脑白质病变影像学研究进展

大量研究证实脑白质病变不是一种无害的影像学表现,其不仅增加卒中的危险性,而且与认知、运动、情感等功能障碍相关。现已将脑白质病变列入了脑小血管疾病的神经影像表现之一。本文就近年影像技术的发展,探讨白质病变及其影像在临床上的表现,阐述脑白质病变生理机制。白质病变的影像学表现及评价20世纪80年代初,神经影像技术的引入使人     

伴皮质下梗死和白质病变的常染色体显性遗传性脑动脉病患者骨髓源性祖细胞降低

伴皮质下梗死和脑白质病变的常染色体显性遗传性脑动脉病（CADASIL）是一种遗传性脑微血管疾病，临床表现包括脑卒中、进展性认知功能障碍以及躯体残疾等。从骨髓中提取的内皮祖细胞和循环祖细胞能够促进血管结构和功能重建，改善缺血区血液循环。     

遗传性脑小血管病概述

脑小血管病是指脑小动脉及微动脉病变引起的一类脑血管病。遗传性脑小血管病是指有明确遗传学机制的家族性脑小血管病[1]。随着分子遗传学研究的不断深入,越来越多的脑血管病已经归入遗传性脑小血管病,如伴皮质下梗死和白质脑病的常染色体隐性遗传性脑动脉病(CARASIL)、伴皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病(CADASIL)、弥漫性躯体性血管角化瘤病(Fabry病)、伴有视网膜病-肾病-卒中的遗传性内皮细胞病(HERNS)等[2]。本文以目前研究较多的CARASIL、CADASIL和     

脑小血管病与认知功能障碍

脑小血管病是指颅内小动脉和做动脉病变引起脑的缺血或出血损害,是血管性认知功能障碍的重要亚型。其主要的影像学表现为腔隙性脑梗死、脑白质疏松和脑做出血。脑小血管病的临床分类主要包括腔隙综合征、Binswanger脑病、脑淀粉样血管病、伴有皮质下腑梗死和白质肭痫的常染色体显性遗传性脑动脉病、伴有皮质下脑梗死和白质脑病的常染色体隐性遗传性脑动脉病及其它较少见的小血管病。其临床表现则丰要为静灶腑血管病（静灶腔隙性脑梗化、脑微出血和部分白质疏松）、各类腔隙综合征和血管性认知功能障碍。     

聚焦卒中临床问题(Ⅱ)——2007国际卒中大会

2 遗传性脑动脉疾病 法国Viswanathan等的双中心队列研究提示，与伴皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病（CADASIL）患者日常生活能力及认知功能障碍独立相关的危险因素是腔隙性脑梗死，而不是MRI脑白质高信号。背景：CADASIL是由于Notch3基因变异导致的遗传性动脉病，患者临床表现有生活能力和认知功能降低；在影像学上表现为脑白质疏松和多发性腔隙性梗死等。     

年龄相关性脑小血管病1例NOTCH3基因变异分析

<正>年龄相关性脑小血管病包括脑白质病变和腔隙性脑梗死,其中脑白质病变与认知损害、痴呆、步态不稳、跌倒相关,是致残的预测指标。病因方面,除了年龄和高血压,其他致病因素尚不清楚。伴有皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病(CADASIL)在影像和组织病理学方面与年龄相关性脑小血管病非常相似,是由位于第19号染色体上的NOTCH3基因突变所致。NOTCH3基因可能在年龄相关性脑小血管病的     

脑囊尾蚴病患者治疗后脑CT影像学特征变化

目的 探讨脑囊尾蚴病患者抗囊尾蚴治疗期间脑CT影像变化。方法 选择2010年5月至2015年5月在山东省医学科学院第三附属医院就诊的380例脑囊尾蚴病住院患者作为研究对象,临床给予3阶段阿苯达唑、吡喹酮抗囊尾蚴化疗,治疗前后均行头颅CT扫描,其中210例行增强扫描,对治疗不同阶段患者脑CT影像学资料进行分析。结果 脑囊尾蚴病患者治疗前CT影像显示有单个或多个小囊状低密度,囊内可见小结节状高密度头节影,伴周围水肿;治疗后脑CT复查显示81.58% （310/380）的脑囊尾蚴病患者低密度灶完全吸收,16.32% （62/380）病灶大部分吸收,2.11%（8/380）CT影像显示为钙化灶。患者一般于服用抗囊尾蚴药物2～3 d后出现杀虫反应;随着治疗时间的延长,抗囊尾蚴药物反应逐渐减轻,在第3阶段治疗后大多数患者病灶吸收或钙化。结论 CT检查可明确脑囊尾蚴病病变部位、范围,并可对脑囊尾蚴病进行分型,还能根据抗囊尾蚴治疗期间影像学变化评价治疗效果。     

