儿童Rasmussen脑炎的MRI影像特点及诊断

目的分析儿童Rasmussen脑炎的MRI表现特点,提高对该病的认识及诊断水平。方法收集9例经临床或病理证实的Rasmussen脑炎患者的MRI表现及临床资料,男5例,女4例,平均年龄7.3岁,急性发病时平均年龄4.7岁,评估患者脑内异常信号及脑萎缩改变及进展情况。结果 9例Rasmussen脑炎MRI特点:1)信号异常:皮层及皮层下T_2WI、FLAIR高信号(8/9),累及两个或以上脑叶(5/8),以额顶叶多见;DWI稍高信号(2/8),等或稍低信号(6/8);尾状核或壳核T_2WI、FLAIR高信号(5/8); MRI信号无异常(1/9),SPECT患侧半球灌注减低;2)脑萎缩(8/9):患侧局部脑回变小及脑沟增宽(7/8),尾状核及壳核萎缩(5/8),外侧裂增宽(7/8),患侧颞角扩大(8/8),患侧侧脑室体部扩大(5/8),病变晚期皮层萎缩为半球性(7/8);3)病变进展情况(3/9):3例接受随访患者MRI表现患侧半球脑皮层异常信号范围加大,萎缩程度加重。结论儿童Rasmussen脑炎MRI影像表现对该病的诊断及预后评估有较高的价值,其特点为一侧皮层或皮层下T_2WI、FLAIR高信号,大脑半球进行性萎缩改变,可累及深部灰质核团,了解此病的MRI特点,有助于提高对该病的认识水平。     

局灶性脑皮层发育不良的MRI诊断

目的 研究局灶性脑皮层发育不良(focal cortical dysplasia,FCD)的MRI表现特点.资料与方法 回顾性分析23例经手术病理证实的FCD患者的MRI表现.常规行横断位、矢状位及垂直于海马长轴的斜冠状位扫描,获得T1 WI、T2WI及液体衰减反转恢复序列(FLAIR)图像.结果 23例FCD病灶均表现为一侧大脑半球内局限性病变.病灶区域皮质增厚18例,灰白质分界模糊20例,皮层下白质异常信号22例,脑回、脑沟形态异常14例,邻近蛛网膜下腔局限性扩大4例.T1WI、T2WI及FLAIR显示灰白质分界模糊分别为6例、20例及18例;皮层下白质异常信号分别为3例、16例及19例;脑回、脑沟形态异常分别为12例、10例及11例.结论 FCD的MRI表现为皮质增厚、灰白质分界模糊、皮层下白质异常信号、脑回、脑沟形态异常及邻近蛛网膜下腔局限性扩大.T2WI及FLAIR显示灰白质界限、白质内异常信号较T1WI敏感,T1WI显示脑回、脑沟形态有一定的价值.     

Clinical Manifestations and MRI features of Rasmussen Syndrome

目的 分析Rasmussen综合征的临床表现及MRI特点.方法 对经临床及影像确诊的5例患者的病例资料进行回顾性分析,男3例,女2例,均行头颅MRI检查,回顾性分析其MRI表现,总结其影像学特点.结果 5例患者临床主要表现为全身或局部肢体抽搐,肢体乏力,记忆力及认知能力下降等.5例患者均出现一侧半球萎缩,脑回和侧脑室扩大,同时有颞角萎缩,侧裂扩大.其中4例表现为左侧半球萎缩,1例表现为右侧半球萎缩.2例患者脑实质未见异常信号,另外3例表现为脑实质斑片状异常信号.其中1例位于右侧额顶叶,1例位于左侧内囊后肢、放射冠,1例位于左侧额颞枕叶,T1WI上表现为低信号或高信号,T2WI上表现为高信号,T2-液体衰减反转恢复序列(FIAIR)上大部为高信号,部分伴有少许低信号.增强扫描5例患者脑内均未见异常强化.MRA上2例患侧大脑中动脉分支较对侧减少.磁共振波谱(MRS)示2例患者患侧脑皮质N-乙酰天门冬氨酸(NAA)峰轻度下降.结论 Rasmussen综合征是一种主要累及一侧大脑的慢性炎症性疾病,具有独特的临床表现,MRI表现具有一定特征性,结合临床及相关检查可作出正确诊断.     

