脊髓纵裂畸形的MRI诊断

目的:探讨脊髓纵裂畸形的MRI诊断价值。方法:共搜集8例脊髓纵裂畸形的临床及MRI资料,其中,男1例,女7例,年龄1~29岁,平均11岁。均行横轴面、冠状面T1WI,矢状面T1WI、T2WI。结果:本组Ⅰ型6例,2个半脊髓分别位于各自独立的硬膜囊,中间为骨或软骨间隔分开;Ⅱ型2例,2个半脊髓位于同一硬膜囊内,中间可有纤维性间隔。结论:MRI是诊断脊髓纵裂畸形及其椎管内伴发病变最有效的非创伤性检查方法;横断面T1WI是诊断脊髓纵裂的最佳断面;冠状面T1WI也能较好显示地病变。     

小儿脊髓纵裂畸形的CT诊断

目的　分析脊髓纵裂畸形的CT表现。方法　回顾性分析 48例脊髓纵裂畸形的临床及CT资料 ,其中 ,男 2 1例 ,女 2 7例 ,年龄 1d～ 8岁 ,平均 11.6个月 ,均行轴位CT平扫并行冠状及矢状面重建。结果　本组Ⅰ型 3 6例 ,分裂的 2个半脊髓分别位于各自独立的硬膜囊内 ,中间为骨性或软骨性间隔 ;Ⅱ型 12例 ,2个半脊髓位于同一硬膜囊内 ,2个半脊髓间可有纤维性间隔。伴随的畸形有 :脊髓栓系 3 6例 ,脊髓空洞积水症 9例 ,硬膜囊内脂肪瘤 10例和脊膜膨出 18例等。结论　CT可清楚地显示脊髓纵裂的部位、形态、间隔以及伴随畸形的形态学异常     

脊髓纵裂畸形的MRI诊断3例

病例1 女,14岁.以脊柱侧弯,胸背部肿物10年为主诉就诊.MRI检查示:胸椎和腰椎侧弯畸形,C7～T1,T3～8,T10～11椎体融合,T4,T6～9椎板裂,T6水平背部见软组织肿块,约2.2 cm大小,肿块与局部椎管间形成窦道样软组织影,约T6水平脊髓纵裂畸形.     

全脊柱MR成像对脊柱侧弯的术前诊断价值

目的探讨全脊柱MR成像对脊柱侧弯患者术前诊断的价值。方法使用Philips Achieva 1.5T双梯度超导磁共振成像系统和全神经系统组合线圈,对230例脊柱侧弯患者术前进行全脊柱MR扫描,分析研究MR图像。结果全脊柱MR分段图像对接良好,准确显示全脊柱解剖形态。230例脊柱侧弯患者中特发性脊柱侧弯151例,椎管内肿瘤3例,椎体及椎旁肿瘤5例,半椎体及蝴蝶椎畸形38例,Chiari畸形20例,脊髓栓系及脊髓纵裂9例。结论全脊柱MRI对脊柱侧弯患者术前的诊断具有重要的价值。     

脊髓纵裂畸形并脊髓栓系一例

患者　女 ,2岁。小便失禁 2年 ,便秘 2年。会行走晚 ,易呕吐。体检 :颅神经未见异常 ,双下肢肌力、肌张力正常 ,双侧病理反射未引出 ;胸 5、6椎体水平及腰 5至骶 3椎体水平脊柱后凸。MR检查 :见脊髓及终丝中间分离 ,分离脊髓呈圆形 ,两侧大致均等 ,中间被脑脊液间隔 ,轴面显示最清楚 (图 1) ,MR脊髓成像见脊髓分裂始自胸 11椎体水平 ,分离脊髓呈低信号 ,位于同一硬膜囊内 ,于腰 5椎体上缘水平硬膜囊被分隔为左右均等的两部分 ,双侧肾盂肾盏扩张积水 ,尤以左侧为著 (图 2 ) ;脊髓低位 ,圆锥位于第 4腰椎上缘水平 ,终丝粗短 ,脊髓受牵拉变直…     

