卵巢子宫内膜异位囊肿的MRI和CT表现（附13例分析）

目的：探讨卵巢子宫内膜异位囊肿的ＭＲＩ及ＣＴ表现的特点。材料和方法：回顾性研究１９９４年１月至１９９５年１０月经ＭＲＩ、ＣＴ扫描表现异常的１３例共２２个卵巢子宫内膜异位囊肿，１３例中１２例作ＭＲＩ，２例同时作ＭＲＩ和ＣＴ，１例仅作ＣＴ扫描。全部病例均经手术病理证实。结果：在２１个囊肿中，ＭＲＩＴ１、Ｔ２加权像显示囊肿的不同信号强度，在Ｔ１加权像中，３个显示低信号，３个显示中等信号，６个显示混杂信号，９个显示高信号；在Ｔ２加权像中，２个显示低信号，９个显示混杂信号，１０个显示高信号。另外，２例ＣＴ平扫＋增强扫描为高密度，１例为低密度。囊肿直径约２～９ｃｍ，最大９ｃｍ×７ｃｍ。囊肿反复出血，是ＭＲＩ信号和ＣＴ密度不同的主要原因。结论：认识卵巢子宫内膜异位囊肿ＭＲＩ以高信号和混杂信号为主要表现的特点，将有助于作出正确的诊断。而卵巢子宫内膜异位囊肿在ＣＴ平扫和增强扫描表现为高密度，可能有定性诊断意义     

原发性肝细胞癌磁共振成像与血管造影检查的对照研究

目的：探讨原发性肝细胞癌（ＨＣＣ）的ＭＲ与肝血管造影表现的相关性。材料与方法：研究对象：于ＭＲＩ检查后１０日内行肝血管造影检查的ＨＣＣ患者６６例。ＭＲＩ采用ＳＥ序列,矩阵１２８×２５６,层厚５～１０ｎｍ,层间隔１ｍｍ。Ｔ１加权像：ＴＲ＝５３０ｍｓ,ＴＥ＝１５ｍｓ,Ｔ２加权像：ＴＲ＝２０００ｍｓ,ＴＥ＝８０ｍｓ。肝血管造影采用Ｓｅｌｄｉｎｇｅｒ经皮穿刺股动脉插管技术,行肝动脉和间接门静脉造影。结果：     

脑白质疏松症

白质疏松症（ｌｅｕｋｏ－ａｒａｉｏｓｉｓ，ＬＡ）是神经系统疾病表现的非特异性神经影像学改变，指脑室周围或皮质下（半卵圆中心）区ＣＴ上的斑片状，弥漫性低密度带或ＭＲＩ Ｔ２加权像上的弥漫性高信号，边缘模糊，病灶可相互融合改变。其发病机制尚不十分明确，结合解剖和临床，动物实验，目前认为与缺血的关系最为密切，还与脑脊液循环障碍和血脑屏障的通透性改变有关。     

脑白质疏松症

白质疏松症（ｌｅｕｋｏ－ａｒａｉｏｓｉｓ,ＬＡ）是神经系统疾病表现的非特异性神经影像学改变,指脑室周围或皮质下（半卵圆中心）区ＣＴ上的斑片状,弥漫性低密度带或ＭＲＩ Ｔ２加权像上的弥漫性高信号,边缘模糊,病灶可相互融合改变。其发病机制尚不十分明确,结合解剖和临床,动物实验,目前认为与缺血的关系最为密切,还与脑脊液循环障碍和血脑屏障的通透性改变有关。     

脊椎血管瘤的影像诊断（附30例分析）

目的：探讨脊椎血管瘤的影像表现特征及临床意义。材料与方法：结合临床资料回顾性分析３０例脊椎血管瘤的Ｘ线、ＣＴ或ＭＲＩ影像特征。结果：Ｘ线片可见椎体呈典型的栅栏样改变，ＣＴ可见网眼状影像中夹杂着低密度脂肪，在ＭＲＩ Ｔ１加权像上呈等或高低混杂信号，Ｔ２加权像上呈均匀高信号，并见随回波时间延长信号逐渐变亮这一典型血管瘤信号特征，ＭＲＩ可发现脊髓受压变性程度。据ＭＲＩ表现和临床资料，作者提出了脊椎血管瘤     

