3.0T心脏磁共振技术与病毒性心肌炎患儿心肌损伤、左心室结构关联性及对预后的影响

目的 探究3.0T心脏磁共振(cardiac magnetic resonance, CMR)测定T2比值、LGE范围与病毒性心肌炎(viral moycarditis, VMC)患儿心肌损伤、左心室结构关联性及对预后的影响。方法 选取VMC患儿93例作为研究对象,均行3.0T CMR检查,根据6个月预后分为预后良好组(68例)与预后不良组(25例)。比较2组一般资料、血清肌钙蛋白T(cardiac troponin T,cTnT)、磷酸肌酸激酶同工酶(creatine kinase isoenzyme, CK-MB)、左心室结构[舒张期室间隔厚度(inter ventricular septum thickness, IVST)、舒张末容积(end diastolic volume, EDV)、收缩末容积(end systolic volume, ESV)]、CMR检查参数[T2比值、晚期钆增强(late gadolinium enhancement, LGE)范围],分析T2比值、LGE范围与血清cTnT、CK-MB、左心室结构指标相关性及VMC患儿预后的影响因素,并评价T2比值、...     

Primary cardiac fibroma in an infant: Computed tomography and magnetic resonance imaging findings

Cardiac fibromas (CFs) are benign primary tumors that typically occur during childhood and may be asymptomatic. However, due to the proximity of CFs to the cardiac structure, significant morbidity and mortality may also be anticipated. CFs do not show spontaneous regression and surgical resection generally remains the treatment of choice for these tumors in children. Thus, it is important to take aggressive steps to obtain accurate pretreatment image diagnosis. A full-term male infant was presented to our facility suffering from shortness of breath, after an episode of upper respiratory tract infection at age 1.5 months. Subsequent chest X-ray revealed widening of the mediastinum and trachea deviation. Cardiogenic pathology was suspected. Computed tomography and magnetic resonance imaging were performed, and we confirmed a diagnosis of benign CF. Thoracotomy biopsy of the tumor confirmed the pathological diagnosis.     

儿童大脑胶质瘤的磁共振灌注成像技术研究

目的 研究磁共振灌注成像技术应用于儿童大脑胶质瘤诊断的可行性及其扫描技术的优化。方法 儿童大脑胶质瘤患儿18例，男12例，女6例，年龄5～16岁，对照组儿童25例，男16例，女9例，年龄3～14岁。使用GE1．5T Signa High-SpeedMRI扫描仪，双倍剂量造影剂马根维显（0．2mmol／kg）根据不同患儿血管情况分别以2～4ml／s注入速度通过18G套管针经最佳的血管注射，随后以相同速度注射生理盐水20ml。结果 磁共振灌注图像质量分为“差”“中”“优”分为三级，造影剂注射速度2ml／s组灌注图像质量多为“差”（12／17），注射速度3ml／s组多为“中”（14／16），注射速度4ml／s组全为“优”（6／6）。结论 磁共振灌注图像的质量与造影剂注射速度密切相关，造影剂注射速度〉3ml／s是获得满意磁共振灌注图像的基本条件；而扫描前护士对血管的选择及血管状况的评估是造影剂高速注射成功的前提。     

