子痫脑病的影像学表现及其临床意义

目的:对子痫引起的脑后部可逆性病变(子痫脑病)的影像学表现进行分析,加深对本病的认识。方法:回顾性分析我院2015年3月至2016年3月9例子痫脑病患者的临床表现、CT检查、MRI检查资料。9例行CT检查及磁共振成像(MRI)检查,5例于314天后复查MRI。结果:9例CT平扫为不规则形低密度区;MRI平扫T1WI上低信号,T2WI及T2Fliar呈高信号,扩散加权成像(DWI)病灶呈高信号,弥散表观系数(ADC)图上呈高信号。7例增强扫描均未见强化。3例行磁共振血管成像(MRA)均未发现特殊。1例患者磁共振静脉血管成像(MRV)检查正常。经治疗后5例复查MRI,3例显示病灶完全消失,病灶范围明显缩小者2例。病变主要以双侧顶枕叶为主,其次是额叶和颞叶,基底节区和小脑半球亦有累及。临床出现抽搐9例,头痛7例、视物模糊1例,意识障碍4例。治疗后症状缓解或消失,实验室指标恢复正常。结论:子痫脑病常急性起病,收缩压及舒张压均突然增高。影像学表现非常具有特征性,MRI扩散加权成像对鉴别诊断及早期明确诊断和指导治疗有重要的意义。     

产褥期脑血管疾病8例临床分析

目的:探讨产褥期脑血管病的致病因素、临床表现及防治。方法:回顾分析8例产褥期脑血管病的诱因、卒中类型、发病时间、临床及影像学表现。结果:产褥期脑血管病的发病诱因主要是产前妊娠期高血压疾病(6例),以脑梗死(4例)多见,8例均发生在产后2周内,临床上主要表现为头痛、呕吐等高颅压症状,通过CT、MRI及数字减影血管造影(DSA)等辅助检查确诊。7例患者治愈出院,1例因多系统器官衰竭死亡。结论:妊娠期高血压疾病为产褥期脑血管疾病的主要致病因素,临床主要表现高颅压症状。提高产科医生对产褥期脑血管疾病的认识,提早预防,及时而必要的治疗是降低产妇死亡率的关键。     

子宫肌瘤动脉内数字减影血管造影影像学特点及临床意义

目的 观察子宫骨瘤动脉内数字减影血管造影（IADSA）影像学特点。方法 对156例子宫肌瘤患者行子宫动脉栓塞术（UAE），通过术时DSA造影及术后DSA片观察子宫肌瘤DSA影像学特点。结果 156子宫肌瘤的血供均来自子宫动脉，共分3种类型：（1）Ⅰ型：一侧子宫动脉供血为主型，占53.2%（83／156）；（2）Ⅱ型：双侧子宫动脉供血为主型，占34.6%（54／156）；（3）Ⅲ型：单纯一侧子宫动脉供血型，占12.25(19/156)。子宫肌瘤的血管肉分两层，一层存在于子宫肌瘤的表面形成粗大的血管肉，另一层在子宫肌瘤的内部形成致密的毛细血管网。结论 子宫肌瘤属富血管性肿瘤，其血供来源于子宫动脉，由内外两层血管网组成。     

