视神经脊髓炎颈髓常规MRI及扩散张量成像研究

目的通过颈髓常规MRI及扩散张量成像(DTI)观察视神经脊髓炎(neuromyelitis optica,NMO)患者的颈髓病灶表现,并探讨其临床应用价值。方法 20例视神经脊髓炎及20例健康志愿者,行颈髓常规MRI及DTI检查,分析颈髓常规MRI的影像特点,并测量C2~C5水平前索、后索、侧索及灰质感兴趣区的各向异性分数(FA)值及平均扩散率(MD)值,比较两组间差异。结果 NMO患者的脊髓病灶可单纯位于颈髓(20%),或单纯位于胸髓(5%),或颈胸髓内均存在病灶(75%);可为单发(80%)或多发(20%),可呈中心性(70%)或偏心性分布(30%),病灶多呈条片状。在T1WI上,病灶表现为低信号或等信号;T2WI上为高或稍高信号。与正常对照组相比,视神经脊髓炎患者颈髓前索、侧索、后索及灰质的FA值降低,侧索、后索及灰质的MD值升高,且差异均具有统计学意义(均为P0.05)。结论常规MRI可以发现NMO患者脊髓病灶,明确病灶位置及信号特点,DTI能定量检测出其扩散指标的异常,为临床诊断及鉴别诊断提供重要的信息。     

亚急性脊髓联合变性的MRI表现

目的 :探讨亚急性脊髓联合变性(SCD)的MRI表现及特点,以提高SCD的诊断准确性。方法 :回顾性分析我院28例经临床及实验室检查证实的SCD,均行颈、胸段脊髓MRI平扫,其中9例行MRI增强扫描。结果:28例中血清维生素水平降低17例(60.7%),血清同型半胱氨酸水平升高11例(39.3%)。MRI上出现阳性特征16例(57.1%),其中颈髓阳性9例,胸髓阳性5例,颈胸髓同时阳性2例。增强扫描仅1例轻度强化。治疗后23个月复查,所有患者症状均不同程度减轻,MRI上异常信号范围缩小。结论:VB_(12)降低可引起SCD,当VB_(12)水平未明显下降时,血清同型半胱氨酸水平的升高有助于诊断该病。SCD的MRI表现有一定特点,可用于监测病情变化。     

多发性硬化MRI表现及其诊断价值

目的：探讨多发性硬化(MS)的MRI表现特征及其诊断价值。方法：对21例MS患者进行了MRI检查，所有病例均行Gd-DTPA增强扫描。扫描序列包括：T1WI、T2WI、FLAIR，6例进行了随访观察。结果：21例均有MRI阳性表现，3例仅有脊髓病灶，12例仅有脑部病灶，6例脊髓与脑均有病灶。脑内病灶共358个，以侧脑室旁白质区和半卵圆中心多见。形态大小不等，幕上多于幕下。胼胝体受累6例，典型者病灶长轴与侧脑室体部垂直。脊髓表现为髓内长条状长T2信号影，颈髓多见。19例有不同程度的增强表现，病灶强化程度与病灶活动性明显相关。随访病例发现：2例病情稳定者无强化表现并无新病灶出现，4例病情反复者出现新病灶并有强化表现。结论：MRI能清楚显示脑和脊髓的MS病灶，并具有相对特征性的表现，能客观地反映病灶的活动性。     

磁共振对脊髓亚急性联合变性的诊断价值

目的探讨磁共振对脊髓亚急性联合变性的诊断价值,以提高对本病诊断的准确性。方法回顾性分析20例经临床证实的脊髓亚急性联合变性患者的资料,确诊前所有患者均行脊柱MRI检查,其中6例行增强扫描。结果 20例中,16例脊髓内可见异常信号(16/20,80%),颈髓受累8例,胸髓受累5例,颈胸髓同时受累3例,位于脊髓后索11例,侧索并后索3例,侧、后、前索同时受累2例,另1例扫描平面未在病灶水平;脊髓均未见明显肿胀;Gd-DTPA增强扫描1例轻度强化,余5例未见明显强化;血清VB12水平降低15例,正常3例,升高2例。治疗5~15个月后复查,MRI异常信号范围不同程度的缩小或消失。结论磁共振结合临床及实验室检查对本病确诊及疗效随访具有重要价值。     

增强CT和MRI轮辐征在诊断肝脏局灶性结节增生中的价值

目的 分析增强CT和MRI轮辐征在鉴别诊断肝脏局灶性结节增生(FNH)和其他肝脏局灶性病变中的价值.方法 回顾性分析经病理证实的210例肝脏局灶性病变患者的增强CT及MRI图像,其中FNH 37例(40个病灶),其他肝脏局灶性病变173例(219个病灶).采用x2检验比较不同检查方式、增强期相FNH轮辐征的检出率,计算...     

