儿童急性坏死性脑病影像及临床分析

目的 探讨儿童急性坏死性脑病(acute necrotizing encepha-lopathy of childhood,ANEC)的影像及临床特点,为早期识别ANEC提供参考依据。方法 选取2010年9月～2020年12月本院ANEC患儿的临床及影像资料,分析本病的临床表现、实验室检查及MRI特点。结果 21例患儿实验室检查血小板计数降低,转氨酶、乳酸脱氢酶、肌酸激酶同工酶不同程度升高,脑脊液细胞计数正常、蛋白定量明显升高,MRI显示病变呈双侧对称性分布,病灶为丘脑21例、基底节区15例、脑干14例、大脑白质14例、小脑8例、胼胝体2例和海马1例,病死率38. 1%(8/21)。结论 ANEC早期无特异性临床表现,病情进展快,病死率高,在冬季(12月～2月)对于存在高热、意识障碍并伴转氨酶、肌酸激酶同工酶升高的婴幼儿,应尽早完善MRI检查,以早期识别、诊断,为后续治疗、护理争取时间,提高存活率。     

急性坏死性脑病MRI诊断

目的探讨急性坏死性脑病(ANE)的磁共振影像学特征与临床病理的关系。方法资料完整的ANE 2例,结合文献复习其MRI特点,并与临床对照。结果 2例患者均为男性,发病年龄分别为1岁及1岁5个月,有典型的临床表现,发病前有明确的前驱感染史,之后短时间陷入浅昏迷,并有惊厥抽搐发作,脑脊液生化检查蛋白含量增高,MRI示颅内多发、对称性分布病灶,均累及双侧丘脑及脑干并出血,T1WI呈高信号,T2WI呈混杂高信号为主,T2-FLAIR为混杂高信号,增强后呈轻度环形强化,病例1双侧海马受累及,病例2双侧侧脑室旁白质、基底节区、小脑半球受累及。结论急性坏死性脑病MRI最突出的影像学特点是对称性地累及双侧丘脑,而且T1WI常呈高信号。     

遗传代谢性脑病的MRI表现特点初探

目的探讨遗传代谢性脑病的MRI表现。方法回顾性分析9例遗传代谢性脑病的MR资料,其中男8例,女1例,所有病例均行头颅MRI扫描,包括常规T_1WI,T_2WI和扩散加权成像序列(diffusion-weighted imaging,DWI),并随访其中3例。结果 8例表现为两侧大脑半球白质对称性稍长T_1稍长T_2信号影,DWI呈高信号,ADC呈低信号,两侧背侧丘脑、基底节区、和/或脑干、和/或皮质脊髓束走行区、和/或MRI皮层下U形纤维对称性扩散受限。1例胼胝体亦受累,1例病灶亦累及两侧额叶及扣带回皮层。3例戊二酸血症Ⅰ型除上述表现外尾状核头、豆状核壳核出现长T_2信号影,双侧脑外部间隙及外侧裂池增宽,脑白质髓鞘化延迟,且其中2例四叠体池扩大,1例见硬膜下积液。随访3例均见不同程度脑沟增宽。结论双侧背侧丘脑、基底节区、和/或脑干和/或皮质脊髓束走行区对称性扩散受限伴有双侧大脑半球白质水肿,扩散受限,应怀疑遗传代谢性脑病的可能性。     