近期流产后并发脑静脉窦血栓形成12例临床对比分析

目的:探讨近期流产后(流产后2周内)并发脑静脉窦血栓形成(CVST)的临床特征、治疗效果及短期预后。方法:收集CVST患者22例,根据是否近期流产分为近期流产组(RM-CVST组,12例)和近期无流产组(NM-CVST组,10例),从临床表现、诊断、治疗及短期预后等方面对两组进行比较。结果:1 RM-CVST组患者的病程时间(3.59±6.14天)短于NM-CVST组(14.57±20.49天),而急性起病患者比例(66.7%)高于NM-CVST组(20.0%),差异均有统计学意义(P0.05);RM-CVST组临床表现中癫痫发作、发热、视力障碍的比例高于NM-CVST组,差异均有统计学意义(P0.05)。2两组头部CT平扫检出率仅50.0%,头部低场强磁共振脑静脉窦血管成像(MRV)和影像学检查数字减影血管造影(DSA)检出率达100.0%;RM-CVST组头部MRI平扫检出率(90.0%)高于NM-CVST组(55.6%),差异有统计学意义(P0.05)。3RM-CVST组治疗的有效率和Rankin量表短期预后评分良好的比例与NM-CVST组比较,差异均无统计学意义(P0.05)。结论:近期流产后发生CVST的患者病程短、发病急、病情进展迅速;MRV和DSA检查对CVST患者有较高诊断率,近期有流产的CVST患者MRI检出率更高;经及早诊断、规范化治疗近期有流产CVST患者可获得与近期无流产患者一样的良好结局。     

剖宫产瘢痕妊娠数字化三维模型在其子宫动脉栓塞术中的应用

目的:探讨剖宫产瘢痕妊娠(CSP)数字化三维模型的构建方法及其在CSP子宫动脉栓塞术(UAE)中的应用和意义.方法:5例CSP患者在UAE术前行双源CT血管造影(CTA)扫描,获取CTA横断面图像后,利用Mimics10.01软件对骨盆和盆腔动脉系统进行三维重建.将构建的CSP数字化三维模型用于指导UAE手术操作,并与数字减影血管造影(DSA)结果进行对比.结果:①病灶的血供来源:2例由双例子宫动脉和卵巢动脉共同供血,3例仅由双侧子宫动脉供血;②血供的分布:所有患者均双侧血供不均衡,其中3例以左侧为主,2例以右侧为主;③疗效和与DSA比较:5例患者均在三维模型的指导下成功行UAE,术后恢复好,均无明显副反应发生.5例患者的数字化三维模型与DSA对比相一致,1例患者DSA造影中未显示卵巢动脉供血.结论:构建的CSP数字化三维模型真实性、准确性高,可为剖宫产瘢痕妊娠子宫动脉栓塞术提供术前指导和术中参考,使之更加个体化和精确化.     

评价经阴道超声及磁共振成像联合数字减影血管造影技术在早期剖宫产瘢痕妊娠诊治中的作用

目的:探讨经阴道超声(TVS)及磁共振成像(MRI)联合数字减影血管造影技术(DSA)在早期剖宫产瘢痕妊娠(CSP)诊治中的应用价值。方法:选择我院收治的临床拟诊CSP患者23例,停经时间41~49天,分别行TVS、MRI、DSA检查,所有患者行子宫动脉栓塞术,术后TVS随访。结果:1TVS明确诊断CSP 17例,不能明确诊断6例,其中3例于子宫下段见孕囊回声,不能明确孕囊与瘢痕的位置关系;3例包块周边环状血流信号不明显,不能除外难免流产孕囊滞留于瘢痕处。MRI检查23例均明确诊断。2所有患者行DSA下子宫动脉栓塞术,手术成功。术后3天TVS检查:2例孕囊自行排出,1例包块完全吸收,15例见包块缩小且周围血流信号明显减少,5例包块未见明显缩小但周围血流信号明显减少。314例于治疗后1周行刮宫手术,手术顺利,术中术后24小时出血量60~155 ml;6例经MRI诊断包块位于肌层的患者未行刮宫术,密切随访血β-HCG及TVS,包块于栓塞术后4~10周后完全吸收。结论:TVS是CSP的首选诊断方法及子宫动脉栓塞术后评价疗效的方法,当超声检查不能明确诊断时,MRI是必要的辅助手段。DSA下行子宫动脉栓塞术对于早期CSP是一种安全、有效的治疗方法。     

