原发性中枢神经系统血管炎的影像诊断

目的探讨原发性中枢神经系统血管炎的影像学诊断.方法对7例临床或病理证实的中枢神经系统血管炎的MRI、CT表现进行回顾性分析.结果 6例位于幕上,以额叶多见,其中1例为双侧多发,幕下1例位于小脑半球.影像学上,多数病灶边界模糊,累及灰质和白质,以白质为主,可有水肿,有不同程度斑片样或脑回样强化,部分类似肿瘤.结论原发性中枢神经系统血管炎的影像学表现多种多样,CT和MRI在该病的诊断和随访上具有重要价值.     

原发性中枢神经系统血管炎的影像诊断(附7例报告并文献复习)

目的探讨原发性中枢神经系统血管炎的影像学诊断.方法对7例临床或病理证实的中枢神经系统血管炎的MRI、CT表现进行回顾性分析.结果 6例位于幕上,以额叶多见,其中1例为双侧多发,幕下1例位于小脑半球.影像学上,多数病灶边界模糊,累及灰质和白质,以白质为主,可有水肿,有不同程度斑片样或脑回样强化,部分类似肿瘤.结论原发性中枢神经系统血管炎的影像学表现多种多样,CT和MRI在该病的诊断和随访上具有重要价值.     

肿块样原发性中枢神经系统血管炎的磁共振表现

目的：描述肿块样原发性中枢神经系统血管炎的MRI表现,探讨该病变的MRI诊断价值。方法：对进行了MR检查的8例经活检病理证实的肿块样原发性中枢神经系统血管炎的MR影像学表现特征进行了回顾性分析。结果：MRI显示6例表现为单发局限性肿块;2例表现为多发肿块。3例呈均匀长T1信号,5例呈短T1及长T1混杂信号;3例呈均匀长T2信号,5例呈不均匀长T2信号。全部8例经钆喷替酸葡甲胺（Gd-DTPA）增强,病灶均有明显强化。所有8例患者的全部病变均呈团块样强化。结论：肿块样原发性中枢神经系统血管炎影像学诊断较困难,MR检查常将本病误诊为肿瘤。认识其MRI表现特点有助于诊断该疾病,以避免手术造成的严重损伤,但最终确诊仍需脑活检。     

原发性中枢神经系统血管炎9例

目的 初步探讨原发性中枢神经系统血管炎的临床特点及全身和局部免疫抑制治疗方法.方法 对北京协和医院9例诊断为原发性中枢神经系统血管炎的患者进行回顾性分析.结果 患者平均发病年龄35岁,临床表现多种多样,脑脊液异常者8例,血沉和C反应蛋白升高者4例.所有患者均有头颅磁共振(MRI)或磁共振血管成像(MRA)的异常.多数患者激素及环磷酰胺治疗有效,部分患者鞘内注射地塞米松和甲氨蝶呤显效.结论 原发性中枢神经系统血管炎是一种罕见的主要累及中枢神经系统的自身免疫性疾病,诊断需结合临床、实验室、影像学和病理.     

脑内原发性恶性淋巴瘤的MRI诊断

目的:评价MRI对脑内原发性恶性淋巴瘤的诊断价值。方法:收集经MRI检查并由手术病理证实的脑内原发性恶性淋巴瘤患者12例(其中5例做了增强MRI),回顾分析其MRI表现。结果:单发病灶10例、多发病灶2例,共检出病灶14个,幕上13个,幕下1个;大部分位于深部脑白质,其中累及额叶9个,侵及胼胝体6个,侵及室管膜2个;T1WI呈略低信号或等信号12个,T2WI全部呈等信号或略高信号。增强后“握拳”样强化2例,“团块”样强化3例。病灶直径大于5cm的5个,3~5cm的7个,小于3cm的2个。病灶周围轻度水肿7个,中度水肿6个,重度水肿1个。结论:尽管脑内原发性恶性淋巴瘤缺乏特征性的影像学表现,但全面分析其MRI表现,能够明显提高本病的诊断准确率。     