视神经脊髓炎患者41例视神经磁共振分析

目的:探讨视神经脊髓炎(neuromyelitis optica,NMO)患者视神经的MRI表现特点。方法:对临床疑似NMO患者进行视神经、脑部和脊髓扫描,将满足NMO最新Wingerchuk诊断标准的41例患者纳为研究对象,进行随访研究,分析不同病程阶段视神经MRI表现特点,并与32位健康志愿者进行对照。同时,回顾性分析患者视神经诱发电位(visual evoked potential,VEP)检查结果,探讨MRI表现与VEP之间的关系。结果:正常志愿者MRI显示双侧视神经走行笔直,部分节段视神经鞘膜腔表现为稍高信号,但“双轨样”改变不明显。而NMO患者最常见的异常改变为视神经鞘膜腔信号显著增高,呈全程连续性“双轨样”改变,较健康志愿者明显不同。急性期,22例患者(53.7%)伴有视神经增粗或(和)扭曲; 17例(41.5%)可见视神经内点状高信号表现;31例(75.6%)在横断位T1WI上可见到视神经强化。缓解期,15例(36.6%)MRI上可见单侧或双侧视神经萎缩、变细和(或)扭曲。在本组研究结束时,共35例(80.5%)视神经内见点状高信号表现。对照VEP检查结果,MRI在反映视神经脱髓鞘改变上,敏感性为94.6%,但在急性期仅为43.6%,说明MRI检查具有一定的时间依赖性,不及VEP敏感。 结论:MRI能清晰显示NMO患者各个病理阶段视神经的形态改变,MRI可以成为视神经的首选影像学检查方法。     

心脏永久起搏器置入患者接受磁共振检查安全性探讨

目的探讨心脏永久起搏器非依赖患者接受磁共振成像(MRI)检查的安全性。方法选择7例起搏器非依赖患者分别行头、腰椎、髂血管和心脏MRI检查。检查前、后对生命体征进行记录,并作统计学分析,随访心电图。结果7例患者检查中无自述不适。6例患者未见心律失常及起搏器感知、起搏功能异常。1例患者检查中(射频脉冲启动时)出现自身缓慢心率,心率55次/分左右,偶见起搏QRS波形,但患者神志清楚,未诉心悸、不适,生命体征正常,在专科医生密切观察及严密心电监护下顺利完成检查。7例患者检查后无自主不适,随访心电图示起搏器功能正常。结论心脏永久起搏器非依赖患者可安全接受MRI检查。     

大脑胶质瘤病的磁共振及磁共振波谱诊断价值

目的探讨磁共振成像(MRI)和磁共振波谱成像(MRS)对大脑胶质瘤病的诊断价值。方法对13例经手术或活组织病理检查证实的大脑胶质瘤病患者的临床表现及MRI平扫、增强、MRS影像学资料进行回顾性分析。MRI常规行T1加权像(T1WI)、T2加权像(T2WI)及液体衰减反转恢复序列(FLAIR),采用时间飞跃法(TOF)的磁共振血管成像(MRA)、T1WI增强扫描。氢质子MRS采用单体素激励回波探测法(STEAM),并分析N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱复合物(Cho)等物质峰值改变。结果所有病例均侵犯2个或2个以上脑叶,以颞叶、枕叶、胼胝体、基底节和丘脑等部位侵犯受累常见。病变区T1WI呈低或等信号、T2WI呈高或混杂高信号、液体衰减反转恢复序列上为高信号,未见明显坏死、钙化,受累区域脑组织肿胀,占位效应轻。注射钆喷酸葡胺增强扫描示,9例无明显强化,2例斑片状强化,1例结节状强化,1例线状轻度强化。病变区域MRS表现为不同程度NAA降低,NAA/Cr比值降低;Cho上升,Cho/Cr和Cho/NAA比值上升。结论 MRI结合MRS对大脑胶质瘤病的诊断及鉴别诊断具有较大临床价值,是目前诊断大脑胶质瘤病的首选影像学方法。     

磁共振扩散谱成像

磁共振成像技术(magnetic resonance imaging,MRI)通过探测水分子的扩散特征能获取生物组织的物理特征和微观结构,进而提供生物学和临床医学信息,具有无创、无须使用外源性对比剂等优点~[1].     

Characteristic findings of malignant melanoma in the sinonasal cavity on magnetic resonance imaging

Background  Malignant sinonasal melanoma (MSM) is a rare tumor with a perplexing signal intensity due to variable histopathologic components. This study was undertaken to delineate its MR imaging features.

Methods  MR imaging findings of 10 patients (6 women and 4 men, mean age 61.3 years old) with pathologically confirmed MSM were retrospectively reviewed. The location, size, signal intensity, enhancement, and internal imaging characteristics of all tumors were evaluated. Signal intensity and degree of enhancement was graded in comparison with the gray matter and adjacent muscle uptake, respectively.

