磁共振内耳三维重建在Ⅱ型Waardenburg综合征患者中的应用

目的探讨磁共振内耳三维重建在Ⅱ型Waardenburg综合征中的应用。方法回顾性分析2008～2011年期间行人工耳蜗植入术的6例Ⅱ型Waardenburg综合征患儿术前磁共振内耳三维重建影像学检查结果,观察内耳的发育情况及人工耳蜗植入效果。结果 2例内耳无明显异常,4例有半规管畸形,3例有耳蜗畸形,术中均顺利植入全部电极,术后均顺利开机,听觉和言语水平明显提高。结论术前磁共振内耳三维重建影像学检查可清晰显示Ⅱ型Waardenburg患者的前庭、半规管及耳蜗情况,为内耳畸形特别是耳蜗畸形患者的人工耳蜗植入手术提供指导。     

电影磁共振及纤维喉镜对阻塞性睡眠呼吸暂停低通气综合征患者上气道阻塞部位检查对比研究

目的 探讨电影磁共振(cine magnetic resonance,CMR)检查及纤维喉镜下Müller试验对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome , OSAHS)患者进行上气道阻塞部位定位的应用价值.方法 选取2015年9月~2016年4月到郑州大学第一附属医院咽喉头颈外科就诊并经多导睡眠监测(PSG)及专科检查确诊的阻塞性睡眠呼吸暂停低通气综合征患者22例,于术前行纤维喉镜下Müller试验检查并分别在睡眠及清醒状态下行电影磁共振检查,观察软腭区、舌后区及会厌区狭窄或阻塞发生情况.结果 电影磁共振与纤维喉镜下Müller试验对于软腭区阻塞的定位(22例对22例)具有完全的一致性(Kappa=1),而对于舌后区(13例对6例)(Kappa=0.412)、会厌区(4例对2例)(Kappa=0.621)及多部位同时阻塞的定位(13例对6例)(Kappa=0.412),二者一致性一般.结论 对多部位阻塞的中重度OSAHS患者,术前应用电影磁共振及纤维喉镜检查能够更好地明确阻塞部位.     

先天性感音性聋患者大脑皮层静息态功能磁共振研究

目的：应用血氧水平依赖功能磁共振成像（blood oxygenation level dependent functional magnetic resonance imag ing ,BOLD－ fM RI）技术观察先天性感音神经性聋患者静息态双侧大脑半球皮层功能活动。方法对23例行人工耳蜗植入术的双侧先天性感音性聋患者（实验组）和10例听力正常者（对照组）行静息态BOLD—fMRI检查,采用fMRI低频震荡振幅（ALFF）方法比较实验组和对照组双侧大脑皮层功能活动情况,并进行定量分析。结果实验组大脑皮层左侧颞下回、左侧梭状回、右侧扣带回及左侧中央后回静息态激活强度明显大于对照组相应皮层的激活强度（P＜0．01）。结论先天性感音性聋患者感觉系统相关皮层可能发生了功能重塑,其大脑皮层存在知觉补偿现象。     

双侧先天性重度感音神经性耳聋患儿低频振幅功能磁共振研究

目的研究应用静息态功能磁共振低频振幅方法分析双侧先天性重度感音神经性耳聋患儿脑功能磁共振改变。方法采集16例双侧先天性重度感音神经性耳聋患儿及20例正常听力儿童的静息态磁共振血氧水平依赖(blood oxygenation level dependent,BOLD)数据,对BOLD数据进行后处理,获得低频振幅(amplitude of low-frequency fluctuation,ALFF)图像,比较两组间ALFF信号得出两组间的差异性脑区。结果双侧先天性重度感音神经性耳聋组较正常听力儿童对照组ALFF增加且差异具有统计学意义(P<0.05)脑区包括左、右额中上回。双侧先天性重度感音神经性耳聋组较正常听力儿童对照组ALFF减低且差异具有统计学意义(P<0.05)脑区包括右后扣带回、右中央旁回。结论双侧先天性重度感音神经性耳聋患儿相关脑区的脑功能活动水平与正Gguiling,YANG Ming,LIU Yuting,WU Han,GUAN Hongmei(Department of Radiology,Children's Hospital Affiliated to Nanjing Medical University,Jiangsu Nanjing 210008常听力儿童不同提示耳聋患儿存在脑代偿性功能及相关脑区功能会发生改变及重组。     

Computed Tomography and Magnetic Resonance Diagnosis of Allergic Fungal Sinusitis

The objective of this study was to describe CT and MR findings in patients with allergic fungal sinusitis (AFS). CT and MR images were examined from 10 patients with histologically proven AFS. All patients demonstrated CT evidence of central sinus high attenuation and T2-weighted MR signal void corresponding to surgically proven areas of thick inspissated allergic mucin. AFS is a distinct clinical entity with a highly specific radiographic appearance based on CT and MRI.     