新生儿缺氧缺血性脑病MRI检查常用序列的诊断价值

目的探讨核磁共振成像(MRI)各序列对新生儿缺氧缺血性脑病的诊断价值。方法分析2012-01/10经临床证实的50例新生儿急性缺氧缺血性脑病的MRI表现及分度。结果 50例患儿MRI均发现异常信号影,但T1WI序列有5例未发现异常,而T2WI、flair、DWI则无漏诊;与临床分度符合率最高的是DWI。结论 MRI是新生儿急性缺氧缺血性脑病的早期诊断和分度重要手段,为提高分度的准确性,不能只作常规的T1WI和T2WI,还应加作flair、DWI,这对发现出血尤其重要。     

产后大出血行急诊动脉栓塞治疗65例疗效分析

目的:探讨急诊行子宫动脉栓塞(EUAE)治疗产后大出血的临床疗效。方法:65例产后大出血患者行急诊介入造影检查,明确出血部位后,采用丙烯酸微球(TAGM)、明胶海绵颗粒、栓塞弹簧圈及聚乙烯醇(PVA)颗粒对出血动脉行急诊栓塞治疗,对动脉造影表现及治疗效果进行回顾性分析。结果:子宫动脉造影表现:子宫动脉明显增粗,分支迂曲、增多、紊乱43例;子宫动脉造影剂明显外溢27例;假性动脉瘤形成5例,其中左侧2例,右侧3例;由髂外动脉参与供血1例。65例患者经EUAE治疗,62例阴道流血的症状消失,3例仍有阴道流血症状,3例均为胎盘植入,术后行子宫切除。术后随访12个月,62例患者均恢复正常月经周期,未出现严重并发症。结论:双侧子宫动脉造影,对明确诊断出血部位及出血量具有重要意义。EUAE治疗产后大出血是一种创伤小、止血效果确切、无严重的并发症且可保存患者的生育能力的治疗手段。     

36例前置胎盘或伴胎盘植入的磁共振脂肪抑制T2加权成像评价

目的:探讨磁共振脂肪抑制T2加权(T2WI)对前置胎盘或伴胎盘植入36例患者的临床评估价值。方法:回顾性分析2012年1月至2013年12月最终确诊为前置胎盘或伴胎盘植入36例患者的临床资料,患者均采用1.5T超导磁共振成像(MRI)成像仪,全腹平扫脂肪抑制T2WI,对其诊断结果与手术及病理检查结果进行比较。结果:MRI诊断中央性前置胎盘27例,部分性前置胎盘4例,边缘性前置胎盘4例和胎盘低置1例,表现为宫颈口高信号影(胎盘组织),均与术后诊断一致;而B超诊断漏诊1例。MRI诊断胎盘植入9例,病理检查证实诊断正确8例,1例误诊;诊断无胎盘植入27例,病理检查证实其中7例有胎盘植入,漏诊7例。MRI诊断前置胎盘伴胎盘植入的敏感度为53.33%,特异度为95.23%,阳性预测值为88.89%,阴性预测值为74.07%。结论:利用磁共振脂肪抑制T2WI可准确诊断前置胎盘,对胎盘植入情况具一定敏感度,可为临床手术治疗提供一定的指导,是B超检查有效的补充手段。     

妊娠合并烟雾病一例报告

正烟雾病(moyamoya disease,MMD)是一种罕见脑血管病,其影像学特征为颈内动脉末端和(或)其分支(大脑前、中动脉)起始段的进行性狭窄,伴随着颅底异常血管网的形成。因其在脑血管造影片上模糊不清的血管网形如烟雾升起,故名MMD。妊娠合并MMD少见[1],规律产前检查,重视神经症状及体征,并行数字减影血管造影(digital subtraction angiography,DSA)确诊,适时终止妊娠,孕产妇多可取得较好结     

MRI features and differential diagnoses of congenital vaginal atresia

Objective: To investigate the MRI manifestations of congenital vaginal atresia, analyze its imaging features, and improve the understanding of the disease.

Methods: MRI findings and clinical data of 12 patients with congenital vaginal atresia confirmed by hysteroscopy and laparoscopic surgery were retrospectively analyzed. Vaginal atresia was classified according to vaginal dysplasia in AFS female genital malformation classification system.