婴幼儿多囊性脑软化磁共振诊断

目的：分析多囊性脑软化的MRI表现,以提高对此病的认识。方法：22例多囊性脑软化患儿（年龄7 d至17个月）纳入回顾性分析,全部完成颅脑MRI检查（SIEMENS ESSENZA 1.5 T MR机）,6例超过2次检查,分析其MRI特征和规律。结果：全脑型15例,半脑型3例,局部型4例。MRI见皮质及皮质下区脑软化,脑回结构可见,其中5例合并基底节区或背侧丘脑软化灶。所有病例脑白质容量减少,脑室扩张,胼胝体变薄。6例随访病例,初次检查急性脑水肿期4例、脑细胞坏死期2例,复查都处于脑软化形成期,即形成多囊性脑软化。4例脑缺氧缺血性脑病（HIE）患儿在出生后1周左右见弥散加权成像（DWI）高信号。DWI信号增高（4例）、短T1信号（3例）域,复查形成更明显脑软化。结论：多囊性脑软化的MRI表现有一定特征,皮质和皮质下区结构损伤,可提示诊断。HIE患者早期DWI高信号和短T1信号提示可能发展成更明显的脑软化。     

中毒性脑病的CT与MRI表现

目的:分析各种中毒性脑病的CT与MRI表现.材料和方法:分析23例中毒性脑病患者的CT和MRI表现,其中7例海洛因烫吸中毒,8例CO中毒,2例工业有机溶剂中毒,6例代谢性中毒,总结其CT和MRI的诊断要点.结果:CT表现为脑白质及神经核团的对称性低密度,MRI表现为相应的长T1、长T2信号.其中基底节区发生改变的有19例,小脑齿状核的有5例,脑干有3例,丘脑有6例,发生广泛白质改变的有10例.小脑齿状核发生改变的仅限于海洛因烫吸中毒患者.结论:CT和MRI能发现脑白质及神经核团的变性和坏死改变,但各种中毒性脑病的这些改变大都不具有特异性,只是小脑齿状核的改变仅见于海洛因烫吸中毒患者.正确的诊断需认真分析影像表现,密切结合临床病史.     

妊娠期高血压疾病合并可逆性后部脑病综合征的影像学特征

目的：探讨妊娠期高血压疾病合并可逆性后部脑病综合征（RPES）的影像学特征,提高对此病的认识。方法：回顾性分析35例妊娠期高血压合并RPES患者的临床及影像学特征。首次影像学检查：CT检查19例,MRI检查16例。影像学复查：17例患者于首次检查后3～14d进行复查,平均复查间隔时间为6d,其中CT复查7例,MRI复查10例。结果：RPES主要表现为对称性皮层下脑水肿,于CT图像上呈不规则形低密度区,于MRT。wI上呈高信号,主要位于双侧顶枕叶（32／35）,其次是额叶（23／35）和颞叶（16／35）,也累及深部脑白质（15／35）和基底节区（11／35）,小脑（5／35）和脑干（3／35）偶有累及;合并蛛网膜下腔出血2例。MRI增强扫描：5例患者病灶均未见强化;MRA：左侧大脑中动脉闭塞1例,正常3例;2例患者MRV检查均正常;DWI：病灶多呈等信号或低信号（10／12）,ADC图上呈高信号;DWI示2例病灶中出现斑点状高信号,ADC图提示此区域扩散受限。复查：17例患者治疗后CT或MRI复查显示病灶完全消失13例,病灶范围明显缩小4例。结论：妊娠期高血压疾病合并RPES的影像学表现有一定特征性,主要表现为皮层下脑白质血管源性水肿,以累及后循环供血区域为主,双侧较对称,治疗后病变范围迅速减小甚至消失。     

枫糖尿病的临床和脑磁共振成像特点

目的：探讨枫糖尿病(MSUD)脑 MRI 表现及其诊断价值。方法经气相色谱、串联质谱、基因确诊9例 MSUD 患儿,通过 MRI 了解脑损伤特点,结合临床表现、生化特点进行分析,重点分析影像学表现。结果9例患儿于生后3 d~6岁发病,临床表现缺乏特异性,主要是喂养困难、昏睡、反应差、抽搐发作、智力下降。患者血亮氨酸、异亮氨酸、缬氨酸显著增高。9例均行 MRI 检查,2例同时行氢质子磁共振波谱(1 H-MRS)检查。脑 MRI 显示小脑半球、小脑脚、大脑脚、脑干、苍白球各有5例受累,4例累及丘脑、内囊后肢,3例累及半卵圆中心,2例同时合并胼胝体、枕部、颞叶深部、额叶、顶叶信号异常。受累的区域均表现为 T1稍低、T2稍高信号,而在扩散加权成像(DWI)上表现为明显高信号。1例影像正常。2例1 H-MRS 于0.9 ppm 处均未见甲基峰。结论MSUD 临床表现缺乏特异性,MRI 特点主要是生后已经开始髓鞘化的脑白质区域如小脑半球、内囊后肢、脑干内、小脑脚、大脑脚等在 DWI 上表现为明显高信号。     

