;脑桥分水岭区梗死常提示可能基底动脉主干硬化和狭窄,旁正中动脉梗死则多为小动脉闭塞所致。     

急性脑桥梗死进展发生的影像学特点

目的探讨急性脑桥梗死进展发生的影像学特点。方法采用头颅MRI及磁共振血管造影(MRA)检查,对151例急性脑桥梗死患者的影像学特征进行分类,将其分为2组,进展组42例,非进展组109例。比较2组患者的影像学分型及梗死部位的不同。结果 151例急性脑桥梗死患者中发生进展者占27.8%,非进展者占72.2%;进展组与非进展组在一般情况、危险因素、实验室检查、美国国立卫生研究院卒中量表评分、药物治疗等方面比较差异无统计学意义(P>0.05)。进展组基底动脉分支病变的发生率(73.8%)明显高于非进展组(34.9%,P=0.000),同时发现,进展组下部脑桥梗死的发生率(42.9%)明显高于非进展组(24.8%,P=0.029)。结论基底动脉分支病变和下部脑桥梗死可能是急性脑桥梗死进展发生的重要预测指标,对可疑的急性脑桥梗死患者,及时行头颅MRI(包括弥散加权成像)及MRA检查,明确其影像学分型及梗死部位,对预防急性脑桥梗死进展的发生可能具有重要意义。     

孤立性脑桥梗死患者静脉溶栓的短期预后及安全性探讨

目的探讨发病4.5h内孤立性脑桥梗死患者静脉溶栓的短期预后和安全性。方法选择静脉溶栓登记的605例患者,其中静脉溶栓后经头颅MRI证实的孤立性脑桥梗死29例(脑桥梗死组),基底节区梗死59例(基底节区梗死组)。对比分析2组患者临床特征、危险因素、实验室检查和出院时、90d的良好预后(改良Rankin量表评分≤2分)及颅内外出血发生率;同时观察孤立性脑桥梗死患者静脉溶栓后神经功能缺损进展或波动的发生情况。结果脑桥梗死组溶栓前纤维蛋白原水平明显高于基底节区梗死组[(3.7±1.2)g/L vs(3.2±0.9)g/L,P=0.037]。2组良好预后在出院时(51.7%vs 62.7%,P=0.324)和90d(86.2%vs 78.0%,P=0.375)比较,差异无统计学意义。29例脑桥梗死患者中,12例发生进展或波动,6例(50.0%)出院时预后良好,只有1例(8.3%)90d预后不良。结论孤立性脑桥梗死超急性期静脉溶栓可能是有效和安全的。尽管溶栓后神经功能缺损进展或波动发生高,但短期预后仍较好。     

脑干腹侧中线旁对称性脑梗死的临床及影像学分析

目的探讨脑干腹侧部中线旁对称性脑梗死综合征的临床特点。方法对11例脑干腹侧部中线旁对称性脑梗死患者的临床资料及影像学检查进行回顾性分析。比较7例孤立性脑干病灶与4例合并后循环其他部位病灶患者,6例老年与5例中青年患者的临床资料。结果患者均为急性起病,以不同程度的意识障碍、眼球运动障碍及四肢瘫痪为主要特点;病灶累及延髓1例,延髓脑桥交界区1例,单纯累及脑桥3例,同时累及中脑和脑桥4例,单纯累及中脑2例;3例死亡,3例持续性意识障碍,5例好转。孤立性脑干病灶与后循环多发病灶患者高脂血症、吸烟史和出院改良的Rankin量表≥4分比较,差异有统计学意义(P0.05,P0.01);老年患者意识障碍、合并肺感染、死亡或未愈比例较中青年患者高(P0.05,P0.01)。结论脑干腹侧部中线旁对称性脑梗死是椎基底动脉梗死的一种特殊类型,常见病因为椎基底动脉穿支闭塞,临床症状复杂多样,老年患者预后更差。     

Magnetic Resonance Angiography in Paced Complex Heterotaxy Syndrome with Fontan Conduit Obstruction and Venovenous Collateral Decompression

Imaging of complex congenital heart diseases (CHDs) in children is challenging. This article reviews the complementary role of high temporal and high spatial resolution magnetic resonance (MR) angiographic imaging techniques in evaluation of a patient with complex congenital cardiovascular disease and related postsurgical complications. A 4‐year‐old female patient with complex CHD and multiple previous palliative surgical procedures underwent MR angiography to evaluate the cause of refractory hypoxia. High‐resolution MR angiography demonstrated the complex postsurgical cardiovascular anatomy and also assisted in the evaluation of cavopulmonary shunt patency and secondary venovenous shunt formation. Time‐resolved MR angiography evaluated pulmonary perfusion and demonstrated a significant pulmonary arteriovenous malformation. This information guided physicians in planning further managements, which resulted in a satisfactory clinical outcome.     