病毒性脑炎的MRI诊断

目的探讨病毒性脑炎MR I表现特点及与急性播散性脑脊髓炎(ADEM)鉴别的可能性。方法分析56例病毒性脑炎及50例ADEM的脑部MR I表现,重点分析病毒性脑炎的脑部MR I表现。结果病毒性脑炎脑内有多发或单发的对称或不对称大片状病灶,主要位于皮层、皮层下及基底节-丘脑区,MR I呈长T1长T2信号,增强扫描27例,显示病灶强化者17例,其中呈大片状或脑回状强化者10例。ADEM则脑内有多发不对称斑点、斑片状病灶,主要位于双侧脑室周围及额颞顶枕叶脑白质区,MR I呈长T1长T2信号,增强扫描20例,显示病灶强化者15例,均为环形或斑点状强化。结论MR I是诊断病毒性脑炎重要的辅助检查方法,可在一定程度上为临床的早期诊断及鉴别诊断提供依据。     

脑真菌感染的MRI表现

目的探讨脑内真菌感染的MRI表现。方法回顾性分析6例诊断为脑真菌感染患者的MRI形态及信号表现特征。结果6例脑内真菌感染MRI均有清晰显示,其中2例为单发,位于额叶皮层和皮层下;4例为多发病变,位于半球脑皮层、皮层下、深部白质和基底节区,呈多发斑片状。MRI T 1WI均呈等低信号,T 2WI均呈周围高中间稍低信号,DWI呈等和稍高信号;MRI增强检查病灶表现为斑片状、不规则环状或脑回样较明显强化,病灶中心坏死区均无强化。结论脑内真菌感染临床和影像缺少特异性,但部分患者MRI如果表现为多发,累及范围较大,T 2WI呈周围高中间低信号、DWI呈等或稍高信号,MRI增强检查表现为斑片状、不规则环状或脑回样较明显强化,应考虑到本病。     

有机磷中毒性脑病恢复期MRI表现(附4例报告)

目的:探讨有机磷中毒性脑病恢复期的MRI特征.方法:回顾性分析4例重度有机磷中毒慢性期脑结构变化.结果:双侧巴宾斯基征阳性4例,脑电图轻度异常4例.1例右侧小脑半球和中脑长T1长T2信号.1例双侧尾状核和壳核对称性长T2信号,T1WI高信号.1例双侧尾状核、壳核和苍白球对称性长T1长T2信号,侧脑室扩大,小脑萎缩.1例双侧尾状核、壳核和苍白球对称性异常信号,T1WI部分萎缩的小脑回呈高信号;脑室扩大,双侧枕叶内侧回、脑干和小脑萎缩.结论:有机磷中毒性脑病恢复期MRI表现主要累及尾状核、苍白球、丘脑、中脑和小脑;严重者皮质出现软化灶,伴有脑萎缩.     

Rasmussen综合征临床表现及MRI特点

目的分析Rasmussen综合征的临床表现及MRI特点。方法对经临床及影像确诊的5例患者的病例资料进行回顾性分析,男3例,女2例,均行头颅MRI检查,回顾性分析其MRI表现,总结其影像学特点。结果 5例患者临床主要表现为全身或局部肢体抽搐,肢体乏力,记忆力及认知能力下降等。5例患者均出现一侧半球萎缩,脑回和侧脑室扩大,同时有颞角萎缩,侧裂扩大。其中4例表现为左侧半球萎缩,1例表现为右侧半球萎缩。2例患者脑实质未见异常信号,另外3例表现为脑实质斑片状异常信号。其中1例位于右侧额顶叶,1例位于左侧内囊后肢、放射冠,1例位于左侧额颞枕叶,T1WI上表现为低信号或高信号,T2WI上表现为高信号,T2-液体衰减反转恢复序列(FIAIR)上大部为高信号,部分伴有少许低信号。增强扫描5例患者脑内均未见异常强化。MRA上2例患侧大脑中动脉分支较对侧减少。磁共振波谱(MRS)示2例患者患侧脑皮质N-乙酰天门冬氨酸(NAA)峰轻度下降。结论 Rasmussen综合征是一种主要累及一侧大脑的慢性炎症性疾病,具有独特的临床表现,MRI表现具有一定特征性,结合临床及相关检查可作出正确诊断。     

