肝门部胆管癌的MRI及MRCP的诊断价值

目的探讨MRI及MRCP检查对肝门部胆管癌的诊断价值。方法采用0.35 T磁共振成像系统,回顾分析26例肝门部胆管癌的MRI及MRCP表现。结果 MRI显示肝门部肿块26例,增强动脉期大多数轻中度强化,延迟明显强化;肝门部胆管形态改变20例,肝内胆管扩张26例;MRCP显示肝门区胆管的空虚区,左右肝管在汇合前中断、肝内胆管呈中度或重度扩张,呈软藤征。结论肝门部胆管癌在磁共振成像上有特征性的表现,MRI及MRCP是显示胆管癌的最佳影像学方法。     

骨巨细胞瘤CT和MRI表现对照分析

目的：通过对骨巨细胞瘤的CT和MRI表现对照分析,寻找CT和MRI表现之间的相关性及其与肿瘤复发的关系,进一步提高对骨巨细胞瘤CT和MRI表现的认识。方法搜集自1995年1月-2012年12月年期间在该院手术及病理证实为骨巨细胞瘤、随访2年以上并同时有CT和MR检查的195例病例资料,对照分析其CT骨皮质破坏中断情况、骨皮质膨胀程度、有无软组织肿块形成与MR病灶内实质成份比例、周围水肿程度等情况,并于肿瘤是否复发对照。结果 CT上骨皮质破坏程度与MRI上实质成份比例及病灶周围水肿程度差异有统计学意义(P<0.05)。CT及MRI表现与肿瘤是否复发对照显示,CT上骨质破坏程度与是否复发差异有统计学意义(P=0.018约0.05)。结论骨巨细胞瘤的CT表现与MRI表现有一定的内在联系,CT所示的骨质破坏程度与MRI中的实质成份比例、水肿程度等表现有关,提示肿瘤的侵袭性较高,并与肿瘤的复发具有一定相关性,但其病理学基础有待进一步研究。     

肝脏不典型腺瘤样增生结节的MRI应用价值

目的：探讨肝脏不典型腺瘤样增生结节的MRI应用价值。方法选取该院2003年1月—2014年5月肝脏不典型腺瘤样增生结节的病人50例,常规T1 T2WI序列及正反相位序列,LAVA序列动态增强扫描。结果50例病人60个病灶,所有病灶均表现为T1WI高或稍高信号,T1WI脂肪抑制序列病灶为高信号或稍高信号,反相位序列病灶仍为高信号或稍高信号,T2WI加强病灶为低或稍低信号,该组60个病灶,其中55个病灶动态增强扫描动脉期门静脉期及延迟期病灶无强化,5个病灶呈轻中度强化。结论肝脏不典型腺瘤样增生结节的MRI表现具有一定特征性,MRI可以很好显示肝脏不典型腺瘤样增生结节病灶,是诊断肝脏不典型腺瘤样增生结节首选的影像方法,具有重要的临床应用价值。     

肥厚性硬脑膜炎病例1例分析并文献复习

目的:探讨肥厚性硬脑膜炎(HCP)的临床特征、影像学表现。方法:报道1例HCP患者的临床资料并结合文献进行回顾性分析。结果:该患者以头痛起病,伴视力下降;血液学检验:ANA(+);腰椎穿刺示:脑脊液压力≥330 mmH_2O;头颅MRI平扫+增强示:大脑镰、小脑幕、双侧额顶叶硬脑膜增厚伴强化;硬脑膜活检病理示:玻璃样变纤维血管组织中散在淋巴细胞、浆细胞,以血管周围较明显;免疫组化:CD138(散在+),IgG(个别细胞+),IgG4(个别细胞+);予以激素治疗,症状明显好转。搜索近5年报道的HCP患者189例,最常见的首发症状为头痛,所有患者头颅磁共振平扫+增强均见不同部位的硬脑膜肥厚伴强化,予以激素、激素联合免疫抑制剂或手术治疗后,90%以上患者症状改善。讨论:HCP临床症状可表现为慢性头痛、颅神经受累、共济失调。需进一步完善血液学检验、头颅磁共振平扫+增强检查,必要时硬脑膜活检以确诊。     

三种不同检查方法对早产儿脑损伤评估优越性比较

目的：探究与分析振幅整合脑电图、彩超、MRI在早产儿脑损伤中的诊断研究,旨在为早产儿的临床脑损伤提供可靠的诊断依据。方法：选取2012年8月-2014年8月本院儿科收治的120例早产儿,在其住院期间给予振幅整合脑电图、彩超、MRI检查,观察与记录三种方法的检测结果。结果：振幅整合脑电图检查结果：早产儿中有48例表现为不连续低电压或病理型图形,阳性率为40.00%（48/120）,且未能检测到成熟CY。彩超检查结果：早产儿中有33例颅内发现阳性病灶,阳性率为27.50%（33/120）,其中15例早产儿被诊断为脑室内出血,占45.45%（15/33）,另有18例早产儿被诊断为缺氧缺血性改变,占54.55%（18/33）。MRI检查结果：早产儿中有62例在颅内发现了阳性病灶,阳性率为51.67%（62/120）,其中有34例诊断为脑室内缺血,19例诊断为脑实质点状出血,占30.66%（19/62）,9例诊断为脑室内缺血合并蛛网膜下腔出血,占14.52%（9/62）。结论：MRI对于早产儿诊断的准确性及敏感性明显高于振幅整合脑电图及彩超检查,其中振幅整合脑电图可通过针对早产儿醒睡周期异常改变进行诊断,而彩超则可作为初诊及随访追踪的方法推广应用于临床工作中。     