实验性癫癎大鼠脑MRI与病理学对照研究

目的：观察１．５Ｔ ＭＲＩ检出大鼠痫性脑损伤的能力。材料和方法：Ｗｉｓｔａｒ大鼠３０只,毛果云香碱３５０ｍｇ／ｋｇ腹腔注射,诱发反复强真－痉挛全面大发作持续状态,ＨＦ染色,光镜下观察癫痫持续不同时间脑组织损害程度,并与１．５Ｔ ＭＲ成像对比（ＭＲＩ参数：ＳＥ序列Ｔ１加权像：重复时间＝５００ｍｓ,回波时间＝１５ｍｓ;ＦＳＥ序列Ｔ２加权像：重复时间＝４００ｍｓ;用表面线圈,层厚２．２ｍｍ,无间隔）。结果：癫痫持续时间与脑损伤呈相关性改变。癫痫持续３ｄ后,可见颞叶、海马区严重神经元脱失、胶质增生和脑水肿,ＭＲ扫描除在１只发作持续１８ｈ的大鼠左颞区检出长Ｔ１、长Ｔ２异常信号外（光镜提示为在灶）,未发现其余动物脑的结构异常和信号变化。结论：随着动物大发作持续时间延长,痫性脑损害加重,大鼠癫痫持续３ｈ以上,有明显的海马神经     

膝关节外伤性骨髓水肿的MR脂肪抑制术成像

目的 分析膝外伤所致周围骨质骨髓水肿的ＭＲＩ表现,探讨其形成的病理学机制。材料与方法 ＭＲＩ检查发现膝关节外伤性骨髓水肿４３例,除常规Ｔ１、Ｔ２加权像检查外,均有矢状面和冠状面脂肪抑制术检查。结果 ４３例患者中共发现膝关节周围水肿６８处,常规Ｔ１、Ｔ２加权像能显示大部分病灶,均呈相对低信号,脂肪抑制术后均可显示,呈明显的高信号。结论 ＭＲＩ脂肪抑制Ｔ２加权像有准确显示膝关节周围骨质的外伤性骨髓水肿     

脑弥漫性轴索损伤的实验性研究

目的：探讨急性期脑弥漫性轴索损伤（ｄｉｆｕｓｅａｘｏｎａｌｉｎｊｕｒｙ，ＤＡＩ）的病理改变及与ＣＴ、ＭＲＩ特征的相关性。材料和方法：本实验应用自行设计的“损伤加速机”对２２只猫按两种大小不等的角加速度损伤，首次应用猫建立了ＤＡＩ动物模型。结果：急性期（７２小时内）ＤＡＩ的病理表现为轴索的扭曲、肿胀、断裂及间质水肿。ＣＴ可见弥漫性脑肿胀、皮层下及脑深部小出血灶、蛛网膜下腔及脑室内出血。ＭＲＩ可见弥漫性脑肿胀（脑白质在Ｔ１加权像上信号减低及脑沟、脑裂消失）和单发或多发脑白质小灶性损伤（脑白质在Ｔ２加权像上可见单发或多发小灶性高信号影）。离体脑白质磁共振波谱（ｍａｇｎｅｔｉｃｒｅｓｏｎａｎｃｅｓｐｅｃｔｒｏｓｃｏｐｙ，ＭＲＳ）检查发现损伤后脑白质游离水相对含量明显高于正常对照组，损伤后结合水相对含量明显低于正常对照组，二者Ｔ１值均较正常对照组延长。结论：ＭＲＩ对ＤＡＩ的诊断价值明显优于ＣＴ。通过对ＣＴ、ＭＲ图像分析，可以间接推测ＤＡＩ的病理改变及程度，有利于做出正确、全面的诊断和制定恰当的治疗方案。     