脑皮质层状坏死的MR诊断

目的:探讨脑皮质层状坏死(cortical laminar necrosis,CLN)的MRI表现特点。方法:回顾性分析13例经我院神经内科及儿内科确诊为脑皮质层状坏死患者MRI表现及临床资料,总结其影像学特点。结果:所有病例在发病后MRI均有异常表现,病灶区呈层状短T1、长T2改变(13/13),其中6例(6/13)呈短T1、长T2改变出现在病灶侧皮质表面或沿脑回走行;3例(3/13)同时出现在病灶侧皮质表面或沿脑回走行、病灶侧基底节区和皮质下;2例(2/13)仅出现在病灶侧基底节区和皮质下;2例(2/13)呈斑点状出现在病变区内。FLAIR像上均呈高信号(13/13),即使T1WI高信号消失后,FLAIR高信号仍可持续1年左右(2/13)。DWI像上有9例(9/13)表现为弥散受限,呈高信号或稍高信号,较T1WI高信号显示病变范围更广有3例(3/13)。GD-DTPA早期即可明显强化,多呈线样、脑回样强化。结论:引起脑皮质层状坏死的病因较多,影像学上有特征性改变,T1WI脑回样高信号和长时间FLAIR高信号是其特异征象,结合临床病史,不难做出准确诊断。     

支原体脑炎的磁共振诊断价值

目的:探讨磁共振成像对支原体脑炎的影像学特点及临床诊断价值。方法:对21例支原体脑炎患者行颅脑MRI检查,12例增强扫描。结果:MRI表现异常16例,正常5例。①病变形态及分布:脑白质多发、散在的点状或/及斑片状异常信号8例;两侧大脑半球弥漫性异常信号3例;脑室扩大,侧脑室后角周围异常信号3例;皮层灰质内脑回状异常信号2例;②病变信号:所有病例T2WI及FLAIR序列呈略高或高信号,T1WI呈等或低信号,在DWI(b=1000)像上均呈异常高信号;③增强扫描:12例行增强扫描中,4例呈点状或/及斑片状强化,8例无异常强化。结论:MRI表现具有一定特征性,且有助于诊断支原体脑炎,并可显示支原体脑炎脑实质受累范围和程度,为临床治疗及判定预后提供可靠依据。     

脑神经元移行异常的MRI诊断

目的:报导38例脑神经元移行异常并总结本病MRI特点.材料和方法:38例小儿脑神经元移行异常患者.年龄3个月～14岁.主要临床表现为癫痫11例,智力减退17例,运动障碍16例.采用Toshiba 0.35T超导型MRI系统以自旋回波T1加权(T1WI)500/25ms及T2加权(T2WI)2000—4000/80ms,横断面及矢状面平扫,层厚5—10mm.结果:MRI特点:l)巨脑回/无脑回畸形20例.其中以无脑回为主者10例,表现额叶仅有几个扁平、粗大的脑回,顶枕叶脑表面光滑,无沟回显示.皮层增厚,白质变薄.以巨脑回为主者10例,主要表现脑回增宽,脑沟变浅.2)脑裂畸形16例.7例裂隙一端融合,9例裂隙分离.合并透明隔缺如者9例,合并多小脑回畸形者3例.3)灰质异位9例.孤立性2例,合并巨脑回/无脑回者3例,脑裂畸形者4例.结论:脑神经元移行异常MRI检查有典型征象,在本病诊断中起重要作用.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

人体中的镭-226、镭-228、钋-210、铅-210

本文报道了广东阳江高本底地区6名、对照地区8名人尸体的骨²²⁶Ra、²²⁶Ra的浓度以及部分居民内脏器官中。²¹⁰Po、²¹⁰Pb的浓度。结果轰明阳江高本底地区和对照地区居民骨镭-226、镭-228的浓度分别为29.9pCi/kg, 26.9pCi/kgl 8.7pCi/kg, 8.2pCi/kg.由此估算出阳江高本底地区屠民骨中²²⁶Ra、²²⁸Ra的负薄璧及对骨衬、骨髓所产生的剂量当量分别为对照地区民民的3.4倍, 3.3倍。两地区居民内脏器官中^{210Po、210Pb的测定分析铡数较少但仍看出, 高本底地区均明显高于对照地区.}     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).