磁共振成像在多发性硬化中的应用:解读2010年西班牙神经科学协会关于磁共振成像对多发性硬化检查推荐规范

近20年来,由于磁共振成像对多发性硬化病灶最为敏感,其被广泛应用于多发性硬化的诊断和治疗监控.但是,在多发性硬化的日常临床实践中还是存在磁共振成像技术应用不尽合理的问题.为此,2010年西班牙神经科学协会多发性硬化专家组基于大量文献回顾和其自身经验,制定了多发性硬化磁共振成像应用指南,针对不同类型、不同时期的多发性硬化...     

多发性硬化的临床、磁共振成像及诱发电位的综合研究

目的：研究多发性硬化患者的临床表现，起病形式，类型，分析磁共振成像和三种诱发电位的诊断价值。方法：回顾性分析51例确诊为多发性硬化患者的临床特征，头颅和脊髓磁共振成像，视觉诱发电位，脑干听觉诱发电位和体感诱发电位的结果及相互间关系。结果：本组患者以视神经脊髓炎和东方型多发性硬化为多见，头颅和脊髓磁共振成像均有病灶，视觉诱发电位的敏感性最高。结论：本组患者的临床特征符合亚洲多发性硬化的特点。磁共振成像和诱发电位相结合，能提高诊断的阳性率。     

儿童多发性硬化的磁共振成像特点

儿童多发性硬化已日益受到人们的重视,由于儿童自身的特点,其临床特征易于与其它疾病相混淆。磁共振成像在多发性硬化的诊断、病情监测和疗效评价中具有重要价值,与成人患者相比,儿童患者在病灶的形态、分布及其与预后的关系方面表现出了不同的特点,该文就以上内容及儿童多发性硬化的磁共振成像的诊断标准、鉴别诊断作一介绍。     

多发性硬化新旧诊断标准比较(附60例临床分析)

多发性硬化(multiple sclerosis,MS)是中枢神经系统脱髓鞘疾病,既往诊断多发性硬化主要根据临床表现和体征,随着医学影像学技术的发展,尤其是磁共振成像的出现,多发性硬化的检出率增高,使以往的诊断标准受到挑战.2000年7月国际多发性硬化诊断专家组在英国伦敦召开会议并于10月发表了多发性硬化新的诊断标准.现对新旧诊断标准进行比较,并结合我院1994年至今收治的60例多发性硬化患者进行分析,以探讨新旧诊断标准的异同.     

磁共振中央静脉征在多发性硬化方面的作用

多发性硬化的诊断通常比较困难,及时、正确的诊断对疾病的早期治疗和预后有重要的作用。磁共振成像是常规用于检测脑白质病变的较敏感的工具,但其诊断特异性仍不理想,故临床上经常出现诊断不明确的病例。MRI对颅内静脉周围的病灶的检测提高了诊断的特异性,对颅内中央静脉征的发现有望成为诊断的标志物。研究证明,白质病灶中中央静脉征的存在有助于区分多发性硬化和与其类似的炎性疾病及自身免疫性疾病。该文系统分析中央静脉征在头颅磁共振的特征及其在多发性硬化诊断和鉴别方面的作用,为临床提供重要线索。     

健康脊髓及脊髓疾病DTI量化研究进展

目前,脊髓磁共振成像存在诸多局限性,近年来随着扩散张量成像(diffusion tensor imaging,DTI)应用,改善了脊髓成像质量,使定量测量成为可能,并逐渐应用于各种脊髓疾病诊断.作者对脊髓DTI成像技术及在健康脊髓、肌萎缩侧索硬化症(amyotrophic lateral sclerosis,ALS)、脊髓压迫症、脊髓炎、多发性硬化(multiple sclerosis,MS)、脊髓损伤(spinal cord injury,SCI)和肿瘤等多种脊髓疾病中的应用进行了综述.脊髓DTI成像除能定量描述健康脊髓的扩散特点,还能早期诊断各种脊髓疾病并明确病变范围,监测病情进展及评估术后恢复情况.     