臂丛区神经源性肿瘤的X线平片、CT及MRI表现（附5例报告）

报道５例臂丛神经源性肿瘤，主要描述其影像学表现。５例中，男性４例，女性１例，年龄３２岁～６６岁，临床症状无特殊。影像学检查方法包括胸部正、侧位片（ｎ＝４），颈椎平片（ｎ＝３），ＣＴ扫描（ｎ＝４）及ＭＲＩ检查（ｎ＝４）。病变位于右侧者４例，左侧１例，均经手术及病理证实，其中神经鞘瘤３例，神经纤维瘤２例。普通Ｘ线表现包括肺尖区肿块（ｎ＝３），椎间孔扩大（ｎ＝１）。ＣＴ所见：肿块呈梭形（ｎ＝２）或哑铃状（ｎ＝２），平扫密度与肌肉ＣＴ值相近，注射造影剂后肿块增强幅度高于肌肉。ＭＲＩ表现：Ｔ１加权像上肿瘤信号与肌肉相近３例，略低于肌肉信号１例；Ｔ２加权像显示病变均为高信号。初步结论：根据病变的分布及上述影像学表现，臂丛神经源性肿瘤可于手术前做出诊断。     

CT及MRI诊断嗅神经母细胞瘤的价值

目的：探讨ＣＴ和ＭＲＩ在嗅神经母细胞瘤的诊断、分期及疗后随诊中的价值。材料和方法：回顾性复习１０例嗅神经母细胞瘤的ＣＴ扫描和１例ＭＲＩ的表现。男６例，女５例。年龄１３～６５岁，中位年龄３２岁。临床表现为鼻堵、鼻衄各６例，眼外突４例，偏头痛、视力下降、鼻翼肿物各２例。ＣＴ平扫５例，增强扫描６例；横断面８例，冠状面７例。ＭＲＩ为ＳＥ序列，Ｔ１和Ｔ２加权像，并用Ｇｄ－ＤＴＰＡ作增强扫描。６例有随诊ＣＴ，１例有随诊ＭＲＩ。结果：按Ｋａｄｉｓｈ分期标准：Ａ期１例，Ｂ期２例，Ｃ期８例。侵犯范围为鼻腔１１例，同侧筛窦、眼眶各６例，蝶窦、上颌窦、前颅凹内各４例，鼻翼软组织２例。ＣＴ增强扫描６例中５例为中度不均质强化，１例为高度强化。ＭＲＩＴ１加权像呈中、低信号，Ｔ２加权像呈中、高信号。结论：嗅神经母细胞瘤的影像学表现无特异性。影像学检查目的为界定肿瘤侵犯范围。冠状面扫描有助于显示颅内、眶内病变，必不可少。ＭＲＩ的Ｔ２加权像有助于鉴别肿瘤和鼻窦内积液，在界定肿瘤范围方面优于ＣＴ。疗后的基线所见和定期随诊影像学检查有助于检出复发，及时行补救治疗     

皮质下动脉硬化性脑病的临床表现及CT分析

目的：分析皮质下动脉硬化性脑病（SAE）的CT特征及其与临床表现的关系。方法：回顾性分析经临床确诊的216例SAE患者的临床表现有CT特征。结果：全部患者中214例颅脑CT平扫显示双侧脑室周围自质有稍低密度影，病变模糊边界不清，双侧对称或基本对称；合并腔隙性梗塞210例，合并程度不同脑萎缩187例。渐进性痴呆表现越重，CT异常表现越明显。结论：对有脑动脉硬化表现者行头颅CT平扫可较早期诊断SAE。     

一氧化碳中毒迟发性脑病的MRI表现

目的:研究一氧化碳(CO)中毒迟发性脑病的MRI特征.方法:回顾性分析32例CO中毒迟发性脑病患者的MRI和临床资料.结果:CO中毒迟发性脑病MRI表现可分为三型:①神经核团受累型;②脑白质受累型;③皮层受累型.MRI特征:苍白球为对称性的卵圆形长T1、长T2信号,皮层下白质为对称性的弥漫、模糊云雾状长T1、长T2信号,侧脑室周围、半卵圆中心白质亦为对称云絮状长T1、长T2信号,胼胝体常受累.MRI显示苍白球合并脑白质受累者及皮层受累者,临床表现较重.结论:CO中毒迟发性脑病MRI表现有一定特征性,且能反应其病理过程,并对CO中毒迟发性脑病的诊断和评价临床表现、预后均有意义.     