学龄唐氏综合征患儿与正常儿童口腔共鸣声学特征比较

目的探讨7～16岁唐氏综合征儿童与正常儿童口腔共鸣声学特征的差异。方法29例7～16岁唐氏综合征儿童和90例7～16岁正常儿童发/a/、/u/、/i/音各3次,每次1～2秒,采用启音博士言语测量仪分别测量两组3个元音的第一共振峰（F1）、第二共振峰（F2）、舌距和下颌距,比较两组结果。结果随年龄增长,正常儿童的F2（a ）呈显著降低的趋势、F2（i ）和舌距则呈显著增高的趋势,而唐氏综合征患儿的F2（i ）呈显著增高趋势;不同性别正常儿童各口腔共鸣指标均无显著差异,而唐氏综合征男童的 F1（i ）和 F1（u ）显著低于唐氏综合征女童（P＜0．05）,其下颌距则显著大于唐氏综合征女童（P＜0．05）;唐氏综合征患儿的F2（u）和F1（i）显著大于正常儿童（分别为 P＜0．001和 P＜0．01）,而舌距显著小于正常儿童（ P＜0．001）。结论随着年龄的增长,正常儿童舌向前运动的幅度和舌前后运动的范围会显著增加,口腔聚焦点会逐渐前移,而唐氏综合征患儿舌的向后运动幅度及前后运动范围的发展均落后于正常儿童,更易出现口腔共鸣障碍。     

蜗神经磁共振成像在感音神经性聋中的应用

目的探讨蜗神经磁共振成像在感音神经性聋(SNHL)中的应用价值。方法采用GE TwinExct1.5T磁共振扫描仪对130例(260耳)SNHL患者进行蜗神经磁共振成像及内耳水成像。蜗神经成像序列为斜矢状位FRFSET2加权像,内耳水成像为3DFIESTA序列。结果 90例大于等于18岁的患者中,85例170耳显示蜗神经、迷路正常;1例2耳前庭导水管扩大;1例1耳蜗神经信号缺失;3例6耳蜗神经细小;40例小于18岁的患者中,19例38耳显示蜗神经、迷路正常;2例3耳Michel畸形;6例12耳Mondini畸形;1例2耳共腔畸形;12例24耳前庭导水管扩大;21例畸形中7例14耳蜗神经信号缺失。2例4耳显示内听道狭窄伴蜗神经细小。结论磁共振内耳成像对诊断SNHL有着重要的价值,对判断患者内耳蜗神经发育情况及内耳畸形有着不可替代的作用,是这类患者进行人工耳蜗植入术前必要检查。     

Percutaneous Magnetic Resonance Image–Guided Biopsy and Aspiration in the Head and Neck

Objective/Hypothesis To test the hypotheses that 1) magnetic resonance imaging (MRI)–guided biopsy and aspiration with an open 0.2‐T system (Magnetom Open, Siemens, Erlangen, Germany) in the head and neck is feasible and successful and 2) procedure times can be sufficiently short to be well tolerated by the patient. Methods Sixty‐one MRI‐guided procedures were performed in 47 patients (ages, 6 mo–88 y) in the head and neck, including the mucosal sites and masticator and parapharyngeal spaces (n = 23), parotid space (n = 6), submandibular space (n = 2), cervical vertebral column/paraspinal tissues (n = 8), skull base (n = 3), larynx or hypopharynx (n = 3), and infrahyoid nodal chains and surrounding tissues (n = 16). A clinical C‐arm imaging system was used, supplemented by an in‐room radiofrequency–shielded liquid crystal monitor, rapid gradient echo sequences for needle guidance, and MRI‐compatible anesthesia, monitoring, and surgical lighting equipment. Tissue sampling included fine‐needle aspiration (n = 58) and cutting‐needle core biopsy (n = 27), with 24 patients undergoing both procedures. Procedures were evaluated for success of needle placement, procedure time, and complications. Results Successful needle placement was accomplished in all cases without complication, with tissue sufficient for pathological diagnosis obtained for all but five patients with an average of 2.1 passes per patient. For fine‐needle aspiration, average instrument time was 7.8 minutes per pass, and average cutting‐needle core biopsy time was 9.2 minutes. Conclusions Interactive MRI guidance for needle biopsy and aspiration of deep head and neck lesions is feasible, successful, and safe. Procedure times are sufficiently short to be well tolerated by the patient.     

Acute vestibular asymmetry disorder: a new disease entity in acute vestibular syndrome?

Background: Acute vestibular syndrome (AVS) is characterized by the rapid onset of vertigo, nausea, vomiting and gait unsteadiness, which lasts for days.

Aims/objectives: We report cases as acute vestibular asymmetry disorder (AVAD), with presentations that mimic vestibular neuritis (VN) but without central lesions.

Materials and methods: We retrospectively reviewed records of patients presenting with acute spontaneous vertigo lasting more than 24?h from January 2011 to June 2016. Among 341 patients, five showed different findings that did not indicate either VN or stroke. We analyzed the clinical features and vestibular assessments of these patients.