产前子痫脑病的CT和MRI表现

目的分析产前子痫患者脑病的MR及CT特点以及MRI表现的病理基础.材料和方法回顾性分析4例产前子痫患者头颅MRI/CT影像资料.结果病灶主要分布在两侧大脑半球皮质及皮质下白质,对称性分布.可同时累及基底节区、脑干及小脑.CT表现为片状低密度影,病变面积大者脑池、脑裂、脑沟明显变窄.MRI T1WI为低信号,T2WI为高信号,DWI为等信号或略低信号,ADC升高.结论产前子痫患者脑病影像学表现有一定的特征性,结合临床能明确诊断.     

手足口病并发脑炎的临床及头颅MRI分析

目的 探讨儿童手足口病并发脑炎的临床特点及头颅MRI影像特征.方法 对71例临床诊断为手足口病并发脑炎的患儿进行头颅MRI检查,获得T1WI、T2WI图像并分析脑部MRI表现.结果 25例累及脑干,其中23例(92%)累及脑桥被盖,21例(84%)累及延髓,19例(76%)累及相邻小脑中脚,8例(32%)累及小脑齿状核.表现为不同范围的T2WI高信号病变,T1WI多呈等信号,少数(12%)呈低信号.结论 手足口病并发脑炎常累及脑干,MRI表现具有特征性.     

可逆性后部白质脑病综合征的临床特征及影像学分析

目的:探讨可逆性后部白质脑病综合征(RPLS )的临床表现及影像学特征.方法:分析5例RPLS患者的临床及影像学资料.总结该病的临床表现及影像学检查方法在疾病的诊断、治疗及预后中的作用.结果:主要临床表现为头痛,视觉障碍,恶心、呕吐,痫性发作,意识状态改变,精神异常和行为改变.影像学检查显示双侧大脑后部白质水肿,额叶、顶叶、颞叶、脑干、小脑、基底节区和大脑皮质亦可累及.MRI T1WI为略低或等信号,T2WI和FLAIR为高信号,ADC图呈高信号.结论:RPLS的发病机制为急性大脑白质血管源性水肿.绝大数RPLS患者的症状、体征和影像学检查可以完全恢复至病前水平.DWI和ADC图对于早期明确诊断和指导治疗具有非常重要的意义.     

磁共振SWI在诊断脑血管病微出血灶中的应用价值

目的 探讨分析磁共振磁敏感加权成像技术(SWI)在脑血管病微出血灶检出中的应用价值.方法 选取本院常规MRI扫描(T1WI、T2WI、T2-FLAIR)、DWI及SWI扫描,且SWI脑微出血灶检出阳性的脑血管病患者55例,探讨常规MRI序列、DWI及SWI在微出血灶检出阳性及检出病灶数目方面的差异.结果 55例患者微出...     