Results  There were 8 tumors that were pathologically confirmed to contain melanin. Compared to gray matter of the brain, 7 of them demonstrated hyperintensity on T1WI and 6 (6/7) showed hypointensity on T2WI. There was multiple linear, dark-signal intensity on T2WI within the mass in 9 of the 10 patients’ tumors. Evaluated with gadolinium-enhanced imaging, all 10 patients showed moderate enhancement within the areas that were isointense in the lesion on pregadolinium T1WI. Moreover, some parts which displayed hyperintensity on T1WI within the tumors of 7 patients showed mild enhancement that was similar to muscle on a time-intensity curve (TIC).

Conclusions  MSM shows characteristic MR signal intensity (hyperintensity on T1WI and the linear, low-signal intensity on T2WI), which may provide valuable information for clinical diagnosis. Together with conventional MRI, TIC may be useful for indicating pleomorphic patterns of MSM.

     

中枢神经细胞瘤磁共振成像及氢质子磁共振波谱的诊断价值

目的 探讨中枢神经细胞瘤(CNC)的常规磁共振成像(MRI)和氢质子磁共振波谱(1H MRS)的表现特征和诊断价值.方法 回顾性分析5例经手术病理证实的CNC进行常规MRI检查,其中4例加做多体素1H MRS,并分析其MRI及1H MRS表现.结果 5例CNC患者肿瘤特征性位于侧脑室,邻近Monra孔并累及透明隔.在T1加权成像4例呈等低不均匀信号,1例呈等高不均匀信号;T2加权成像呈等高不均匀信号;增强后肿瘤呈中度及明显不均匀强化.4例1H MRS均表现为胆碱峰明显增高,N-乙酰门冬氨酸(NAA)峰下降,胆碱/肌苷比值升高,NAA/肌苷比值降低.结论 20~40岁的患者发生于侧脑室透明隔处邻近Monra孔的肿瘤,结合其MRI及1H MRS表现特征应考虑到CNC诊断.     

MRI动态增强在直肠癌诊断中的价值

目的：探讨直肠癌磁共振动态增强检查的影像表现及应用价值.方法：2005年12月-2010年3月96例直肠癌患者于术前行动态增强扫描,其中73例直肠癌患者,绘制时间-信号强度曲线,测量直肠肿瘤、正常直肠肠壁、盆腔淋巴结的峰值时间、峰值、信号强化率、最大信号强化率.比较不同临床病理分期与磁共振动态增强参数值之间的关系.结果：磁共振动态增强检查中,直肠癌相较于正常直肠肠壁具有更早的峰值时间[Tpeak（18.9±6.7） vs （21.4±6.6）,P=0.046 8]及更高的峰值[SIpeak（1 105.9±354.6） vs （805.2±345.8）,P〈0.000 1]、信号强化率[E（191.6±65.4） vs （158.0±67.3）,P=0.028 7].Dukes分期C的直肠癌具有更早的Tpeak值和更高的 Kep（P=0.045 3）.结论：直肠癌的磁共振功能成像可以部分反映肿瘤局部血管情况,为临床治疗与术后评估提供帮助.     

Dysembryoplastic neuroepithelial tumors: magnetic resonance imaging and magnetic resonance spectroscopy evaluation