Effects of Chronic Alcohol Abuse and HIV Infection on Brain Phosphorus Metabolites

We examined the effects of human immunodeficiency virus (HIV) infection and chronic alcohol consumption on cerebral phosphorus metabolites to determine if chronic alcohol abuse is a risk factor for the progression of neurological effects of HIV infection. We studied 15 HIV- alcoholics, 8 HIV- light/nondrinkers, 32 HIV+ alcoholics, and 41 HIV+ light/nondrinking men, with both HIV+ groups having similar CD4 lymphocyte counts. We used localized 31-phosphorus magnetic resonance spectroscopy after magnetic resonance imaging to examine two brain volumes in superior white matter and subcortical gray matter. Chronic alcohol consumption was associated with reduced white matter concentrations of phosphodiester (PDE) and phosphocreatine (PCr). Also in the white matter, acquired immune deficiency syndrome (AIDS) and AIDS-related complex (ARC) were associated with reduced concentrations of PDE and PCr, compared with both HIV- and clinically asymptomatic HIV+ subjects. Because no alcohol-by-HIV interactions were detected, the effects of HIV infection and alcohol abuse were cumulative. This is reflected in a successive decrease of white matter PDE and PCr concentrations in the order HIV- light/nondrinkers/HIV- alcoholics/HIV+ light/nondrinkers/HIV+ alcoholics. Subcortical gray matter PDE concentrations were lower in ARC/AIDS alcoholics than in HIV-light/nondrinking individuals. These findings suggest altered brain phospholipid metabolites and energy metabolites with alcohol abuse and HIV infection. They demonstrate that the adverse metabolic effects of HIV on the brain are augmented by chronic alcohol abuse.     

4D心脏磁共振与3D心脏磁共振评价正常左心室功能的对比研究

目的通过4D心脏磁共振(4D MR)法和3D心脏磁共振(3D MR)法检测正常人左心室功能的对比,评价4D MR法检测左心室功能的优势。方法采用4D MR法和3D MR法对9例正常志愿者的每搏输出量(SV)进行测量,并与相位对比磁共振法所测结果进行比较。结果 4D MR法、3D MR法测量左心室的收缩末期容积、舒张末期容积、SV无明显差别。4D MR法获取SV花费时间少,受操作者影响小。结论 4D MR法具有准确性和可重复性高、花费时间短、直观等优点,可作为临床心功能检查的主要方法。     

Demonstration of calf abnormalities by magnetic resonance imaging in polyarteritis nodosa

Summary A 36-year-old Caucasian woman presenting with persisting painful calves after a flu-like illness was diagnosed as having polyarteritis nodosa. Magnetic resonance imaging of the lower legs showed abnormal signal intensity of the outer muscle groups with sparing of the central located muscles. The good clinical response to oral prednisone was supported by improvement of MRI.     

病毒性心肌炎磁共振成像诊断的初步探讨

研究磁共振成像(MRI)在病毒性心肌炎(VMC)中的表现及价值,从而提供一种无创性的诊断手段.本文对VMC患者19例和正常志愿者5例行MRI检查.心电门控、自旋回波技术.采用T1加权像、T2加权像及Gd-DTPA增强后T1加权像.以心室心肌区异常高信号改变为阳性,各断面心肌区信号均匀一致为阴性.结果:5例正常志愿者均无阳性发现,VMC组中有12例在增强以后的T1加权像有阳性发现,其中2例在T2加权像有同样的改变.增强后5min、10min、15min阳性率无显著差异.炎症病灶呈局灶,散在分布.部分病程长的患者仍有阳性发现.MRI敏感性好.Gd-DTPA安全有效,故MRI作为心肌炎诊断的无创性手段有巨大潜力.     

卒中后抑郁患者的局部一致性降低:静息态功能磁共振成像研究

目的 探讨卒中后抑郁(post-stroke depression,PSD)患者静息态脑功能磁共振成像(functional magnetic resonance imaging,fMRI)特征.方法 分别对13例PSD患者以及无PSD卒中患者进行静息态fMRI扫描,采用局部一致性(regional homogeneity,ReHo)作为指标,分析PSD患者脑功能.结果 与对照组相比,PSD组患者左侧额中回、右侧额上回、右侧额中回、右侧扣带前回、右侧扣带后回、左侧岛叶、左侧尾状核和左侧海马的ReHo值显著降低.结论 PSD患者存在静息态神经环路功能异常,提示在临床治疗过程中需要重视卒中患者的情绪状态.     