磁共振新技术在多发性硬化的临床应用

MRI新技术的应用使临床对多发性硬化（multipl esclerosis,MS）的病情评估达到了前所未有的水平,这些新技术包括液体衰减反转恢复序列、磁共振波谱、磁化传递成像、弥散成像等等,该文就这些新技术的原理及其在MS中的应用作了简介,供临床参考。     

多发性硬化36例临床分析

目的探讨多发性硬化（MS）的临床特点。方法回顾性分析36例多发性硬化患者的一般临床表现及辅助检查。结果MS多见于青壮年,起病多为急性或亚急性,首发症状以肢体无力、感觉障碍及视觉障碍为主要表现,临床表现、影像学特点及诱发电位对MS的诊断具有重要意义。结论根据临床特点,磁共振成像及诱发电位可提高临床确诊率。     

不同类型多发性硬化患者的神经功能预后分析

目的 通过比较不同临床类型的多发性硬化患者的一般资料、临床表现、磁共振成像检查结果,对其神经功能的恢复情况进行分析,从而评估不同类型多发性硬化患者的预后.方法 选择76例多发性硬化患者,根据不同的临床类型,分别统计其一般资料、临床资料、MRI受累部位,并用扩展致残量表(EDSS)进行神经功能评分.结果 治疗前复发缓解型多发性硬化患者锥体系功能和EDSS评分分别为2.03±1.44和4.91±1.71,显著低于继发进展型多发性硬化的3.23±1.17 和6.08±1.51,差异有统计学意义(P＜0.05).进展复发型多发性硬化患者治疗后膀胱/直肠、小脑和皮质功能评分分别为1.25±1.07,1.07±0.71和0.83±1.04,与治疗前的1.39±1.19,1.67±1.29和0.94±1.06无显著性差异(P＞0.05);继发进展型多发性硬化患者治疗后小脑、膀胱/直肠和皮质功能评分分别为1.86±0.89,1.54±0.88和0.92±1.12,与治疗前的2.00±1.31,1.85±0.99和1.00±1.23无显著性差异(P＞0.05).结论 复发缓解型与继发进展型和原发进展型相比,神经功能缺损程度较轻,预后相对好;而复发缓解型多发性硬化患者若出现锥体系症状明显加重,或EDSS评分显著升高,提示进展为继发进展型多发性硬化的可能性较大,预后不佳.进展复发型多发性硬化患者若出现二便障碍或/和精神症状,继发进展型多发性硬化患者若出现小脑性共济失调、二便障碍及精神障碍均提示治疗困难,预后不佳.     

多发性硬化的肾上腺皮质激素治疗

多发性硬化是一种发生于中枢神经系统的、主要由细胞免疫介导的自身免疫性疾病.近年来国外数项多中心、随机、双盲、安慰剂对照的前瞻性临床研究的结果显示,肾上腺皮质激素(激素)对多发性硬化急性期疗效肯定,可作为治疗多发性硬化急性发作和复发的主要药物.该文就多发性硬化的激素治疗相关内容作一概述,以供临床参考.     

CT、MRI诊断咀嚼肌间隙肿瘤

目的 观察咀嚼肌间隙(MS)肿瘤的CT、MRI表现及继发肿瘤累及MS的途径.方法 57例MS肿瘤患者,2例接受CT检查,17例接受MR检查,38例同时接受CT和MR检查.回顾性分析57例影像学表现.结果 7例原发MS肿瘤,6例原发良性肿瘤边界清楚、相邻咀嚼肌和骨质受压,1例原发恶性肿瘤边界不清伴骨质破坏.50例继发肿瘤,14例颅底、眼眶肿瘤经眶下裂累及MS,7例泪腺腺样囊性癌、1例白血病破坏眼眶外壁侵犯MS,2例视网膜母细胞瘤跳跃性转移至MS,9例鼻腔、鼻窦、鼻咽肿瘤经蝶腭孔累及MS,15例上颌窦肿瘤、1例鼻腔筛窦肿瘤破坏上颌窦后壁侵犯MS,1例翼腭窝肿瘤直接侵犯MS.20例继发良性肿瘤多边界清楚、咀嚼肌受压或萎缩、相邻骨质受压,30例继发恶性肿瘤多边界不清、上颌窦后间隙消失、翼突骨质破坏.结论 CT和MRI能清晰显示MS肿瘤的形态、边界、范围、相邻结构的异常改变,对原发肿瘤的诊断、继发恶性肿瘤的临床分期有重要价值.     