Background Dysembryoplastic neuroepithelial tumor （DNT） is a rare benign neoplasm of the central nervous system affecting young people. A correct preoperative diagnosis is helpful for planning surgical strategies and improving prognosis. The purpose of this study was to characterize DNTs using magnetic resonance imaging （MRI） and magnetic resonance spectroscopy （MRS） and to analyze the value of these two techniques in the diagnosis of DNTs. Methods MR images of 13 patients with DNTs were reviewed retrospectively; and five of the patients also underwent MRS. Tumors were confirmed by surgery. The distribution, extension and signal features of the lesions were assessed, and the MRS results were analyzed. Results All tumors were supratentorial. The cortex was the main area involved, with nine tumors located in the temporal lobe, three in the frontal lobe, and one on the boundary between the temporal and occipital lobes. All cases had decreased signal intensity on Tl-weighted MR images and increased signal intensity on T2-weighted images. On fluid attenuated inversion recovery weighted images, the hyperintense ＂ring sign＂ and internal septation of the lesion were seen in 9 cases. Eight tumors had well-demarcated borders. Peritumoral edema or mass effect was absent in all cases. A contrast enhancement examination was performed in 9 cases. Contrast enhancement was absent in five cases, and four cases showed significant enhancement. The MRS showed a low N-acetylaspartate peak and a lack of elevated choline-containing component （Cho） or Cho-Cr ratio （Cho/Cr） in five patients. Conclusions The MRI findings of DNTs were stereotypical. The combination of MRI and MRS techniques were helpful in making a correct presurgical diagnosis.     

磁共振成像对肺癌的诊断价值

目的：探讨磁共振成像对术前肺部恶性、良性肿瘤诊断的准确性。方法：回顾性分析了104例肺部肿瘤磁共振成像术前检查与术后病理检查的结果。结果：磁共振成像对术前肺部恶性、良性肿瘤的诊断准确率分别为70％和30％，术后病理检查对肺部恶性、良性肿瘤的诊断准确率分别为83％和17％。结论：磁共振成像对肺部恶性和良性肿瘤具有一定的诊断价值。     

多参数磁共振成像在前列腺癌中的诊断价值

前列腺癌（PCa）是全球范围内发病率最高的男性恶性肿瘤之一,严重危害着老年男性的身心健康,早期诊断和早期治疗对PCa治疗策略的制定和预后的判断非常关键。目前PCa诊断主要依靠直肠指诊、血清前列腺特异性抗原及经直肠超声引导下穿刺活组织检查。但这些方法的诊断效能均较低。近年来随着功能磁共振成像的推广运用,多参数磁共振成像（mpMRI）成为目前公认的诊断PCa最有效的影像学方法,其不仅能够进行前列腺疾病的鉴别诊断,还能进一步预测PCa病理评分,以及指导后续的靶向穿刺及局部治疗。mpMRI对PCa的精确诊断和后续的个体化治疗意义重大,本文就其在PCa诊断中的研究现状作一综述。     

社区人群说谎的功能磁共振研究

目的 探讨社区人群与说谎有关的认知模式及神经联系.方法 对社区志愿者进行说真话及说谎条件下的功能磁共振扫描.使用SPM2软件分析受试在两条件下脑区激活的差异.结果 说谎任务对比说真话任务,受试双侧背外侧前额叶、额内侧回、顶下小叶、右颞下回及小脑激活显著增加.结论 大脑的特定区域参与说谎或说真话,并能被功能磁共振成像(fMRI)检测到.     

海洛因脑病MRI与病理对照分析

目的 探讨海洛因脑病(heroin-associated encephalopathy,HE)的MRI特点及其病理基础.方法 34例病例中,根据流行病学、临床表现、MRI、实验室检查及其中10例病理检查结果,排除其他疾病而诊断HE.MRI检查用1.5T MRI扫描仪,行T1WI、T2WI、FLAIR检查.4例死亡患者中2例进行尸解,8例行脑立体定向活检.MRI与病理对照分析.结果 34例HE,全部病例T1WI低信号,T2WI高信号.病灶同时累及幕上半球、脑干及小脑占85.3%,三者分别单独受累均＜10%.病灶以累及脑白质为主.脑内两侧同时受累占91.2%.MRI显示的幕上半球"八字征"、脑干的"中空征"、及小脑的"蝶翼征"诊断HE有一定意义.MRI信号改变,主要与HE的脑白质脱髓鞘及大量空泡形成,这些空泡构成海绵状结构,内含液体增多有关.结论 MRI对HE能准确的定位定量诊断,并有一定特征MRI表现.MRI显示HE与病理之间有很好的相关性.     