MRI及MRA对皮层下动脉硬化性脑病的诊断价值

目的：评价MRI及MRA对皮层下动脉硬化性脑病（SAE）的诊断价值。方法：选择MRI平扫和MRA检查以及临床共同确诊的病例50例。结果：MRI表现脑白质不同程度缺血性脱髓性改变,呈长T1、长T2信号,FLAIR呈高信号,并伴有腔隙性脑梗死、脑萎缩等征象。MRA表现出典型不同程度的脑动脉硬化。结论：MRI和MRA可早期明确显示SAE的大小和动脉硬化程度,能对SAE做出早期诊断。     

Computerized tomographic findings and differential diagnostic considerations in subcortical arteriosclerotic encephalopathy (Binswanger's disease)

This paper discusses the conditions which may be associated with diffuse periventricular hypodensity on CT. Of these conditions, subacute arteriosclerotic encephalopathy (Binswanger's disease) is a common differential diagnostic consideration. This condition results from ischemic demyelination with loss of axons and astrogliosis. CT usually shows diffuse bilateral confluent hypodensities in the cerebral white matter. This is most prominent and seen earliest in the periventricular region and may extend more diffusely into the centrum semiovale. It is important to differentiate this condition from normal pressure hydrocephalus and primary nonischemic demyelinating disease (multiple sclerosis).     

儿童异染性脑白质营养不良的MRI表现

目的 观察异染性脑白质营养不良（MLD）的特征性表现。方法 回顾分析我院经生化检查证实的MLD共11例,观察MRI上脑内白质病变的部位和特殊结构（白质纤维束、丘脑、胼胝体）受累的情况。结果 11例均表现为双侧脑室周围白质T2WI对称高信号,10例双侧半卵圆中心T2WI对称高信号;4例累及皮层下白质。8例累及胼胝体膝部,9例累及压部,两者同时受累为8例;7例累及内囊后肢,4例累及外囊,4例累及脑干皮质脊髓束（3例中脑,1例桥脑）。1例累及小脑白质,8例半卵圆中心T2WI有虎纹征,8例T2WI丘脑呈低信号;5例侧脑室扩大,1例全脑萎缩。结论 MLD的典型表现为双侧半卵圆中心和侧脑室周围白质T2WI对称高信号,早期皮层下白质不受累,胼胝体膝部和压部受累为重要征象;另外征象包括脑干皮质脊髓束和内、外囊受累及虎纹征。     

皮层下动脉硬化性脑病的CT诊断

51 cases of subcortical arteriosclerotic encephalopathy (SAE) diagnosed by CT were reviewed, the diagnosis and differential diagnosis of CT in SAE were discussed. The pathologic basis of SAE is thought to be arteriosclerotic changes in small penetrating cerebral arteries, which cannot be seen directly by CT, however, the resulting histo-pathologic alterations which include widespread patchy areas of demyelination and small infarcts could be demonstrated on CT image. It is surmised by the authors that these changes in white matter seen on CT are responsible for clinical deterioration of the patients.     

Regional cerebral blood flow and blood volume in patients with subcortical arteriosclerotic encephalopathy (SAE)

The aim of the present study was a detailed analysis of the regional cerebral blood flow and blood volume in patients with subcortical arteriosclerotic encephalopathy (SAE) by means of functional magnetic resonance imaging (MRI). A group of 26 patients with SAE and a group of 16 age-matched healthy volunteers were examined. Using a well-established dynamic susceptibility contrast-enhanced MRI method, the regional cerebral blood flow (rCBF) and blood volume (rCBV) were quantified for each subject in 12 different regions in the brain parenchyma. As compared to healthy volunteers, patients with SAE showed significantly reduced rCBF and rCBV values in white matter regions and in the occipital cortex. Regions containing predominantly grey matter show almost normal rCBF and rCBV values. In conclusion, quantitative analysis of rCBF and rCBV values demonstrates clearly that SAE is a disease that is associated with a reduced microcirculation predominantly in white matter.     