不典型脊椎结核的MRI诊断

目的：探讨MRI对不典型脊椎结核的诊断价值。方法：回顾性分析21例经手术病理证实的脊椎结核患者的影像资料。结果：21例脊椎结核患者,术前行X线检查21例,CT检查19例,MRI检查21例;14例X线平片及10例CT检查阴性;7例X片示单椎体破坏区位于椎体后缘,呈溶骨性破坏、压缩骨折;9例CT显示相邻椎体病变,椎间盘变窄、椎体无明显破坏;无多个椎体跳跃破坏,椎小关节受累、椎旁软组织肿块内未见明确脓肿形成;MRI检查21例中,20例显示病变椎体呈长T1长T2信号,抑脂序列呈不均匀高信号,16例显示椎间隙变窄,间盘裂隙状强化,17例显示椎旁脓肿,以上20例确诊为椎体结核。1例MRI显示椎旁软组织肿块内无脓肿形成,疑诊为肿瘤。结论：MRI对不典型脊椎结核诊断敏感度、特异度及准确性均高于其他影像检查,能为临床提供更有价值的信息。     

椎管闭合不全的MRI诊断(附27例分析)

目的:分析椎管闭合不全的MRI表现特点,评价MRI诊断和鉴别诊断的价值。方法:回顾性分析27例椎管闭合不全的MRI资料,经手术证实9例,MR表现典型18例。结果:MRI显示偏侧脊髓脊膜膨出1例,腰段椎管后裂开,脊髓裂开,左侧脊髓脊膜向后膨出。脊髓纵裂2例,脊髓硬膜囊被骨性或纤维间隔分开。脂肪脊髓裂5例,骶管裂开且皮下脂肪突入椎管内,脂肪瘤—基板界面位于骶管内。脂肪脊髓脊膜膨出2例,腰骶管后裂开且腰骶皮下脂肪瘤通过裂口疝入硬膜下,横断位见脂肪瘤—基板界面位于骶管外。脊膜膨出6例,腰骶背部皮下囊状突出物与蛛网膜下腔脑脊液相通。硬膜下脂肪瘤4例,硬膜下病变在T1WI及T2WI上呈高信号。终丝脂肪瘤4例,T1加权像上见终丝结节状、线条状脂肪信号。椎管内畸胎瘤2例,硬膜囊内不均匀信号团块状占位。骶管内脊膜囊肿1例,骶管内椭圆形在T1WI呈低信号,T2WI呈高信号影。结论:每型椎管闭合不全有相应的MRI表现特点,大多数MRI可准确诊断。     

脊柱转移瘤MRI诊断(附45例报告)

目的　探讨MRI对脊柱转移瘤的敏感性 ,以提高脊柱转移瘤MRI表现的认识。方法　回顾性分析 45例脊柱转移瘤的MRI表现 ,结合文献进行讨论。结果　 45例中共累及 14 9节椎体 ,累及椎弓根 19例 3 2根 ,棘突及横突 7例 11处。椎体压缩呈盘状 8例 2 1节 ,呈楔状 7例 11节 ,病椎轻度膨胀 4例 ,有软组织肿块 18例 ,硬膜囊、脊髓受压 15例 ,脊髓受侵 2例。病椎信号均匀 2 8例 ,不均匀 17例。T1WI为明显低信号 15例 ,略低信号 2 7例 ,等信号 3例。T2 WI为明显高信号 17例 ,略高信号 2 5例 ,等信号 3例。增强 18例 ,病灶明显强化 11例 ,轻度强化 6例 ,不强化 1例。软组织肿块边缘水肿、受压和受侵脊髓在MRI上均显示阳性。结论　MRI检查脊柱转移瘤的敏感性明显优于CT和X线平片 ,尤其肿瘤浸润椎骨尚属水肿、出血、坏死阶段时。     

脊髓型颈椎病MRI强化特点分析及鉴别诊断

【摘要】目的：探讨伴T2WI高信号脊髓型颈椎病(CSM)的脊髓MRI强化特点及方式。方法：回顾性分析33例临床诊断为CSM的患者资料，33例患者T2WI显示脊髓异常高信号，且MRI增强扫描可见脊髓强化；分析脊髓T2WI高信号的范围、部位，脊髓强化的方式、部位和程度。结果：MRI显示脊髓T2WI高信号的范围包括2～6个椎体水平，平均2.76个椎体水平。MRI矢状面增强扫描显示脊髓呈点状（9例）、结节样（11例）或条片状（13例）强化；25例脊髓强化位于椎管最窄层面，1例位于最窄层面偏上，7例位于偏下层面；轴面增强扫描显示25例脊髓灰白质均可见强化，7例强化位于白质，1例位于灰质；脊髓强化程度方面，3例呈轻度强化，23例呈中等程度强化，7例呈明显强化。结论：CSM合并脊髓水肿的强化灶主要位于颈椎管最窄层面，以结节样或点状、中等程度强化为主，灰白质同时强化多见。     