多发性硬化临床表现与MRI分析(附85例分析)

目的:为提高多发性硬化(multiplesclerosis,MS)的临床诊断水平。方法:回顾性分析了85例临床明确MS患者的临床与MRI资料,总结该病的临床与MRI特点。结果:MS好发于中年(平均发病年龄33.0±10.81岁)女性(61.2%);受凉和/或上呼吸道感染为最常见诱因(53.3%);常见临床症状依次为肢体无力(68.2%)、视力障碍(42.4%)和感觉障碍(42.4%);寡克隆区带和诱发电位检查是最重要的辅助检查手段。MS好发部位依次为侧脑室体旁(67.1%)、半卵圆中心(44.7%)、颈髓(41.2%)、胸髓(34.1%)和胼胝体(31.8%);病灶多呈斑片状(91.8%);在T1WI为低、稍低或等信号,在T2WI上多为高信号;病灶多呈斑片状、斑点状或环形强化。结论:结合临床与MRI表现,可提高对MS诊断的准确性。     

实质性血管母细胞瘤的MRI诊断

目的探讨中枢神经系统实质性血管母细胞瘤的MRI特点及诊断价值。方法回顾性分析7例经病理证实的实质性血管母细胞瘤的MRI资料。结果 4例肿瘤位于小脑半球,1例位于小脑蚓部,颈髓及胸髓各1例。MRI表现为T1WI呈等、低信号,T2WI呈等、高信号,6例病灶内部和周围见血管流空影,增强后肿瘤呈显著强化;1例CE-MRA示肿瘤周边及内部见不规则血管影;2例髓内肿瘤均继发脊髓空洞或囊肿。结论 MRI对中枢神经系统实质性血管母细胞瘤的诊断及鉴别诊断具有临床价值。     

脑和脊髓血管母细胞瘤CT和MRI诊断

目的 :分析脑和脊髓血管母细胞瘤的CT、MRI及MR灌注成像 (PWI)表现 ,着重讨论血管母细胞瘤的PWI特点。方法 :对 44例经手术后病理证实的血管母细胞瘤患者的影像资料进行回顾性分析。其中 3 1例行CT平扫和增强扫描 ,16例行MRI平扫和增强 (其中 5例同时行PWI ,3例曾行CT检查 )。结果 :44例患者中囊腔结节型 3 3例 (其中大囊小结节 2 7例 ,单纯囊性 6例 ) ,实质型 10例 ,43例均为单发 ,1例多发 (小脑半球病灶为大囊小结节 ,颈髓为单纯囊性 )。血管母细胞瘤位于小脑半球 3 3例 ,小脑蚓部 8例 ,脑干 1例 ,胸髓 1例 ,1例多发 (病灶分别位于小脑半球和颈髓 )。所有壁结节及实质型肿瘤均显示明显强化 ;5例血管母细胞瘤实质部分PWI均呈明显高灌注表现 ,血管母细胞瘤的SRRmax和rCBV分别为 ( 87.3 2± 3 .18) %和 70 4.68± 46.74,肿瘤与脑白质的rCBV之比为 13 .79± 0 .99,两者的MTT之差为 ( 0 .99± 0 .3 9)s。结论 :CT、MRI均可用于血管母细胞瘤的诊断 ,MRI因在显示肿瘤壁结节和流空血管方面优势明显 ,价值高于CT。PWI对血管母细胞瘤的诊断和鉴别诊断有一定的价值     

超声造影诊断胰腺局灶性病变的诊断价值

目的探讨超声造影诊断胰腺局灶性病变的价值.材料和方法对140个胰腺局灶性病变进行常规超声及超声造影检查,所有病例均经病理诊断.结果恶性肿瘤80个病灶,良性病灶60个.超声造影诊断的敏感性、特异性及准确性分别为85.0%、85.0%及85.0%,常规超声诊断分别为62.50%、46.67%及55.71%,超声造影诊断的阳性预测值为93.15%,阴性预测值为87.93%.结论实时超声造影技术对鉴别诊断胰腺局灶性病变具有较高的临床应用价值.     