磁共振三维双翻转恢复序列在早期多发性硬化中的初步应用

目的比较MR三维双翻转恢复(3D-DIR)序列与T2加权快速自旋回波(TSE)序列对早期多发性硬化(MS)患者脑内病变的检测能力。方法收集12例临床孤立综合征(CIS)患者和9例早期复发-缓解型MS患者(病程短于2年),采用3.0T MR分别对21例颅内病变患者行3D-DIR及T2W TSE序列扫描。比较两种技术对早期MS患者颅内不同部位病变的检出率。结果与T2W序列相比,3D-DIR对总体病灶的检出增加了(P=0.007),对皮层内和皮层下病灶的检出也增加了(P=0.006,P=0.009)。在灰白质混合病变、深部灰质及白质病变的检测中,3D-DIR与T2WI序列差异无统计学意义。结论应用MR 3D-DIR序列可以提高早期MS患者皮层内和皮层下病变的检出率。     

基于纹理特征的多序列MRI的肝硬化识别研究

目的 采用基于纹理特征的十倍交叉验证法的神经网络分类器,探讨多序列MRI在肝硬化诊断识别中的价值。方法 将5个序列MR图像（T1WI、T2WI、增强动脉期、门静脉期和平衡期）分成正常肝脏组、较早期肝硬化组及中晚期肝硬化组,手动获取ROI;采用灰度共生矩阵提取ROI的56个纹理特征参数;采用十倍交叉验证法的BP网络分类器分别分类识别3组肝脏组织。结果 门静脉期图像对正常肝脏、较早期肝硬化及中晚期肝硬化的分类效果最好,正确率为87.62%（92/105）,T2WI分类效果最差,正确率为78.33%（47/60）,T1WI、动脉期和平衡期图像居两者之间。结论 采用基于纹理特征的十倍交叉验证法的神经网络分类器可以区分正常肝脏、较早期和中晚期肝硬化MRI;在基于多序列MRI的肝硬化识别研究中,门静脉期图像有可能成为首选。     

对比MS BLOCK T1rho、MS HS8 T1rho及3D BLOCK T1rho序列肝脏MR图像质量及T1rho值

目的 对比分析MS BLOCK T1rho、MS HS8 T1rho及3D BLOCK T1rho序列肝脏MR图像质量及T1rho值。方法 分别采用MS BLOCK T1rho（n=33）、MS HS8 T1rho（n=34）及3D BLOCK T1rho（n=22）序列对40名成年健康志愿者行腹部MR扫描,比较3种序列肝脏图像质量及T1rho值,以Pearson相关分析观察3种序列T1rho值的相关性。结果 3种序列的图像质量评分及T1rho值差异均有统计学意义（P均<0.01）,其中MS HS8 T1rho图像质量评分及T1rho值均高于其他2种序列（P均<0.05）。MS BLOCK T1rho序列图像的T1rho值与MS HS8 T1rho、3D BLOCK T1rho均呈正相关（r=0.59、0.73,P均<0.05）,MS HS8 T1rho的T1rho值与3D BLOCK T1rho呈正相关（r=0.72,P<0.05）。结论 MS BLOCK T1rho、MS HS8 T1rho及3D BLOCK T1rho序列均可应用于健康人肝脏MR成像,但用于诊断肝脏疾病时需设定不同的参考值范围。     