钙化性黄韧带肥厚椎管狭窄症的MRI诊断

目的　探讨MRI在诊断钙化性黄韧带肥厚椎管狭窄症中的应用及椎管狭窄分级。方法　本文收集 3 1例钙化性黄韧带肥厚椎管狭窄症的病例 ,经手术及CT扫描证实。结果　本组 3 1例中 ,共计 63个病变 ,分布C3 ～L2 水平 ,2 2个病变分布于C4～ 7椎体水平 ,2 7个病变位于T9～ 12 椎体水平 ,T2 WI显示 5 0个病灶为低信号影 ,13个病灶为低信号区内中等信号影 ,T1WI显示 5 0个病灶为低信号 ,13个病灶为低信号区内高信号影。 2 3例伴随椎间小关节增生硬化 ,18例伴随相应椎间盘突出或退变 ,2 8个病变显示脊髓受压 ,13个病变伴相对应脊髓变性。结论　MRI能直接的无创伤的显示病灶位置和脊髓压迫程度     

MR breast screening in patients with genetic mutation

PURPOSE: To compare screening breast MRI with conventional screening techniques in high-risk patients with genetic mutation. MATERIALS AND METHODS: Prospective study of 85 patients (mean age of 43 years) with genetic mutation and screening > or = 2 years (mean of 2.7 years, 231 screening examinations). BI-RADS lesions 3-5 were biopsied; isolated BI-RADS 3 lesions on MRI were followed. Results from both techniques were compared. The number of short interval follow-up examinations and biopsy results were reviewed. RESULTS: Eight cancers were diagnosed (3 in situ, 5 invasive carcinomas including an interval cancer, mean size of 14 mm). The sensitivity values for mammography, US and MRI were 12.5%, 50% and 95%, and specificity values were 98.7%, 97.3% and 94.8% respectively. Nineteen short interval follow-up MRI examinations were performed (19%): 14% of patients at initial screening and 5% and 6% at the the second and third screenings. Thirty-two biopsies were performed in 17 patients, including 18 after MRI (PPV of cytology: 30%, and biopsy: 58%). CONCLUSION: Our results confirm the value of MRI for screening of high-risk patients with genetic mutation.     

Diffusion tensor MR imaging in pediatric head trauma

PURPOSE: We propose to investigate the fractional anisotropy (FA) values in pediatric patients with closed head trauma and correlate them with the initial Glasgow Coma Scale (GCS). MATERIALS AND METHODS: A retrospective evaluation of 24 pediatric patients (15 men, 9 women; mean age, 13 years; range, 2-18 years) who underwent both unenhanced head computed tomography and cerebral magnetic resonance imaging (MRI), including the tensor diffusion sequence, within 30 days of the incident. Twenty-two atraumatic control patients (9 men, 13 women; mean age, 9 years; range, 4-17 years) were randomly selected from the records of the radiology department within the same period. Fractional anisotropy measurements were taken from each of 6 major white matter volumes. Data extracted from the record of each subject included GCS, initial head computed tomographic results, and length of hospital stay. Kruskal-Wallis and t tests were used for statistical evaluation. RESULTS: The mean acute score on the GCS was 9.7 +/- 5. Mean duration of hospitalization days was 8.7 +/- 10. Statistically significant differences in mean FA values between trauma and control subjects were noted in corpus callosum. Trauma patients with positive findings on MRI and with GCS less than 10 also had lower FA values than patients with GCS greater than 10 and patients who had normal MRI findings. There was a negative correlation between time to discharge and FA values. CONCLUSIONS: In pediatric head trauma, MRI diffusion FA measurements can show abnormalities despite normal-appearing brain MRI findings. Larger investigations are required to verify the stability of correlations.     