脊髓型临床孤立综合征的临床及MRI分析

目的 探讨脊髓型临床孤立综合征(CIS)的临床及磁共振成像(MRI)特征.方法 回顾分析63例临床早期表现为脊髓型CIS的多发性硬化(MS)患者的MRI表现及扩展的功能障碍状况量表(EDSS)评分.结果 52.9%的MS患者在早期表现为脊髓型CIS,其中88.9%以急性或亚急性起病,42.9%的首发症状为孤立的感觉障碍,54.9%为颈髓受累.首次MRI阳性率达91.1%,其中35.3%存在"多灶性"损害,45.1%病变范围在2个椎体节段内,81.7%的独立病灶在矢状位的长度不超过2个椎体高度,89.0%在轴位不超过脊髓横径的1/2.基线MRI的病灶数量、面积与确诊时的EDSS评分有正相关关系;皮质类固醇激素冲击治疗前后的EDSS评分有统计学差异(P=0.003).结论 脊髓型CIS以急性、亚急性起病、颈髓受累多见,脊髓损害不完全,MRI可有"多灶"损害,早期病灶定量分析对评估预后有一定价值,皮质类固醇激素冲击治疗能有效缓解症状.     

Spinal cord magnetic resonance imaging in suspected multiple sclerosis

We examined the value of spinal cord magnetic resonance imaging (MRI) in the diagnostic work-up of multiple sclerosis (MS). Forty patients suspected of having MS were examined within 24 months after the start of symptoms. Disability was assessed, and symptoms were categorized as either brain or spinal cord. Work-up further included cerebrospinal fluid analysis and standard proton-density, T2-, and T1-weighted gadolinium-enhanced brain and spinal cord MRI. Patients were categorized as either clinically definite MS (n = 13), laboratory-supported definite MS (n = 14), or clinically probable MS (n = 4); four patients had clinically probable MS, and in nine MS was suspected. Spinal cord abnormalities were found in 35 of 40 patients (87.5 %), consisting of focal lesions in 31, only diffuse abnormalities in two, and both in two. Asymptomatic spinal cord lesions occurred in six patients. All patients with diffuse spinal cord abnormality had clear spinal cord symptoms and a primary progressive disease course. In clinically definite MS, the inclusion of spinal imaging increased the sensitivity of MRI to 100 %. Seven patients without a definite diagnosis had clinically isolated syndromes involving the spinal cord. Brain MRI was inconclusive, while all had focal spinal cord lesions which explained symptoms and ruled out other causes. Two other patients had atypical brain abnormalities suggesting ischemic/vascular disease. No spinal cord abnormalities were found, and during follow-up MS was ruled out. Spinal cord abnormalities are common in suspected MS, and may occur asymptomatic. Although diagnostic classification is seldom changed, spinal cord imaging increases diagnostic sensitivity of MRI in patients with suspected MS. In addition, patients with primary progressive MS may possibly be earlier diagnosed. Finally, differentiation with atypical lesions may be improved. Received: 21 April 1999; Revised: 3 August 1999; Accepted: 7 August 1999     

椎管内血管性病变的MRI诊断

目的 总结不同类型椎管内血管性病变的影像特点,以提高对该类疾病的诊断水平. 资料与方法 对33例经手术病理或DSA证实的椎管内血管性病变的影像及临床资料进行回顾性分析,其中海绵状血管瘤11例(髓内8例,髓外硬脊膜外3例),血管母细胞瘤4例(单发2例,多发2例),动静脉病变18例(动静脉瘘12 例,动静脉畸形6例).所有病例均行MR平扫和增强扫描. 结果 椎管内血管性病变好发年龄在40岁左右,临床多表现为渐进性的神经系统受损症状.海绵状血管瘤髓内较髓外相对多见,髓内病变颈段好发,病变多局限,病灶周围T2低信号环较具特征性,强化多不明显;硬脊膜外海绵状血管瘤少见,多发生在胸段,常为边界清楚梭型肿物,均匀明显强化.血管母细胞瘤较少见,可单发亦可多发,多发生在颈、胸段,当伴有较大范围脊髓空洞或囊变,并有明显强化结节时,诊断不难;动静脉病变最多见, MRI多能发现蜿蜒血管流空信号,较易诊断,但具体分型有赖于DSA或手术. 结论 椎管内不同类型的血管性病变具有相对特异的影像表现,MRI可较好地显示病变,并能准确定位,同时可以显示脊髓变性的程度和范围,有利于病变的诊治及判断预后.     