增强MRI和全身骨显像间隔时间对肝脾摄取

目的 观察增强MRI和全身骨显像间隔时间对骨显像时肝脾摄取^99mTc-MDP的影响。方法 回顾性分析 3268例全身骨显像患者的资料,通过PACS系统追访骨显像前接受增强MRI、骨显像时肝脾摄取^99mTc-MDP的患者例数,根据增强MRI与全身骨显像的间隔时间将其分为间隔0、1、2、3天组,根据肝脾摄取情况分为肝摄取组、脾摄取组和肝脾摄取组。结果 63例患者骨显像前接受增强MRI,其中42例存在^99mTc-MDP肝脾摄取。间隔0、1天组肝脾摄取^99mTc-MDP例数最多,共计35例(35/42,83.33%)。42例中,单纯肝脏摄取26例,占61.90%(26/42),单纯脾脏摄取1例,占2.38%(1/42),肝脾同时摄取15例,占35.71%(15/42)。结论 增强MRI与全身骨显像间隔时间对骨显像时肝脾摄取^99mTc-MDP有直接影响,建议两种检查间隔3天以上。     

Near-Infrared Imaging with Second-Window Indocyanine Green in Newly Diagnosed High-Grade Gliomas Predicts Gadolinium Enhancement on Postoperative Magnetic Resonance Imaging

Purpose

Intraoperative molecular imaging with tumor-targeting fluorophores offers real-time detection of neoplastic tissue. The second window indocyanine green (SWIG) technique relies on passive accumulation of indocyanine green (ICG), a near-infrared fluorophore, in neoplastic tissues. In this study, we explore the ability of SWIG to detect neoplastic tissue and to predict postoperative magnetic resonance imaging (MRI) findings intraoperatively.

Procedures

Retrospective data were collected from 36 patients with primary high-grade gliomas (HGG) enrolled as part of a larger trial between October 2014 and October 2018. Patients received systemic ICG infusions at 2.5–5 mg/kg 24 h preoperatively. Near-infrared fluorescence was recorded throughout the case and from biopsy specimens. The presence/location of residual SWIG signal after resection was compared to the presence/location of residual gadolinium enhancement on postoperative MRI. The extent of resection was not changed based on near-infrared imaging.

Results

All 36 lesions demonstrated strong near-infrared fluorescence (signal-to-background = 6.8 ± 2.2) and 100 % of tumors reaching the cortex were visualized before durotomy. In 78 biopsy specimens, near-infrared imaging demonstrated higher sensitivity and accuracy than white light for diagnosing neoplastic tissue intraoperatively. Furthermore, near-infrared imaging predicted gadolinium enhancement on postoperative MRI with 91 % accuracy, with visualization of residual enhancement as small as 0.3 cm³. Patients with no residual near-infrared signal after resection were significantly more likely to have complete resection on postoperative MRI (p value < 0.0001).

Conclusions

Intraoperative imaging with SWIG demonstrates highly sensitive detection of HGG tissue in real time. Furthermore, post-resection near-infrared imaging correlates with postoperative MRI. Overall, our findings suggest that SWIG can provide surgeons with MRI-like results in real time, potentially increasing resection rates.

     

PET/MRI观察朗格汉斯细胞组织细胞增生症

目的 观察朗格汉斯细胞组织细胞增生症（LCH）的¹⁸F-FDG PET/MRI表现。方法 回顾性分析11例经病理学证实的LCH患者PET/MRI所示各系统病灶部位、数目、形态及最大标准摄取值（SUV_max）。结果 11例LCH中,8例为症状或影像学未缓解、3例为影像学缓解病例;其中7例累及全身多系统,4例仅累及骨骼系统或垂体,临床表现与病变累及范围相关。8例未缓解LCH中,PET/MRI共检出38个病灶,多表现为不同程度FDG摄取增高,SUV_max为1.23~13.00。结论 LCH累及范围多较广,PET/MRI中病变多呈不同程度FDG摄取增高。     

The Performance of Radiographic Criteria for Bone Malignancy When Applied to Computed Tomography and Magnetic Resonance Imaging