Acute necrotizing encephalopathy of childhood: correlation of MR findings and clinical outcome

BACKGROUND AND PURPOSE: The clinical outcome of acute necrotizing encephalopathy of childhood (ANEC), an encephalopathy characterized by symmetrical involvement of the thalami, has historically been poor, but recent studies have reported better outcomes. By devising a MR imaging scoring system, we determined the relationship between characteristic MR findings and clinical outcome of patients with ANEC. METHODS: MR studies of 12 patients with ANEC were retrospectively reviewed. A MR imaging score was calculated for each patient according to the presence of hemorrhage, cavitation, and location of lesions. Clinical outcome of the patients was assessed, yielding outcome categories based on health state utility value. Spearman rank test was used to correlate the MR imaging score with clinical outcome of the patients. RESULTS: Statistically significant correlation (r = 0.76, P = .001) was found between the MR score and the outcome category. The thalami were involved in all 12 patients, brain stem in 10, cerebral white matter in 8, and cerebellar white matter in 4. Hemorrhage was present in 5 patients and cavitation in 4. Clinical outcome category was 1 in 2 patients, 2 in 8 patients, and 3 in 2 patients. No patients were in category 4. CONCLUSION: There is a significant and positive correlation between the clinical outcome and the MR imaging score in patients with ANEC. The relation between clinical outcome and each individual MR feature remains to be determined. Patients with ANEC may have a better clinical outcome than has been previously reported.     

老年人皮质下动脉硬化性脑病的病理学基础和CT,MRI对照研究

本文就２６例皮质下动脉硬化性脑病患者的ＣＴ、ＭＲＩ检查结合病理学基础进行了分析。ＭＲＩ检查，当ＴＲ＝２０００ｍｓｅｅ，ＴＥ＝３０、６０ｍｓｅｃ时，皮质动脉硬化性脑病损害均为明显的高信号，Ｔ１加权像为低信号。ＣＴ像为低密度改变。Ｔ２加权像上半卵圆中心的白质表现为不均匀弥漫的高信号区，可累及基底节、丘脑、脑干及小脑的白质，并有不同程度的侧脑室扩大、脑室边缘呈斑片状改变可有脑萎缩。病理学特征是弥漫不完全     

小儿手足口病并脑炎的MRI诊断

目的:探讨小儿手足口病并脑炎的MRI影像表现及诊断价值。方法:对52例经临床确诊的手足口病并脑炎患儿行MRI检查。分析手足口病并脑炎患儿脑内病灶的信号特征。结果:52例中有35例可见脑内异常表现,阳性率为67.3%(35/52)。病灶单发者6例,多发者29例;累及大脑灰质29例,丘脑6例,基底核8例,小脑1例,脑干3例。病灶T1WI为低信号21例,等信号14例;T2WI为高信号27例,等信号8例;FLAIR/T2WI为高信号29例,等信号6例;DWI为高信号31例,等信号4例。结论:MRI是小儿手足口病并脑炎的首选影像诊断手段,FLAIR/T2WI和DWI序列是该病的诊断及随访观察的主要扫描序列。     

MRI findings in neuro-beh?et's disease.

AIM: To evaluate the pattern and site of involvement in neuro-Beh?et's disease (NBD). MATERIALS AND METHODS: Twenty-one patients with NBD were evaluated. Using 1.5T magnetic resonance imaging (MRI), T1-weighted axial and sagittal images, gadolinium enhanced axial and coronal images and T2-weighted axial images were obtained. RESULTS: The brainstem, basal ganglia, cerebral white matter, internal capsule, thalamus and spinal cord were involved in eighteen, nine, nine, seven, six and two patients, respectively. In nine patients with cerebral white matter involvement, four had subcortical involvement and three had periventricular involvement, in addition to two patients with focal deep white matter lesions. Among the brainstem lesions, pons involvement was seen in fourteen patients, all had ventrally located lesions, and nine had tegmental involvement. Midbrain involvement was seen in fourteen patients; the cerebral peduncle was involved in 11 of these. Five patients had brainstem atrophy: two cases were demonstrated at initial MRI, the other three cases were seen on follow-up MRI. Pyramidal signs, the most common neurological signs, were demonstrated in fourteen patients. Follow-up MRI was obtained 10 days to 20 months after the initial MRI in eight cases; all showed changes in size, shape and site of involvement. After gadolinium enhancement, thirteen patients demonstrated mottled non-confluent enhancement in the brainstem (eight patients), posterior limb of the internal capsule (three patients), pachymeninges (two patients) and spinal cord (two patients). CONCLUSION: NBD manifests a reversible course, but chronic NBD may result in brainstem atrophy. Characteristic involvement along the corticospinal tract is well correlated with neurological signs.     