Primary angiitis of the central nervous system: serial MRI of brain and spinal cord

MRI findings in primary angiitis of the central nervous system (PACNS) are highly variable, ranging from normal to diffusely abnormal. We describe brain and spinal cord abnormalities in patients with PACNS and changes over time, to provide criteria which could be useful for differential diagnosis. We reviewed six patients, with a final diagnosis of PACNS, who underwent serial contrast-enhanced brain and spinal MRI. Follow-up ranged from 12 to 60 months. Brain MRI showed multiple small abnormalities in all patients, giving high signal on T2-weighted images, focal or diffuse, mainly in deep and subcortical white matter; four patients had both supra- and infratentorial lesions. On the initial MRI, in five patients, almost 90 % of the abnormal foci showed contrast enhancement. Virchow-Robin perivascular spaces were enlarged and simultaneously enhancing in four patients. Three patients also had spinal cord abnormalities, in the cervical and thoracic segments in two, and exclusively cervical segment in one. Two patients had brain biopsy-proven PACNS; in the remainder, the diagnosis of PACNS was presumptive, considering similarities in clinical and MRI features and MRI follow-up. On MRI, after steroid and immunosuppressive therapy, a significant decrease in the number and size of the abnormalities, enhancing and nonenhancing and of enhancing perivascular spaces was observed. Simultaneous enhancement of brain and spinal cord lesions and of perivascular spaces, at the onset of the disease, which resolves during follow-up, can therefore suggest PACNS. Received: 1 July 2000 Accepted: 21 November 2000     

脊髓亚急性联合变性的MRI诊断要点分析

目的分析脊髓亚急性联合变性(SCD)的MRI诊断要点。资料与方法回顾性分析15例临床确诊SCD的病人临床及MRI资料,分析其脊髓MRI表现特点,统计分析SCD病人受累脊髓节段数与血清VB12水平、发病时间的相关性。结果 15例SCD病人均于横断面影像上显示颈胸段脊髓对称性等或长T1、长T2信号,13例病变主要位于颈胸段水平脊髓后索,2例同时累及后索、侧索及前索。但于横断面T2WI上颈段与胸段脊髓异常信号形态各具特点。颈段脊髓受累时于横断面T2WI上呈脊髓内"倒V"形或"反兔耳"形的对称性高信号。胸段脊髓受累时于横断面T2WI上呈脊髓内"哑铃"形的对称性高信号。统计学分析显示15例SCD病人脊髓受累节段数与血清VB12水平呈负相关,而与病程长短无相关性。结论脊髓MR成像对于SCD脊髓疾病的诊断有重要价值。     

脊髓多发性硬化的MRI诊断

目的 提高对脊髓多发性硬化的MRI诊断水平。材料与方法 对14例脊髓多发性硬化病变的部位、范围、病变处脊髓形态、MR信号及强化程度进行分析评价。结果 脊髓多发性硬化的特征性MRI表现为：主要发生在颈段脊髓,病变平均为5个椎体长度,急性期病变局部脊髓肿胀,病变呈斑片状,T1WI呈低或等信号,T2WI呈高信号,静脉注射Gd-DTPA后病变呈斑片状或边缘强化。经激素正规治疗后病变脊髓恢复正常,强化程度减弱或无强化。结论 MRI不仅有助于脊髓多发性硬化的诊断,而且有助于与其他脊髓内病变的鉴别诊断。     

不典型髓母细胞瘤的MRI诊断

目的 探讨不典型髓母细胞瘤的MRI表现，提高对髓母细胞瘤的认识。资料与方法 搜集经MRI诊断、临床及病理证实的12例髓母细胞瘤，其中8例为原发性髓母细胞瘤，4例为髓母细胞瘤转移；8例有增强MRI扫描资料，1例作颈胸椎MR扫描，分析其MRI表现。结果 8例原发性髓母细胞瘤中，1例表现为两侧小脑半球多发结节状病灶，所有病灶均明显强化；4例病变居于第四脑室内；2例病变侵犯桥臂；1例表现为完全囊性病变。4例髓母细胞瘤转移中，1例为上颈髓内转移；1例为颈、胸椎多发椎体转移；2例为两侧大脑半球内多发转移。结论 髓母细胞瘤的不典型表现可为两侧小脑半球多发病变，居于第四脑室内或侵犯桥臂、完全囊变等，其不典型转移方式可为骨转移、脑内或脊髓内转移等。     

Comparison of a conventional cardiac-triggered dual spin-echo and a fast STIR sequence in detection of spinal cord lesions in multiple sclerosis