Results: In this study, 12 cases of congenital vaginal atresia were diagnosed by combined preoperative MRI with operative diagnosis. Among them, 10 patients all had type-I congenital vaginal atresia, and their uterus and cervix were normal (1 patient had ectopic renal malformation combined with left ovarian endometriosis cyst and 1 patient with uterine empyema). The other two cases were diagnosed congenital vaginal atresia type II (1 case merged with residual uterus, 1 case with cervical dysplasia). MRI mainly manifested as dilatation and hemorrhage in the uterine cavity, cervical canal and vaginal upper segment. T1WI showed high signal, T2WI showed slightly lower and slightly higher signal. The dilated vagina was above the perineal level.

Conclusion: MRI features of congenital vaginal atresia have certain characteristics. MRI cannot only accurately assess the type of vaginal dysplasia and its associated complications, but also make objective evaluation and diagnosis, so it can be used as the best effective preoperative image evaluation.     

急性胆红素脑病磁共振成像特征及其与预后关系的研究

摘要：目的　探讨急性胆红素脑病的磁共振成像（MRI）特征及其与预后的关系。方法　回顾性分析2006年5月至2008年4月温州医学院附属第二医院暨育英儿童医院新生儿科11例急性胆红素脑病患儿的头颅MRI图像 ,以同期6例正常新生儿头颅MRI作对照。结果　11例急性胆红素脑病中,8例双侧苍白球在T1WI呈对称性高信号,在T2WI呈正常的稍高信号,其余3例未见明显异常。对5例急性胆红素脑病患儿进行了随访研究,初次MRI异常的3例诊断为手足徐动型脑性瘫痪,其双侧苍白球T1WI上的高信号消失, T2WI上正常的稍高信号转为对称性高信号;初次MRI正常和异常各1例,临床随访神经发育均正常。结论　双侧苍白球在T1WI呈对称性高信号是急性胆红素脑病相对特征性表现,由于病例数较少,MRI图像特征与临床预后的关系尚须进一步研究。     

Dural arteriovenous malformation of the transverse sinus with sinus occlusion: report of a case.

We report a case of dural arteriovenous malformation (AVM) of the transverse sinus with sinus occlusion. This 49-year-old man developed right parietal lobe dysfunction with acute onset. Computed tomography and magnetic resonance imaging (MRI) showed a non-hemorrhagic venous infarct in the subcortical white matter of the right parietal lobe, and diffusely dilated subcortical veins. Thrombosis of the right internal jugular bulb was also revealed on MRI. Cerebral angiography showed a dural AVM in the posterior fossa with occlusion of the right transverse sinus and retrograde venous drainage into the superior sagittal sinus, causing diffuse engorgement of the superficial cortical and the deep intramedullary veins. The focal neurologic deficits in this case were due to a non-hemorrhagic venous infarct in the subcortical white matter of the right parietal lobe secondary to retrograde cortical venous drainage.     

Prenatal diagnosis of capillary telangiectasia of the cerebellum--ultrasound and MRI features

OBJECTIVE: To report three cases of capillary telangiectasia (CT) of the cerebellum revealed as focal cerebellar lesions. METHODS: Ultrasound and magnetic resonance imaging (MRI) were performed in all cases in the prenatal period. Prenatal imaging findings were compared with either post-mortem examination (case 1) or post-natal MRI (cases 2 & 3). RESULTS: A discrepancy between a hyperechoic lesion without any mass effect on sonogram and normal T1 and T2 spin-echo fetal magnetic resonance images was found in all cases. The diagnosis of CT was made on post-mortem examination in case 1. Prenatal ultrasound and magnetic resonance imaging findings were suggestive of the diagnosis in cases 2 and 3. In both cases, the pregnancy was managed conservatively and the diagnosis of CT was documented on post-natal MRI after gadolinium injection. CONCLUSION: The diagnosis of CT of the cerebellum was strongly suggested in these three cases in the prenatal period by the combination of ultrasound and fetal MRI findings. In the vast majority of cases, CT has a benign clinical course and complication with haemorrhage appears to be exceedingly rare. This fact should be taken into account in the prenatal counselling.     