Prevalence and distribution of adnexal findings suggesting endometriosis in patients with MR diagnosis of adenomyosis

The purpose of this investigation was to establish the prevalence and distribution of MR findings associated with pelvic endometriosis in patients with a MRI diagnosis of adenomyosis. Retrospective review of the pelvic MRI in 59 patients (age 32-54 years, mean 42 years) who met strict MRI criteria for adenomyosis was performed. T1 weighted fat saturated and T2 weighted images in these patients were reviewed for the presence or absence of T1 bright signal suggesting endometriosis in any of nine locations (uterine serosa, right and left ovary, right and left fallopian tube, right and left broad ligament, and right and left pelvic side wall). 20 (20/59) patients (34%), showed characteristic MRI features associated with endometriosis. A total of 54 sites of involvement were identified (uterine serosa n = 17, ovaries n = 14, broad ligaments n = 10, fallopian tubes n = 8, pelvic side walls n = 5) in 20 patients with an average of 2.7 sites per patient. Implants (n = 43) were more common than endometriomas (n = 11). Endometriomas occurred most often in the ovaries (ovaries n = 9, broad ligament n = 2) whereas implants were seen on all locations (uterine serosa n = 17, ovaries n = 5, broad ligaments n = 8, fallopian tubes n = 8, pelvic side walls n = 5). One third of patients with adenomyosis diagnosed by MRI also had MRI findings of endometriosis, with serosal implants being the most common finding. Imaging protocols should routinely include T1 weighted fat saturated imaging sequences in order to detect coexistent endometriosis in patents undergoing pelvic MRI for the diagnosis of adenomyosis.     

膝关节半月板后根部撕裂的MRI评价

目的 探讨MRI对膝关节半月板后根部撕裂的价值.方法 回顾分析经关节镜证实的30例半月板后根部撕裂患者(17例累及内侧半月板,13例累及外侧半月板)的MRI表现,分析MRI对半月板后根部撕裂的诊断敏感度,MRI对内侧、外侧半月板后根部撕裂的检出比例比较采用Fisher确切概率法检验.结果 30例半月板后根部撕裂患者中,MRI正确诊断26例(包括17例内侧半月板后根部撕裂和9例外侧半月板后根部撕裂),诊断敏感度为86.7%(26/30).半月板后根部撕裂的MRI表现主要为后根部形态失常,代之以异常高信号影.MRI对内侧半月板后根部撕裂的检出比例(17/17)明显高于外侧(9/13)(P=0.026).内侧半月板后根部撕裂合并半月板脱位的发生比例(15/17)明显高于外侧(6/13)(P=0.020),但并发前交叉韧带损伤的发生比例(5/17)则明显低于外侧(11/13)(P=0.004).结论 MRI是诊断半月板后根部撕裂及伴发损伤的较好方法.     

The natural history of familial cerebral cavernomas: a retrospective MRI study of 40 patients

Our objective was to determine the natural history and prognostic factors of familial forms of cerebral cavernous malformations (CCM). Cavernomas are one of the most common central nervous system vascular malformations. Familial CCM is increasingly diagnosed, but little is known about its natural history. In a national survey, we analysed clinical and MRI features of 173 patients from 57 unrelated French families. Of these 40 had undergone at least two clinical and MRI examinations. Occurrence of haemorrhage, new lesions, change in signal intensity and size of lesions have been studied by comparison between first and last MRI studies. The CCM were classified according to Zabramski et al. Mean follow-up was 3.2 years (range 0.5–6.5 years). We followed 232 cavernomas (mean 5.9 per patient, range 1–17). Serial MRI demonstrated changes in 28 patients (70 %). Bleeding occurred in 21 lesions (9.1 %) in 14 patients (35 %). The haemorrhagic risk was 2.5 % per lesion-year, higher in type I and brain-stem CCM. We saw 23 new lesions appear in 11 patients (27.5 %), with an incidence of 0.2 lesions per patient year. Signal change was observed in 11 patients (27.5 %), in 14 lesions (6 %), while 9 lesions (3.9 %) in 9 patients (22.5 %) changed significantly in size. Received: 20 May 1999/Accepted: 1 September 1999     