纵隔巨淋巴细胞增生症的多层螺旋CT诊断

目的探讨纵隔巨淋巴细胞增生症的多层螺旋CT表现及病理基础,以期能提高对此类病变的诊断认识。方法回顾性分析2003至2013年江苏省苏北人民医院经手术病理证实的20例纵隔巨淋巴细胞增生症的CT表现。主要观察病变的大小、包膜、密度、强化等特点。结果本组20例纵隔巨淋巴细胞增生,病变直径(长径)大小2.9~5.2 cm,其中3例病灶直径5 cm。病灶均呈实性,未见坏死、囊变、出血密度;10例可见点状、沙粒状小钙化;瘤体均有包膜,呈膨胀性生长,压迫邻近血管、心脏及肺组织结构,但未见浸润、破坏及转移征象。增强扫描16例瘤体呈明显血管样均匀强化,4例呈中度强化,动脉期CT值83~151(126.0±9.9)HU,静脉期持续强化,CT值101~183(146.0±11.3)HU。结论纵隔巨淋巴细胞增生CT表现为实性肿块,有完整薄膜,坏死囊变罕见,可见沙粒状小钙化,增强扫描血管样强化具有一定的特点,可为临床诊断提供帮助。     

脑星形细胞瘤磁共振磁敏感加权成像与VEGF的相关性研究

目的探讨MRI磁敏感加权成像(SWI)在脑星形细胞瘤分级中的应用价值,及其与血管内皮细胞生长因子(VEGF)的相关性研究。方法 42例经手术病理证实的脑星形细胞瘤患者,低级别组(Ⅰ~Ⅱ级,15例)和高级别组(Ⅲ~Ⅳ级,27例),术前行MRI常规扫描(T1WI、CE T1WI、T2WI和T2FLAIR)及SWI扫描(SWI、CE SWI)。计算每个序列上肿瘤横断面小血管数目及出血面积。两样本t检验比较组间各序列小血管数目及出血面积差异;应用Spearman相关分析研究SWI与VEGF的相关性。结果 SWI序列比MRI各常规序列在观察脑星形细胞瘤内小血管及出血灶更加敏感;CE SWI比CE T1WI在区分肿瘤内部结构更有优势;SWI示高级别组较低级别组有更多的瘤内小血管及出血灶;脑星形细胞瘤肿瘤血管数目(r=0.834;P=0.01)与VEGF表达水平呈显著正相关。结论 SWI在脑星形细胞瘤分级中有非常重要的作用,其可以反映VEGF的表达水平;和CE T 1WI比较,CE SWI在区分肿瘤组织结构更有优势。     

线粒体脑肌病伴高乳酸血症和卒中样发作综合征的临床特点

目的探讨线粒体脑肌病伴高乳酸血症和卒中样发作综合征（MELAS）的临床特点。方法回顾性分析15例MELAS患者的临床表现、乳酸运动耐量试验、影像学检查、电生理检查、肌肉病理及基因检测情况。结果 MELAS患者主要临床表现为反复卒中样发作、癫痫、偏头痛、认知功能障碍,部分表现为运动不耐受、身材矮小、神经性耳聋、心肌病、心脏传导阻滞、心衰、糖尿病、发热等。MRI检查显示枕叶、颞顶叶、皮质、皮质下的白质有异常信号,基因检测显示mtDNA A3243G杂合突变。其中2例误诊为动脉硬化性脑梗死,1例误诊为糖尿病,1例误诊为单疱脑炎,1例误诊为特发性癫痫。结论 MELAS的临床表现复杂多样,无特异性表现,易误诊;诊断须结合临床表现、影像学、病理学和基因突变检测等结果综合分析。     