构建在体胎盘植入数字化三维模型在介入治疗中的应用

目的探讨构建数字化三维模型在胎盘植入患者行子宫动脉栓塞术(UAE)中的应用方法及意义。方法 2010年9月至2010年12月在南方医科大学南方医院将4例胎盘植入患者在UAE术前行双源CTA扫描,获取原始图像后利用Mimics10.01软件对其骨盆和动脉系统进行三维重建。将构建的胎盘植入数字化三维模型用于指导UAE操作并与数字减影血管造影(DSA)进行对比。结果胎盘植入数字化三维模型中1例患者的子宫动脉(2条)起源于髂内动脉,3例(6条)起源于臀下动脉,并可精确测量子宫动脉的起源角度、开口类型。胎盘的血供来源:3例来自双侧子宫动脉和卵巢动脉共同供血,1例仅由双侧子宫动脉供血,但该患者存在明显的子宫动脉卵巢支;血供的分布情况为3例双侧血供分布不均,以左侧为主,1例双侧供血均衡。除1例患者要求保守治疗外,其他3例均行UAE治疗并在术后顺利排出胎盘,术中DSA与重建结果对比,子宫动脉的起源和双侧血管的血供分布等均相同。结论构建的在体数字化三维模型对胎盘植入的介入治疗具有较大的术前和术中指导意义,可使手术过程更加精确化。     

Arteriovenous malformation in a bicornuate uterus leading to recurrent severe uterine bleeding: a case report

BACKGROUND: Uterine arteriovenous malformations (AVMs) are rare entities that have been documented in a wide age range. Several treatment modalities have been highlighted in the literature. Uterine artery embolization appears to be effective therapy for select cases. Embolization provides an alternative to hysterectomy and the potential for future fertility. To our knowledge, only 1 other case report describes an AVM existing within a bicornuate uterus. CASE: A 31-year-old, married, Caucasian woman with a history of infertility presented with intermittent uterine hemorrhage resulting in symptomatic anemia. The patient was diagnosed with a uterine AVM existing within the left horn of a bicornuate uterus. The patient underwent uterine artery embolization, with resolution of the vascular mass and resumption of regular menstrual flow. CONCLUSION: AVM in a bicornuate uterus is rarely reported. Selective uterine artery embolization offers an effective modality of treatment.     

Diagnostic imaging in uterine incisional necrosis/dehiscence complicating cesarean section

OBJECTIVE: To review the diagnostic imaging studies in patients with surgically proven uterine incisional necrosis/dehiscence complicating cesarean section and to compare these studies with the findings at surgery. STUDY DESIGN: Over a 6-year period, the records of 7 patients with imaging studies prior to surgery for uterine incisional necrosis/dehiscence complicating cesarean delivery were reviewed and compared with the findings at surgery. RESULTS: Four cases underwent computed tomography (CT) and sonography, 1 underwent CT only, and 2 underwent sonography only. Abnormal findings included abdominal free fluid in 4, pleural effusions in 3, dilated bowel in 3, possible bladder flap hematoma in 2 and single instances of liver abscess and retained products of conception. In no cases were all the studies normal, and necrosis/dehiscence was not demonstrated in any patient. CONCLUSION: Abdominal free fluid, bowel distension, pleural effusion and bladder flap hematoma seen on CT or sonogram in the postcesarean context suggest the possibility of uterine incisional necrosis/dehiscence. Magnetic resonance imaging (MRI) might then be indicated since MRI may be superior to CT in evaluating complications at the incisional site because of its multiplanar capability and greater degree of soft tissue contrast.     