肠道病毒71型感染手足口病合并脑炎的MRI表现及特征

目的探讨肠道病毒71型感染手足口病合并脑炎的MR表现及特征,为临床诊断及及时治疗提供帮助。方法回顾性分析2009年4月～2011年7月临床诊断为手足口病合并脑炎并行颅脑MR扫描的64例患儿的图像资料,所有病例均经病原学检查证实为肠道病毒71型感染。结果脑干病变共计32例,其中桥脑6例(主要位于桥脑背侧),延髓8例(6例表现为延髓背侧对称性小片状信号,2例为偏中心病灶),桥脑-延髓交界区8例,中脑10例(多位于双侧大脑脚,呈片状);小脑齿状核4例(双侧);丘脑4例(均为单侧丘脑,斑点状或小片状);右侧内囊后肢1例(呈条形);基底节区9例(多为斑点状信号);放射冠区、半卵圆中心及双侧额、顶叶皮质下区者共38例(病变多为多发斑点状信号);其中病灶位于单个部位者35例(35/64,54.69%),位于多个部位者29例(29/64,45.31%)。结论手足口病合并脑炎发病部位广泛,不只局限于脑干,基底节、内囊后肢、丘脑、小脑齿状核及双侧大脑白质区均可累及。总结其易发病部位,依次为脑干、脑白质、基底节、丘脑、小脑齿状核,MR颅脑扫描能真实、准确显示手足口病合并脑炎脑部受损情况,可为临床诊断及时治疗提供可靠的影像学依据。     

Acute hypertensive encephalopathy with widespread small-vessel disease at MRI in a diabetic patient: pathogenetic hypotheses

We report unusual magnetic resonance imaging (MRI) findings in a diabetic patient with neglected hypertension and hyperglycemia, presenting with seizures and coma. Outcome was fatal despite intensive care. The MRI findings included bilateral insular and temporo-occipital grey and white matter involvement, and numerous, scattered, lacunar-like lesions involving the peripheral and deep white matter, basal ganglia grey matter, and brainstem. Lesions had a low apparent diffusion coefficient, and some enhanced following contrast injection. Hypertensive encephalopathy with widespread and severe acute small-vessel disease was considered. Pathophysiology is discussed.     

Perfusion-weighted magnetic resonance imaging patterns of hypoxic-ischemic encephalopathy in term neonates

PURPOSE: To determine whether an early magnetic resonance imaging (MRI) study using perfusion-weighted imaging (PWI) may define the pattern of brain injury in term neonatal hypoxic-ischemic (HI) encephalopathy. MATERIALS AND METHODS: Five newborns with HI encephalopathy or a marker of perinatal depression, and 2 controls underwent an early MRI (at 2 to 4 days), including PWI. Relative cerebral blood flow (rCBF) values were measured. RESULTS: On early (相似文献   

脑弥漫性轴索损伤的MRI特征（53例分析）

目的：分析弥漫性轴索损伤（ＤＡＩ）的ＭＲＩ特征。材料与方法：搜集１９９４年１０月至１９９６年１０月，对临床疑为ＤＡＩ的５３例头部外伤患者作常规磁共振成像。结果：在５３例中共发现１１０个病灶，包括大脑白质６０灶，小脑２例，基底节区３灶，胼胝体２２灶，大脑脚１８灶，桥脑３灶，延髓２灶。ＭＲＩ的特点是在Ｔ１加权像上呈小片状或片索状稍低信号，Ｔ２加权像上呈高信号灶。结论：ＭＲＩ对评价ＤＡＩ极有用，Ｔ２加权