佩梅病的头颅MRI表现及其与临床、基因分型的关系

目的 探讨佩梅病( PMD)患儿的头颅MRI特点,以及与临床及基因分型的关系.方法 回顾性分析16例经临床诊断为佩梅病患儿的临床和影像资料.患儿均为男性,年龄5个月至9岁8个月.由儿科神经医师对患儿的症状和体征进行检查,将其按照临床症状进行临床分型.由影像科医师对头颅MRI图像的特点进行分析,病灶的位置包括苍白球、锥体束、胼胝体、小脑白质、半卵圆中心,判断大、小脑是否萎缩、是否有“豹纹征”.结果 临床诊断经典型佩梅病8例,中间型7例,先天型1例.16例佩梅病患儿MRI均以广泛的脑白质髓鞘化延迟为特点,病灶累及苍白球13例、锥体束7例、胼胝体11例、小脑白质7例、半卵圆中心12例、脑萎缩5例、小脑萎缩1例,5例有“豹纹征”.锥体束和小脑白质受累在点突变患儿中多见;临床症状较重的中间型及先天型患儿出现小脑白质病变频率较高;“豹纹征”多见于经典型患儿,提示患儿的髓鞘化程度相对较高.结论 佩梅病患儿的头颅MRI具有典型的影像特点,其影像学表现与临床分型和基因突变类型有一定的相关性.     

Subcortical arteriosclerotic encephalopathy: CT spectrum and pathologic correlation

Because of recent papers suggesting that subcortical arteriosclerotic encephalopathy (SAE) (Binswanger's disease) is more common than historically assumed, this investigation was initiated to assess the frequency of SAE, to gauge the reliability of CT in making this diagnosis, and to assess the strength of the correlation between SAE and arterial hypertension. Of 202 autopsied patients in a 17-month period, 82 had undergone antemortem CT. Of these, 20 had CT findings thought to represent varying degrees of the disease spectrum of SAE. Microscopy confirmed this diagnosis in 18 cases. The pattern of diminished attenuation in the white matter was periventricular in 16 patients (marked asymmetry in one) and limited to an isolated focus somewhat removed from the ependyma in two. Among the 16 with periventricular disease, the extent of the process by CT appeared mild in nine, moderate in five, and severe only in two. There were two false positive CT diagnoses of SAE. Among a control group of 10 patients with normal white matter by CT, seven had some microscopic evidence of SAE, although it was generally less severe than in those with positive CT scans. Subcortical arteriosclerotic encephalopathy is common and can be identified in its various forms by CT with a high degree of reliability.     

Delayed encephalopathy of acute carbon monoxide intoxication: diffusivity of cerebral white matter lesions

BACKGROUND AND PURPOSE: Carbon monoxide intoxication has delayed effects on the cerebral white matter characterized by bilateral, confluent lesions that reflect diffuse demyelination. To increase our understanding of this process, we assessed the diffusion characteristics of these lesions. METHODS: Five consecutive patients with delayed encephalopathy of CO intoxication were examined with diffusion MR imaging. Diffusion-weighted images (DWIs) were obtained 25-95 days after their exposure to CO and during a relapse of neuropsychiatric symptoms, which occurred after an initial recovery. Imaging was performed at 1.5 T by using a spin-echo echo-planar sequence with diffusion gradients of 0, 500, and 1000 s/mm(2). DWIs and apparent diffusion coefficient (ADC) maps were visually evaluated, and mean ADCs were calculated from the periventricular white matter and the centrum semiovale, where confluent hyperintensity was seen on T2-weighted images. Findings were compared with those of normal-looking white matter. RESULTS: In all five patients, both T2-weighted images and DWIs showed the white matter lesions as bilateral, diffuse, confluent areas of hyperintensity in the periventricular white matter and centrum semiovale. On ADC maps, these lesions were isointense, with focal areas of hypointensity (n = 4) or diffuse hypointensity (n = 1). Mean ADC values of the white matter lesions were significantly lower than those of normal-looking white matter, regardless of their isointensity or hypointensity on ADC maps (P <.05). CONCLUSION: Bilateral, confluent, white matter lesions in patients with delayed encephalopathy of CO intoxication show decreased diffusivity.