Results: All five patients showed spontaneous nystagmus continuing for several days. However, head impulse tests (HITs) did not reveal a corrective saccade. Brain magnetic resonance imaging showed no abnormal lesions. The bithermal caloric test revealed directional preponderance without canal paresis. Finally, the slow harmonic test of the rotatory chair revealed unilateral high gain and phase within the normal range, but a significantly asymmetric response was observed. No patients showed recurrence during follow-up.

Conclusions and significance: Our study suggests that a normal HIT in AVS is not always a dangerous sign indicating an acute stroke. From our observations, we propose that AVAD would be a new disease entity within AVS.     

口腔共鸣障碍的矫治

本文从口腔共鸣障碍的临床表现和针对口腔共鸣障碍常用的促进治疗法的设计原理出发,探讨如何选择恰当的方法有效地矫治此类问题,为切实提高临床矫治口腔共鸣障碍的效果提供参考.     

Evaluation of the Vestibular System by Magnetic Resonance Angiography

This report describes the normal arterial patterns of the vestibulocerebellar regions visualized by magnetic resonance angiography. Variations in the vertebrobasilar arterial system are described, limitations in imaging are discussed, and collateral connections within the cerebellar vessels and the circle of Willis are reviewed. Clinical correlations are defined between the vestibular nuclei, the associated intra-axial tracts, and with specific posterior cerebral and brain stem arteries.     

Cortical Magnetic Resonance Imaging Findings in Patients With Posttraumatic Olfactory Dysfunction: Comparison According to the Interval Between Trauma and Evaluation

Objectives

Patients with smell loss after craniocerebral trauma are known to have some brain abnormalities, but there was no study to analyze the findings according to the time interval between injury and evaluation. We aimed to identify whether the time interval may influence on the findings in the brain.

Methods

Medical records of 19 patients with posttraumatic olfactory dysfunction were reviewed. All of them underwent a magnetic resonance imaging and olfactory function tests. The patients were divided into early (n=10) and delayed (n=9) groups according to the time interval.

Results

Magnetic resonance imaging was taken at a mean time of 2.2 and 59.6 months after trauma in the early and delayed groups, respectively. Abnormal findings in the brain were found in 6 and 8 patients in the early and delayed groups, respectively. The olfactory bulb and orbitofrontal cortex were commonly affected olfactory pathways in both groups. In the early group, the abnormalities were brain tissue defect, hemorrhage, and focal edema whereas tissue defect was the only finding in the delayed group. In the early group, 5 of 6 patients with severe olfactory dysfunction showed brain abnormality while 1 of 4 patients with mild dysfunction had abnormality. In the delayed group, all the patients had severe dysfunction and 8 of 9 patients showed brain abnormality.

Conclusion

Most patients with traumatic olfactory dysfunction had abnormality in the brain, and brain abnormality might be different according to the timing of evaluation. Furthermore, there might be an association between the severity of olfactory dysfunction and radiological abnormalities.     

Syndromal Vertigo Identified by Magnetic Resonance Imaging and Angiography

The advent of magnetic resonance imaging and angiography has clarified the location and vascular basis for vertigo of a syndromal type. The composite presentation of a vestibular symptom with evidence of cranial nerve or cerebellar dysfunction suggests a lesion within the pons, medulla, or cerebellum. The location may be exactly defined by noninvasive techniques and appropriate therapy can be initiated. Clinical examples are presented; the syndromes of vertebrobasilar artery perfusion disorder are described, and appropriate images are illustrated for confirmation.     

Cine magnetic resonance imaging: evaluation of persistent airway obstruction after tonsil and adenoidectomy in children with Down syndrome

OBJECTIVE/HYPOTHESIS: Although usually successful, not all obstructive sleep apnea is cured by removal of the tonsils and adenoids (T&A). This is particularly true in children with Down syndrome and craniofacial anomalies. This is because of the multiple levels of obstruction in their airways, with obstruction present not only at the level of the tonsils and adenoids but also from base of tongue obstruction, soft palate collapse, and hypopharyngeal collapse. The cine magnetic resonance image (MRI) is useful in evaluating the upper airway in those patients who have not achieved a normal polysomnogram after T&A surgery. STUDY DESIGN: Prospective case series. METHODS: Fifteen children with Down syndrome who had previously undergone a T&A but continued to have abnormal postoperative polysomnograms underwent a cine MRI with fast gradient cine MRI images. RESULTS: The cine MRI identified different areas and levels of obstruction that ultimately affected the children's treatment courses. Recurrent adenoid tissue, glossoptosis, soft palate collapse, hypopharyngeal collapse, and enlarged lingual tonsils were identified. The results as well as several illustrative cases are presented. CONCLUSION: Cine MRI evaluates upper airway obstruction in children who may have multiple sources of obstruction causing their obstructive sleep apnea. This is particularly helpful in children with Down syndrome and craniofacial anomalies. This technology is useful in all children with complex upper airway obstruction.