Tailgut cysts: report of two cases

Aim  An illustration of the diagnosis and management of tailgut cysts. Materials and methods  Two cases of tailgut cyst and a review of the literature. Results  A female patient presented with acute urinary retention with a retrorectal mass felt during rectal examination and confirmed on ultrasound and magnetic resonance imaging underwent surgical resection and histology confirmed a chronically inflamed mucoid fluid-filled cyst partly lined by non-keratinised squamous epithelium. A male patient with ureteric obstruction and a prerectal cyst found on ultrasound scan underwent computed tomography with biopsies, but without reaching a conclusive diagnosis. Surgical resection was carried out and histology showed a chronically inflamed mucoid fluid-filled cyst partly lined with columnar epithelium. Discussion  Tailgut cysts are a rare developmental abnormality arising from remnants of the embryological postanal gut. Usually presenting incidentally or with pressure symptoms in middle-aged females, tailgut cysts are often initially mistaken for other clinical entities. Magnetic resonance imaging helps to differentiate tailgut cysts from other retrorectal lesions and developmental cysts. Histologically, the cyst wall demonstrates a wide variety of epithelial types and has a malignant potential. Malignancy is difficult to rule out with imaging or biopsy. Conclusions  Magnetic resonance imaging is the favoured imaging modality and surgical resection is recommended to relieve pressure symptoms, provide a definitive diagnosis and rule out malignancy.     

Medial meniscal cyst of the knee detected by magnetic resonance imaging in a Moroccan patient: A case report and post-excision follow-up

IntroductionMeniscal cysts are rare and usually asymptomatic. They may cause various symptoms depending upon their size and site of origin. It may present as a palpable mass with or without pain and sometimes grows large enough to limit the patient’s activities of daily living. The magnetic resonance imaging (MRI) is the gold standard for their visualization. Excision is often guided by a careful study of the pre-operative MRI scans in multiple planes.Case reportWe report an unusual case of a medial meniscal cyst of the knee in a 40-year-old Moroccan patient with a progressively increasing swelling of his left knee for 1 year. There was no history of trauma. On examination there was a tender effusion. The range of motion of the knee was limited 0–110°. The MRI showed a meniscal cyst extending around the medial collateral ligament into the soft tissue. The lateral meniscus, anterior cruciate, posterior cruciate and collateral ligaments were normal in appearance. The well-circumscribed cyst was excised and the diagnosis confirmed by the histopathology. At 1-year follow up, he had full range of knee movement and remained asymptomatic, with no sign of recurrence.ConclusionMedial meniscal cysts should be considered in any patient presenting with persistent medial knee discomfort. Rigorous history and physical examination are essential to identify similar rare presentations. The use of MRI is important in confirming such anomalies and plan surgical intervention.     

Comparison of imaging modalities for measuring the diameter of intraductal papillary mucinous neoplasms of the pancreas

BackgroundIntraductal papillary mucinous neoplasms (IPMNs) are pre-malignant pancreatic cysts detected by imaging. Cyst size is one of many features evaluated on computed tomography (CT), magnetic resonance imaging (MRI), or endoscopic ultrasonography (EUS) to help guide IPMN management. Our objective was to determine which imaging modality best predicts pathological cyst size.MethodsWe analyzed records for 57 IPMN cases surgically treated at Moffitt Cancer Center from 2008 to 2016 for whom pre-operative CT, MRI, and EUS IPMN cyst size and post-operative pathological cyst size values were available. Long axis cyst diameter measurements were compared to each other and corresponding pathological cyst measurements using within-subjects ANOVA, Bland-Altman analysis, and linear regression. Consensus measurements were also performed on CT and MRI images.ResultsCyst size measured via CT and MRI overestimated pathological size by 0.33 cm and 0.27 cm, respectively, whereas EUS underestimated pathological size by 0.05 cm and had the narrowest 95% limit of agreement (LOA). Among pathologically-confirmed cysts <3 cm, MRI overestimated pathological size by 0.30 cm (P = 0.049) and had the widest LOA, followed by EUS and CT. Among cysts ≥3 cm, EUS underestimated pathological size by 0.35 cm (P = 0.059) and MRI and CT overestimated pathological size by 0.23 cm and 0.51 cm, respectively.ConclusionsIn this small retrospective study, EUS cyst size measurements correlated best with pathologic specimens compared to CT and MRI, especially for cysts < 3 cm. Larger prospective studies are needed to determine which imaging modalities are best to risk-stratify IPMNs and guide surgical versus. Non-surgical management.     