Three-dimensional computed tomographic angiography in the diagnosis and conservative management of cesarean scar pregnancy with prominent neovascularization

ObjectiveCesarean scar pregnancy (CSP) is a rare potentially life-threatening form of ectopic gestation. However, optimal management has not yet been established. Furthermore, there are limited reports on the diagnostic value of three-dimensional computed tomographic angiography (3D-CTA) for the conservative management of this disorder.Case reportA 33-year-old woman (gravida 3, para 2), with two previous deliveries by low segmental transverse cesarean section, was referred after 5 weeks of amenorrhea. Her serum beta-human chorionic gonadotropin (β-hCG) value was 2921 mIU/mL. Cesarean scar pregnancy was diagnosed by ultrasonography and magnetic resonance imaging. On 3D-CTA, a prominent uteroplacental neovascularized mass was identified. It was supplied by the left uterine artery and a thick draining left ovarian vein. After three cycles of systemic methotrexate (MTX) administration, the serum β-hCG value decreased to 142 mIU/mL. However, the gestational sac enlarged and peritrophoblastic blood flow persisted. In contrast to the ultrasonographic findings, marked reduction of uteroplacental neovascularization at the CSP site with regression of the draining ovarian vein was evident on 3D-CTA. The gestational products were thereafter successfully resected by hysteroscopic surgery without hemorrhagic complications. Fifty-seven days after the initial MTX administration, serum β-hCG reached a normal level.ConclusionThis case emphasizes that, when selecting the method of intervention, 3D-CTA is potentially useful for evaluating uteroplacental neovascularization in a hemodynamically stable CSP.     

磁共振检查在确定胎儿脑室扩张疾病诊断中的临床适应证探讨

目的 通过对产前超声筛查出的脑室扩张胎儿行磁共振检查,探讨其确定诊断的适应证和应用价值.方法 2006年3月至2007年10月在中国医科大学附属盛京医院行产前超声检查的胎儿26 072例,其中产前超声筛查出胎儿脑室扩张104例,超声筛查孕龄为22周+2～39周+5,平均32周+1.按Gaglioti标准对104例脑室扩张胎儿进行分组:脑室扩张10～12 mm组66例,13～15 mm组22例,16～20 mm组14例,21～25 mm组2例;按脑室扩张部位不同分为单侧脑室扩张组75例,双侧脑室扩张组29例.在超声筛查48 h内对各组胎儿行磁共振检查以确定中枢神经系统疾病诊断,并随访妊娠结局.结果 (1)胎儿脑室扩张的发生率为0.39%(104/26 072).(2)脑室扩张10～12 mm组确定诊断3例(5%,3/66),分别为小脑发育不良、脑血管畸形及胸腹联合畸形各1例,单纯脑室扩张63例;13～15 mm组确定诊断5例(23%,5/22),分别为胼胝体缺如、脑出血、脑出血合并脑脊膜膨出、脑脊膜膨出及颅内占位各1例,单纯脑室扩张17例;16-20 mm组确定诊断6例(43%,6/14),分别为胼胝体缺如4例、脑出血1例、胼胝体缺如合并脑室出血1例,单纯脑室扩张8例;21～25 mm组确定诊断2例(2/2),分别为胼胝体缺如1例、脑出血1例,无单纯脑室扩张.10～12 mm组确定诊断率与其他3组比较,差异有统计学意义(P＜0.01).(3)单侧脑室扩张组中确定诊断4例(5%,4/75),双侧脑室扩张组中确定诊断12例(41%,12/29),两组比较,差异有统计学意义(P＜0.01).(4)104例脑室扩张胎儿中磁共振确定中枢神经系统疾病诊断16例,诊断率为15%.16例疾病胎儿中引产15例,尸体检查结果与磁共振确定疾病诊断完全相同;1例为胼胝体缺如,脑室扩张15 mm,在观察下妊娠至足月分娩,为正常新生儿;其余88例均妊娠至足月分娩,为健康新生儿.结论 超声筛查胎儿侧脑室扩张≥16 mm或双侧脑室扩张时,建议行磁共振检查以确定胎儿中枢神经系统的疾病诊断;脑室扩张≤12 mm的单纯侧脑室扩张不必行磁共振检查,可行超声动态观察,当发现胎儿脑室扩张程度有增加趋势时再行磁共振检查以明确诊断.