Megnetic resonance imaging findings in sporadic Mobius syndrome

Background Although neuroradiological findings of M(o)bius syndrome have been reported as a result of brain and brainstem abnormalities,magnetic resonance imaging (MRI) now permits the direct imaging o...     

fMRI在脑肿瘤诊断中的应用价值初探

目的：探讨fMRI在脑肿瘤诊断、鉴别诊断及肿瘤浸润边界划定中的价值。方法：脑肿瘤35例,均行MR平扫、增强、DWI及MRS。在肿瘤强化区、瘤周区、正常参照区,DWI测量各区域信号值,计算相对表观扩散系数（rADC）值;^1H—MRS行MVS采集NAA、Cho、Cr、Lac等波峰,计算不同区域各代谢物比值均值,比较统计学差异。结果：DWI示肿瘤强化区rADC值在脑膜瘤与星形细胞瘤、转移瘤间有显著性差异（P〈0．05）;瘤周区rADC值在星形细胞瘤与脑膜瘤、转移瘤间有统计学差异（P〈0．05）。多体素^1H—MRS示肿瘤强化区各代谢物比值均值与正常参照区比较有显著性差异（P〈0．05）;瘤周区,星形细胞瘤、转移瘤和脑膜瘤间多组代谢物比值具统计学差异（P〈0．05）。结论：fMRI与常规MRI相结合有助于脑肿瘤的鉴别诊断以及确定病灶浸润范围。     

儿童病毒性心肌炎心肌肌钙蛋白I测定的临床意义

目的　探讨心肌肌钙蛋白I在儿童病毒性心肌炎诊断和治疗中的价值。方法　采用免疫酶标法检测 85例病毒性心肌炎患儿 (观察组 )治疗前、治疗后及 90例健康儿童 (对照组 )血清的心肌肌钙蛋白I含量 ,检测结果以( x±s)表示 ,均数间比较采用t检验。结果　观察组治疗前血清心肌肌钙蛋白I含量明显高于治疗后 (P <0 .0 1)及对照组 (P <0 .0 1) ;治疗后心肌肌钙蛋白含量同对照组之间无显著性差异 (P >0 .0 5 )。结论　血清心肌肌钙蛋白I对小儿病毒性心肌炎的诊断、指导临床治疗、评价预后有重要作用。     

原发性失眠症功能磁共振成像研究进展

原发性失眠症（PI）是一种常见的睡眠障碍,会影响人的认知、情绪调节等功能。多项研究表明PI涉及广泛的脑区异常。近年来,功能磁共振成像技术结合不同的分析方法被广泛应用于PI的研究,它可以客观、间接地分析大脑功能活动的改变,有助于阐明PI的神经病理学机制,并为疾病的早期诊断提供可靠的客观依据。本文综述了近年来任务态功能磁共振成像、静息态功能磁共振成像等技术和功能连接分析方法在PI中的应用。     

橄榄脑桥小脑萎缩的磁共振诊断

目的探讨橄榄脑桥小脑萎缩（OPCA）的MRI表现特点，提高对OPCA的认识和早期诊断水平。方法回顾性分析15例OPCA磁共振成像表现。MRI成像采用SE序列，平扫T1wI、T2WI，轴位、冠状位、矢状位成像。结果OPCA的MRI表现有：（1）脑干萎缩变细，以桥脑前后径变小为著，本组15例患者均有此表现；（2）小脑体积变小，小脑沟、裂增宽、加深，半球小叶变细，小脑横径增宽，脑回细，14例为两侧小脑半球对称性缩小，1例为非对称性萎缩，左侧小脑左叶萎缩更明显；（3）15例患者均有四脑室扩大，桥前池、延髓前池增宽。（4）其他表现：3例患者有皮层下多发点状长T1长T2腔隙性脑梗塞；5例患者有大脑皮层萎缩，为轻度萎缩，萎缩程度明显轻于小脑、桥脑。结论OPCA的MRI表现具有特征性，是确诊本病的最佳检查方法。