The midline pineal "eye": MR and CT characteristics of the pineal gland with and without benign cyst formation

Abstract: The purpose of this study was to evaluate the magnetic resonance imaging characteristics of pineal cysts and pineal calcifications and to determine the incidence of benign pineal cysts. Two-hundred-fifty magnetic resonance examinations were retrospectively examined for the incidence of pineal cysts. In addition, 60 collected cases of pineal cysts were evaluated with regard to cross sectional diameter and magnetic resonance signal characteristics. Finally, the magnetic resonance signal characteristics of pineal tissue in 50 patients were compared to companion computed tomographic scans that were scrutinized for the presence or absence of calcification. The incidence of pineal cysts as revealed by magnetic resonance imaging in this study was 10.8%. The minimal and maximal measurements ranged from a low of 2×2×2 mm to a high of 10×12×10 mm. The magnetic resonance signal intensities of pineal cyst as compared to cerebrospinal fluid were iso- or hyperintense on all magnetic resonance sequences in the majority of cases. Calcifications of the pineal gland as revealed by computed tomography tended to be isointense to gray matter if the calcifications were small and hypointense to gray matter if large on all magnetic resonance acquisitions. A careful analysis of the magnetic resonance signal characteristics enables the recognition of moderate- to large-sized pineal calcifications and their differentiation from large pineal cysts. However, small cysts of the pineal gland can be difficult or impossible to distinguish on magnetic resonance imaging from calcifications without comparison with computed tomography.     

Guidelines on management of pancreatic cysts detected in high-risk individuals: An evaluation of the 2017 Fukuoka guidelines and the 2020 International Cancer of the Pancreas Screening (CAPS) consortium statements

BackgroundObjectives: Pancreatic cysts are frequently detected in high-risk individuals (HRI) undergoing surveillance for pancreatic cancer. The International Cancer of the Pancreas Screening (CAPS) Consortium developed consensus recommendations for surgical resection of pancreatic cysts in HRI that are similar to the Fukuoka guidelines used for the management of sporadic cysts. We compared the performance characteristics of CAPS criteria for pancreatic cyst management in HRI with the Fukuoka guidelines originally designed for the management of cysts in non-HRI.MethodsUsing prospectively collected data from CAPS studies, we determined for each patient with resected screen-detected cyst(s) whether Fukuoka guidelines or CAPS consensus statements would have recommended surgery. We compared sensitivity, specificity, PPV, NPV, and Receiver Operator Characteristics (ROC) curves of these guidelines at predicting the presence of high-grade dysplasia or invasive cancer in pancreatic cysts.Results356/732 HRI had ≥ one pancreatic cyst detected; 24 had surgery for concerning cystic lesions. The sensitivity, specificity, PPV, and NPV for the Fukuoka criteria were 40%, 85%, 40%, and 85%, while those of the CAPS criteria were 60%, 85%, 50%, 89%, respectively. ROC curve analyses showed no significant difference between the Fukuoka and CAPS criteria.ConclusionsIn HRI, the CAPS and Fukuoka criteria are moderately specific, but not sufficiently sensitive for detecting advanced neoplasia in cystic lesions. New approaches are needed to guide the surgical management of cystic lesions in HRI.     

A comparative analysis of K-ras mutation and carcinoembryonic antigen in pancreatic cyst fluid

Background/aimsAnalysis of cystic fluid may be useful in distinguishing between benign and malignant cysts which has significant impact on their management. The aim of our study was to assess the diagnostic utility of carcinoembryonic antigen (CEA) and K-ras gene mutation in pancreatic cysts fluid.MethodsThe study included 56 patients with pancreatic cystic fluid collected for analysis. The cysts were classified as benign (simple cysts, pseudocysts, serous cystadenoma) - 39 patients or premalignant/malignant (mucinous cystadenoma, IPMN, cystadenocarcinoma) - 17 patients. The patients history, CEA fluid concentrations and presence of K-ras mutation were analyzed.ResultsCEA were higher in patients with malignant cysts (mean levels 238 ± 12.5 ng/ml; range 32.8–4985 ng/ml) compared to benign lesions (mean levels 34.5 ± 3.7 ng/ml; range 3.9–693 ng/ml; p < 0.001). K-ras mutation correctly classified 11 of 17 patients with premalignant/malignant lesions. It was also detected in 1 patient with final diagnosis of benign cyst (the sensitivity 64.7% and the specificity 97.4%; p < 0.01). If CEA and molecular analysis were combined in that cysts with either CEA level>45 ng/ml or presence of K-ras mutation, than 16 of 17 premalignant/malignant cysts were correctly identified (94.1%).ConclusionMolecular analysis of pancreatic cyst fluid adds diagnostic value to the preoperative diagnosis and should be considered when cyst cytologic examination is negative for malignancy.     