胶原酶直接注射突出组织治疗脱出型腰椎间盘突出症的回顾性研究

目的探讨使用胶原酶直接注射突出组织治疗脱出型腰椎间盘突出症的疗效。资料与方法对76例临床确诊为脱出型腰椎间盘突出症的患者采用经棘突间人路直接穿刺椎间盘脱出组织并注射600U胶原酶。随访时间为半年。3年,回顾性分析随访的MRI和临床资料。结果76例患者,治愈59例,治愈率为77．6％（59／76）,有效9例,总有效率为89．5％（68／76）。其中32例进行了MRI随访（术前、术后7d、1个月、3—24个月）。3例（3／32）MRI复查发现椎间盘变窄,17例（17／76）出现一过性下腰部疼痛,无严重并发症发生。结论经棘突间入路直接穿刺脱出的椎间盘组织行胶原酶髓核溶解术治疗脱出型腰椎间盘突出症是一种相对安全、有效的治疗方法。     

黏多糖病患者神经系统CT及MRI表现

目的 分析黏多糖病(mucopolysaccharidosis,MPS)患者神经系统CT和MRI表现,探讨其对MPS诊断和不同类型MPS鉴别的意义. 资料与方法 回顾性分析24例MPS患儿中枢神经系统的CT和MRI表现.11例行头颅加脊柱MRI,5例行头颅MRI,4例行CT检查,2例行头颅MRI及MRA,1例行头颅MRI及CT检查,1例行颈部MRI. 结果 Ⅰ-H型6例,Ⅰ-S型1例,Ⅱ型1例,Ⅲ型1例,Ⅳ型5例,Ⅵ型9例,Ⅶ型1例.舟状头3例,脑室扩张5例,脑萎缩4例,脑室旁脑白质、放射冠及胼胝体筛网状改变13例,室旁斑片状长T2信号11例,枕骨大孔狭窄,脊髓受压10例,其中1例髓内示异常长T2信号,双侧颞极蛛网膜囊肿3例,寰枢椎畸形7例. 结论 MPS患者中枢神经系统的CT及MRI表现有一定的特征,对临床诊断MPS和鉴别不同类型MPS有帮助.     

Magnetic resonance imaging of chronic myocardial infarcts in man

To evaluate the magnetic resonance imaging (MRI) features of chronic myocardial infarction (MI), 22 patients and several normal volunteers were studied with a 0.35-T cryogenic imaging system. The MIs were 9 months to 16 years old. The patients also had either left ventriculography (17 patients) or two-dimensional echocardiography (17 patients). At least one abnormality indicative of prior infarction was demonstrated on MRI in 20 of the 22 patients. Wall thinning was seen in 20 patients; in six of these, the thinning resulted in aneurysm formation. The other 14 patients had sufficient residual wall thickness to permit measurement of T2 relaxation times and MR signal intensity in the infarcted region. Ten of these 14 patients demonstrated low intensity and shortened T2 of the thinned segments (mean T2 = 28.7 msec) compared to adjacent normal myocardium (mean T2 = 45.4 msec) and to the myocardium of volunteers (mean T2 = 41.3 msec). The percentage of difference in intensity between thinned and normal myocardium was greater on 56-msec-TE images (98.2%) than on 28-msec-TE images (46.1%). In the other four patients, no difference in intensity of the myocardium was perceptible in the thinned region of the myocardial wall. Thus MRI shows regional wall thinning at the site of prior MI. In some patients, the chronic infarct is characterized as decreased spin-echo signal intensity and shortened T2 consistent with replacement of myocardium by fibrous scar.     

Focal cortical dysplasia: comparison of MRI and FDG-PET

PURPOSE: The purpose of this work was to compare the use of MRI and [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) in the diagnosis of focal cortical dysplasia (FCD). METHOD: Nineteen patients with surgically proven FCD were analyzed retrospectively. MRI was performed in all patients, and FDG-PET was performed in 17 patients. We compared the MR and FDG-PET findings of FCD according to the histologic findings that were classified into three grades. RESULTS: Four cases were classified as Grade I, 4 cases as Grade II, and 11 cases as Grade III FCD. The lesions were detected on MRI in 9 (82%) of the 11 patients with Grade III FCD and in only 1 (13%) of the 8 patients with Grade I and II FCD. Cortical hypometabolism of the lesion was revealed on FDG-PET in 6 (86%) of the 7 patients with Grade I and II FCD and in 9 (90%) of the 10 patients with Grade III FCD. The extent of the cortical abnormality was larger on FDG-PET than on MRI in 11 (65%) of the 17 patients. CONCLUSION: FDG-PET is more useful in delineating the cortical abnormality in patients with mild degrees of FCD. The extent of the lesion was larger or similar on FDG-PET compared with that of the MRI.