The current optimal imaging protocol in spinal cord MR imaging in patients with multiple sclerosis includes a long TR conventional spin-echo (CSE) sequence, requiring long acquisition times. Using short tau inversion recovery fast spin-echo (fast STIR) sequences both acquisition time can be shortened and sensitivity in the detection of multiple sclerosis (MS) abnormalities can be increased. This study compares both sequences for the potential to detect both focal and diffuse spinal abnormalities. Spinal cords of 5 volunteers and 20 MS patients were studied at 1.0 T. Magnetic resonance imaging included cardiac-gated sagittal dual-echo CSE and a cardiac-gated fast STIR sequence. Images were scored regarding number, size, and location of focal lesions, diffuse abnormalities and presence/hindrance of artifacts by two experienced radiologists. Examinations were scored as being definitely normal, indeterminate, or definitely abnormal. Interobserver agreement regarding focal lesions was higher for CSE (ϰ = 0.67) than for fast STIR (ϰ = 0.57) but did not differ significantly. Of all focal lesions scored in consensus, 47 % were scored on both sequences, 31 % were only detected by fast STIR, and 22 % only by dual-echo CSE (n. s.). Interobserver agreement for diffuse abnormalities was lower with fast STIR (ϰ = 0.48) than dual-echo CSE (ϰ = 0.65; n. s.). After consensus, fast STIR showed in 10 patients diffuse abnormalities and dual-echo CSE in 3. After consensus, in 19 of 20 patients dual-echo CSE scans were considered as definitely abnormal compared with 17 for fast STIR. The fast STIR sequence is a useful adjunct to dual-echo CSE in detecting focal abnormalities and is helpful in detecting diffuse MS abnormalities in the spinal cord. Due to the frequent occurrence of artifacts and the lower observer concordance, fast STIR cannot be used alone. Received: 9 September 1999; Revised: 14 December 1999; Accepted: 16 December 1999     

脊髓多发性硬化的MRI诊断与鉴别诊断

目的　提高对脊髓多发性硬化MRI特征的认识。方法　对 15例脊髓多发性硬化患者行颈部MRI检查。对病变的位置、长度、横断面上病变大小及病变的强化进行评价 ,并与脊髓内肿瘤、脊髓型颈椎病、急性横贯性脊髓炎的MRI表现进行比较。结果　 15例脊髓多发性硬化主要发生在颈段脊髓 ,病变一般少于 5个椎体长度 ,MRI特点为矢状位脊髓局限性梭形增粗 ,边缘光滑。T1WI呈等或界限模糊的稍低信号 ,T2 WI呈长短不一的条形高信号。轴位像病灶位于脊髓侧方和后方 ,一般小于脊髓截面 1/2。活动期病灶呈条、片状强化 ,但强化区范围明显小于T2 高信号灶范围。反复发作病例多发病灶强化多样性 ,也可不强化。结论　脊髓多发性硬化有其特征性MRI表现 ,能为临床诊断提供可靠的依据     

Comparison of MRI pulse sequences for investigation of lesions of the cervical spinal cord

Small spinal cord lesions, even if clinically significant, can be due to the low sensitivity of some pulse sequences. We compared T2-weighted fast (FSE), and conventional (CSE) spin-echo and short-tau inversion-recovery (STIR)-FSE overlooked on MRI sequences to evaluate their sensitivity to and specificity for lesions of different types. We compared the three sequences in MRI of 57 patients with cervical spinal symptoms. The image sets were assessed by two of us individually for final diagnosis, lesion detectability and image quality. Both readers arrived at the same final diagnoses with all sequences, differentiating four groups of patients. Group 1 (30 patients, 53 %), with a final diagnosis of multiple sclerosis (MS). Demyelinating lesions were better seen on STIR-FSE images, on which the number of lesions was significantly higher than on FSE, while the FSE and CSE images showed approximately equal numbers of lesions; additional lesions were found in 9 patients. The contrast-to-noise ratio (CNR) of 17 demyelinating lesions was significantly higher on STIR-FSE images than with the other sequences. Group 2, 19 patients (33 %) with cervical pain, 15 of whom had disc protrusion or herniation: herniated discs were equally well delineated with all sequences, with better myelographic effect on FSE. In five patients with intrinsic spinal cord abnormalities, the conspicuity and demarcation of the lesions were similar with STIR-FSE and FSE. Group 3, 4 patients (7 %) with acute myelopathy of unknown aetiology. In two patients, STIR-FSE gave better demarcation of lesions and in one a questionable additional lesions. Group 4, 4 patients (7 %) with miscellaneous final diagnoses. STIR-FSE had high sensitivity to demyelinating lesions, can be considered quite specific and should be included in spinal MRI for assessment of suspected demyelinating disease. Received: 21 September 1999/Accepted: 10 December 1999