正常脑深部核团 ADC 值及相位值与年龄的相关性分析

目的：通过比较表观扩散系数（ADC 值）及相位值,探讨3．0 T 磁共振扩散加权成像技术（DWI）和磁敏感加权成像技术（SWI）对不同年龄段正常脑深部核团的水分子弥散及铁分布的研究价值。方法健康受试者32例纳入研究,分为青年组、中年组、老年组,行 DWI、SWI 检查,测量黑质、红核、齿状核、尾状核头、壳核、苍白球的 ADC 值及相位位移值,计算相位值。结果青年组与老年组的尾状核头、壳核及苍白球 ADC 值,黑质、壳核、苍白球、齿状核相位值的差异有统计学意义（P 分别为0．025、0．000、0．004、0．008、0．006、0．002、0．037）;青年组与中年组的壳核 ADC 值,壳核、苍白球相位值的差异有统计学意义（P 分别为0．010、0．007、0．013）;中年组与老年组的黑质相位值的差异有统计学意义（P 为0．030）。壳核、尾状核头 ADC 值与年龄呈正相关;黑质、红核、齿状核、尾状核头、壳核、苍白球相位值与年龄呈负相关。结论DWI 及 SWI 可以分别反映年龄对脑深部核团水分子扩散和铁分布的影响。     

Anomalous functional connectivity within the default-mode network in treatment-naive patients possessing first-episode major depressive disorder

Background and Objective:Previous studies have shown that the default-mode network (DMN) has a substantial role in patients with major depressive disorder (MDD). However, there is a shortage of information regarding variations in the functional connectivity (FC) of the DMN of treatment-naive patients with first-episode MDD. The present study aims to explore the FC of the DMN in such patients.Methods:The study population consisted of 33 patients and 35 controls, paired regarding age, gender, education level, and health condition. Depression severity was assessed through the Hamilton Depression Scale (HAM-D), and subjects underwent evaluation during the resting-state through functional magnetic resonance imaging (rs-fMRI). To assess the result, we used FC and ICA. We used Spearman''s correlation test to detect potential correlations between anomalous FC and severity of HAM-D scores.Results:We have found a decreased FC in the left medial orbitofrontal gyrus (MOFG) and right marginal gyrus (SMG) in depressive patients compared to controls. There was a negative correlation between abnormal FC in the right SMG and HAM-D scores. We have not found any increase in FC of the DMN in treatment-naive, first-episode of MDD patients.Conclusions:Our study provided evidence of a negative correlation between abnormal FC in the DMN and severity of depression symptoms measured by HAM-D in treatment-naive MDD patients. This finding could shed some light on the relevance of DMN for understanding the pathophysiology of cognitive impairment in MDD.     

Anti-IgLON5 disease with distinctive brain MRI findings responding to immunotherapy: A case report

Rationale:Anti-IgLON5 disease was first described as a progressive antibody-associated encephalopathy, with multiple non-specific clinical symptoms including sleep dysfunction, bulbar symptoms, progressive supranuclear palsy-like syndrome, cognitive impairment, and a variety of movement disorders. This newly discovered disease presents with unremarkable or unspecific brain magnetic resonance imagings (MRI), and have poor responsiveness to immunotherapy.Patient concerns:In this case, a 37-year-old man presented with 4-day history of gait instability, dysarthria, and oculomotor abnormalities. The initial neurologic examination revealed mild unsteady gait, subtle dysarthria, and left abducent paralysis.Diagnosis:The patient was diagnosed with anti-IgLON5 disease, based on clinical features and positive anti-IgLON5 antibodies in serum.Interventions:Initially, the patient was treated with high dosages of methylprednisolone and immunoglobulins.Outcomes: The symptoms of patient rapidly improved after high-dose intravenous methylprednisolone and immunoglobulins.Conclusions:In this paper, we report a new case of anti-IgLON5 disease with major symptoms of gait instability, dysarthria, and oculomotor abnormalities, with distinctive brain MRI findings, and responsive to immunotherapy.     

A Prospective,Longitudinal Study of the Effect of Remission on Cortical Thickness and Hippocampal Volume in Patients with Treatment-Resistant Depression

Background:

Magnetic resonance imaging studies have provided evidence of structural modifications in cortical-limbic regions in major depressive disorder. To date, however, few studies have tracked structural changes in patients during treatment. This prospective, longitudinal imaging study investigated associations between brain structure and clinical responsiveness in a sample of patients with treatment-resistant major depressive disorder during an approximate 1-year follow-up period.

Methods:

FreeSurfer software was used to extract volume or cortical thickness values from 6 regions of interest (hippocampus, rostral middle frontal gyrus, orbitofrontal cortex, rostral and caudal anterior cingulate cortices, and inferior temporal gyrus) in patients (n = 26) and matched healthy controls (n = 28). Regions of interest were selected based on previous evidence of potential associations between morphometric characteristics in these regions and treatment response or remission. Analyses were conducted to compare volume and cortical thickness in patients and controls at baseline imaging, determine whether patients’ brain structure at treatment initiation was associated with response over follow-up, and compare longitudinal changes in volume and cortical thickness in patients who achieved sustained 6-month remission (Montgomery-Åsberg Depression Rating Scale Score ≤12) with nonremitters.

Results:

Patients and controls showed no structural differences at baseline. Among patients, thicker right caudal anterior cingulate cortex at baseline was associated with greater symptom improvement over follow-up. Remitters and nonremitters showed subtle changes in volume and thickness over time in opposing directions, with increased hippocampal volume and cortical thickness in the rostral middle frontal gyrus, orbitofrontal cortex, and inferior temporal gyrus in remitters, and decreased volume or thickness in these regions in nonremitters.

Conclusions:

The results suggest that longitudinal structural trajectories may differ in major depressive disorder patients according to their clinical response to treatment.