BackgroundThe conventional radiologic features that differentiate benign from malignant bone lesions were originally described using radiography (x-ray [XR]). When evaluating sectional imaging studies such as magnetic resonance imaging (MRI) and computed tomography (CT), one may apply these principles to identify malignant bone lesions. The aim of this study was to evaluate the performances of these radiographic features for detecting malignity when applied to CT and MRI.Materials and MethodsThis retrospective study was approved by our institutional ethical board. Thirty-nine patients with histopathologic proof of a high-grade bone malignancy and preoperative imaging data obtained with a minimum of two different modalities were included in the study. Four radiologists reviewed the images and scored the lesions for distinctness of margins, presence and type of periosteal reaction, matrix mineralization, and presence of soft tissue mass. The average score for each modality was then tested for accuracy with regard to the histopathology.ResultsWhen lesion margins were considered, XR was the best modality to detect a high-grade malignancy. MRI, especially postcontrast T1-weighted sequence, was the least helpful in this regard. There was no significant difference between CT and XR and between CT and MRI. When the periosteal reaction was considered, XR was the best modality to detect the malignant type of periosteal reaction. In this regard, MRI and CT were misleading; either by not detecting or undergrading periosteal reaction. MRI was the best modality to detect soft tissue mass.ConclusionConventional imaging criteria for bone malignancy can be misleading when applied to MRI or CT. When cross-sectional imaging features contradict those from XR, the latter should be the guide for clinical management.     

Assessing Appropriateness of CT and MRI Referrals for Headache and Lumbar: A Canadian Perspective on Patient-Centered Referrals

BackgroundInappropriate diagnostic imaging is a burgeoning problem within the Canadian healthcare system and imposes considerable burdens to efficiency and timeliness of care. Low back pain and headaches affect an immense portion of the general population and have become exceedingly common complaints from patients seeking diagnostic imaging from primary care physicians.MethodsA total of 399 magnetic resonance imaging (MRI) and computed tomography (CT) requisitions for lumbar and head scans were reviewed and assessed for appropriateness in concordance with published Choosing Wisely guidelines for head and lumbar diagnostic imaging. Requisitions were classified as appropriate, inappropriate, or incomplete. Baseline data collection showed 51.6% appropriateness, 12.0% inappropriateness, and 36.3% incompleteness. New patient-centered referral forms containing evidence-based red flags by Choosing Wisely Canada were created for head and lumbar MRI and CT. The aim was to increase awareness and consideration of the guidelines during the referral process. The new referrals were distributed among 149 local family physicians in addition to information pamphlets summarizing the need to reduce unnecessary diagnostic imaging for head and lower back pain.Results and conclusionAfter collection and review of 251 requisitions in the postintervention period, incomplete referrals dropped from 36.3% to 13.15%. Despite insignificant changes in appropriateness, it is promising that the intervention educated local physicians on the information required to complete the CT or MRI forms as further evidence is provided showing the efficacy of the patient-centered referrals. This study provides insight on the importance of appropriate diagnostic imaging and what methods can be used at the primary care level.     

磁共振成像与多层CT对肝脏局灶性病变定性的比较研究

目的比较综合MRI（1.5T或3T）多种序列与MSCT（16或64层）动态增强扫描对肝脏局灶性病变定性的价值。方法回顾性分析行腹部MSCT与MRI检查（两种检查间隔时间不超过1个月）且发现肝脏局灶性病变的41例患者（75个病灶）的诊断结果。结果MSCT鉴别诊断良恶性病灶的敏感度为80.77%（21/26）,特异度为68.42%（26/38）。MRI鉴别诊断良恶性病灶的敏感度为93.33%（28/30）,特异度为97.56%（40/41）。两者敏感度之间的差异无统计学意义（P=0.311）,MRI的特异度高于MSCT（P〈0.001）。对于具体的各类病灶,MRI的总体诊断准确率（86.36%,57/66）高于（P=0.004）MSCT（64.41%,38/59）。结论MRI对肝脏局灶性病变的定性能力优于MSCT。