Alcohol and the human brain: a systematic review of different neuroimaging methods

Background: Imaging techniques have been in widespread use in the scientific community for more than 3 decades. They facilitate noninvasive, in vivo studies of the human brain in both healthy and diseased persons. These brain‐imaging techniques have contributed significantly to our understanding of the effects of alcohol abuse and dependence on structural and functional changes in the human brain. A systematic review summarizing these contributions has not previously been conducted, and this is the goal of the current paper. Methods: The databases PubMed, PsycINFO, and PSYNDEX were searched using central key words. Fulfilling the inclusion criteria were 140 functional and structural imaging studies, together comprising data from more than 7,000 patients and controls. The structural imaging techniques we considered were cranial computerized tomography and various magnetic resonance imaging–based techniques, including voxel‐based morphometry, deformation‐based morphometry, diffusion tensor magnetic resonance imaging, and diffusion‐weighted magnetic resonance imaging. The functional methods considered were magnetic resonance spectroscopy, positron emission tomography, single photon emission computed tomography, and functional magnetic resonance imaging. Results: Results from studies using structural imaging techniques have revealed that chronic alcohol use is accompanied by volume reductions of gray and white matter, as well as microstructural disruption of various white matter tracts. These changes are partially reversible following abstinence. Results from functional imaging methods have revealed metabolic changes in the brain, lower glucose metabolism, and disruptions of the balance of neurotransmitter systems. Additionally, functional imaging methods have revealed increased brain activity in the mesocorticolimbic system in response to alcohol‐themed pictures relative to nondrug‐associated stimuli, which might be of predictive value with regard to relapse. Conclusions: There has been tremendous progress in the development of imaging technologies. Use of these technologies has clearly demonstrated the structural and functional brain abnormalities that can occur with chronic alcohol use. The study of the alcoholic brain provides an heuristic model which furthers our understanding of neurodegenerative changes in general, as well as their partial reversibility with sustained abstinence. Additionally, functional imaging is poised to become an important tool for generating predictions about individual brain functioning, which can then be used as a basis for personalized medicine.     

Alcoholic Myopathy: Evaluation with Magnetic Resonance Imaging—A Case Study

Magnetic resonance imaging (MRI) of thigh and leg muscles was performed in a patient with alcoholic myopathy showing myalgia, hypercreatine kinasemia, and hypermyoglobinemia. High signal intensities in both T₁- and T₂-weighted images were widely distributed in the affected muscle groups, which most likely reflected lipid accumulation. Although he had hypermyoglobinemia, MRI and muscle biopsy did not show findings of rhabdomyolysis, such as necrosis, regeneration, and edema. We suggest that the high signal intensities in this case may have indicated „prerhabdomyolysis” related to alcohol abuse and that muscle MRI is useful in the evaluation of alcoholic myopathy, mainly predicting the onset of rhabdomyolysis.     

Pulmonary Regurgitation: Determining Severity by Echocardiography and Magnetic Resonance Imaging

Objective. Pulmonary regurgitation (PR) is common after repair of congenital heart disease involving the right ventricular outflow tract. Because PR results in chronic right ventricular volume overload and associated morbidity and mortality, accurate assessment of its severity is important. The aim of this study was to compare echocardiography with the gold standard of PR quantitation by magnetic resonance imaging (MRI) in a young population with repaired congenital heart disease. Design/Methods. Patients with congenital heart disease who had undergone right ventricular outflow tract reconstruction and/or pulmonary valve replacement and had an MRI within 3 months of an echocardiogram formed the study group. Echocardiographic indices were compared with MRI‐determined pulmonary regurgitant fraction (PRF) to determine the most accurate measurements to quantitate PR. Results. Of the 69 MRI/echocardiography pairs in 64 patients, 53 data sets were complete and used in the analysis. For the prediction of MRI PRF ≥20%, PR jet width/annulus ratio ≥0.5 demonstrated excellent sensitivity (94%), specificity (100%), positive predictive value (PPV 100%), and negative predictive value (NPV 82%). For the prediction of MRI PRF ≥40%, jet width/annulus ratio ≥0.7 and diastolic flow reversal in the branch pulmonary arteries showed useful sensitivity (92%), specificity (68%), PPV (76%), and NPV (88%). Conclusion. Pulmonary regurgitation jet width/annulus ratio combined with diastolic flow reversal is the most valuable echocardiographic measure for assessing PR severity after right ventricular outflow tract reconstruction or pulmonary valve replacement; however, this surrogate measure does not replace the importance of MRI evaluation.