Simultaneous Symptomatic Rathke’s Cleft Cyst and GH Secreting Pituitary Adenoma: A Case Report

A case of symptomatic Rathke's cleft cyst and growth hormone (GH) secreting pituitary adenoma is described. A patient presented with a visual field deficit and a brain magnetic resonance imaging (MRI) study demonstrated compression of the optic chiasm by a large suprasellar cyst and a small lesion in the sellar consistent with a microadenoma. Preoperative clinical evaluation revealed mild acromegalic features, glucose intolerance, hypertension, hypercholesterolemia, and carpel tunnel syndrome, and blood testing confirmed an elevated insulin-like growth factor-1 (IGF-1). A modified transsphenoidal skull based approach was performed for selective transsphenoidal adenomectomy and decompression of the surprasellar cyst. The patient had an uneventful postoperative course with resolution of the visual field deficits and dysmenorrhea. Endocrine testing at two-month post procedure were normal. While there have been a small number of cases reported of concomitant pituitary adenomas and Rathke's cleft cysts, there is no report known to these authors of coexisting symptomatic lesions.     

先天性支气管囊肿CT及MRI诊断价值

目的探讨先天性支气管源性囊肿(bronchogenic cysts, BC)的计算机断层扫描(computerized tomography, CT)及磁共振成像(magnetic resonance imaging, MRI)诊断。 方法回顾性分析经手术病理证实的23例BC患者的CT及MRI表现和临床资料。 结果纵隔内11例，其中前纵隔4例，中纵隔3例，后纵隔4例，均为单发，呈类圆形，边缘光滑，密度均匀；其中一例合并出血和感染，平扫表现为稍高密度影、CT值约为50～60 HU，增强扫描可见轻度强化；其余纵隔型BC均表现为平扫低密度影，CT值约为10～30 HU，增强扫描未见明显强化。肺内10例，均为单发类圆形或椭圆形病灶，其中3例为含气囊腔，7例为囊性低密度影，增强扫描未见明显强化。颅内2例，位于左侧额部，MRI表现为椭圆形T1WI低信号，T2WI高信号影，一例其后份可见片状T1WI、T2WI稍高信号影，增强扫描均未见强化。 结论支气管囊肿的CT及MRI表现有一定的相对特征性，结合临床综合分析可提高诊断正确率。     

Recurrent pulmonary microemboli secondary to primary cardiac hydatidosis

Primary cardiac hydatid cysts are rarely diagnosed and seldom rupture to lungs via pulmonary vein resulting in multifocal cystic lesions. We report a rare instance of an interventricular hydatid cyst. A 19-year-old patient was admitted with dyspnea and multiple homogenous opacities with different sizes in his chest X-ray and contrast enhanced thorax computed tomography. We considered recurrent pulmonary microemboli, although neither systemic embolisation nor intravascular cyst of pulmonary arteries was detected. Due to extensive distribution of the pulmonary cysts, only the cardiac cyst was taken surgically. The patient remains in our care without any pulmonary improvement despite appropriate medical treatment.     

Macrocystic type of serous cystadenoma with a communication between the cyst and pancreatic duct

A 42-year-old woman with a cystic lesion in the head of the pancreas was evaluated by using abdominal ultrasonography, a computed tomographic scan, magnetic resonance imaging and endoscopic retrograde pancreatography. Multiple cystic lesions, 5 cm in diameter, which had papillary protrusion inside the cyst in the head of the pancreas and had the communication between the cysts and pancreatic duct, were determined. Pylorus-preserving pancreaticoduodenectomy was performed under the diagnosis of mucinous cystic neoplasm of the pancreas. Although the cut surface of the tumor showed a macrocystic tumor of 3 cm in diameter, part of the cyst wall was cavernous. A histopathological examination showed single-layered cuboidal cells, which lead to the diagnosis as being serous cystadenoma of the pancreas. Serous cystadenoma is a rare, almost benign pancreatic tumor. The macrocystic subtype of serous cystadenoma is even more rare. We describe a patient who had this macrocystic subtype of serous cystadenoma with a communication between the cyst and pancreatic duct. This case illustrates the difficulty in the diagnosis of cystic lesions in the pancreas, and might support the single category of cystic lesions of the pancreas.