病毒性脑干脑炎合并脑动脉炎的磁共振成像特征

目的探讨病毒性脑干脑炎合并脑动脉炎的磁共振成像（MRI）特征。方法回顾性分析经临床和MRI证实的脑干病毒性感染20例临床影像资料。所有患者均行常规T1WI、T2WI、液体衰减反转回复序列（FLAIR）检查,其中增强磁共振血管成像（MRA）检查11例。结果脑干病毒感染性病变位于延髓8例,脑桥13例,中脑5例;病灶单发7例,多发13例;病灶表现为长T1长T2信号。2例椎基底动脉FLAIR显示高信号,增强MRA显示椎基底动脉信号丢失或血管狭窄。结论 FLAIR与增强MRA相结合可以评估椎基底动脉的形态和血液动力学,可在一定程度上为临床的早期诊断脑血管炎及其鉴别诊断提供依据。     

股骨近端骨样骨瘤影像学表现及诊断价值

目的:探讨股骨近端骨样骨瘤影像学表现及其诊断价值。方法:回顾性分析病理证实的6例股骨近端骨样骨瘤患者临床及影像学资料。结果:6例均为单发病灶,其中1例位于股骨头,3例位于股骨颈,1例位于小转子,1例位于转子下。X线平片4例可见圆形或卵圆形瘤巢影,周围有不同程度骨质硬化,其中3例可见点状钙化。CT检查4例均显示类圆形透亮瘤巢影,周围伴骨质增生硬化,其中2例瘤巢内见斑点状钙化。MRI检查2例,均显示瘤巢,T1WI呈低信号,T2WI呈稍高信号,其中1例瘤巢中央可见点状钙化,于T1WI及T2WI均呈低信号。结论:股骨近端骨样骨瘤与其他部位骨样骨瘤影像学表现相似,X线平片结合CT可对其作出正确诊断,可避免不必要穿刺活检或MRI检查。     

颅内原发性恶性淋巴瘤11例CT、MRI诊断及鉴别诊断

目的：提高对颅内原发性恶性淋巴瘤的认识。方法：回顾性分析11例经手术及病理证实的颅内原发性恶性淋巴瘤的CT、MRI表现。结果：11例肿瘤9例位于幕上，2例位于小脑半球，均为单发，且均为非霍奇金淋巴瘤。本病以中老年人多见，病程短，病情发展快。术前诊断困难，较易误诊，确诊依靠手术和病理检查。结论：颅内原发性恶性淋巴瘤影像学表现缺乏特异性，与某些中枢神经系统病变鉴别比较困难，综合分析颅内原发性恶性淋巴瘤的CT、MRI征象，有利于对本病作出更好地诊断。[著者文摘]     

青少年幕上原始神经外胚层肿瘤的CT、MRI和病理分析

目的:探讨幕上原始神经外胚层肿瘤的CT、MRI影像学表现,提高影像学诊断的准确率,减少误诊.方法:分析经手术证实的7例幕上原始神经外胚层肿瘤的CT、MRI表现.结果:多数病灶位于额顶枕叶,普遍较大.1例为多发,囊变1例,壁结节1例,钙化3例,4例T1WI呈等低信号,1例T1WI呈等高信号,5例T2WI呈高信号,流空小血管3例.增强扫描表现为不均匀强化5例.环状强化、结节强化各2例,浸入上矢状窦1例.3例瘤周水肿明显,1例轻度瘤周水肿.3例见斑片状、扭曲样钙化.2例钙化在MRI上亦呈高信号.结论:幕上原始神经外胚层肿瘤影像学表现有一定特征,但特异性不强,一些MRI特征有助于诊断,最后确诊仍需依靠病理学诊断.     

CT和MRI对颅内血管母细胞瘤的诊断价值比较

目的比较CT和MRI对颅内血管母细胞瘤的诊断价值。方法回顾分析经手术及病理证实的26例颅内血管母细胞瘤的临床及影像学资料。经CT检查26例,经MRI检查22例。结果幕下小脑血管母细胞瘤25例(96.2%),幕上大脑半球1例(3.8%)。18例呈大囊小结节型,3例呈实质型,3例呈混合型,2例呈单纯囊型。结论CT与MRI对颅内血管母细胞瘤具有重要诊断价值,MRI更能较全面地显示脑血管母细胞瘤的特点。     

原发性中枢神经系统血管炎的MRI特征

目的 分析原发性中枢神经系统血管炎（PACNS）的MRI特征。方法 回顾性分析16例PACNS患者的临床和MRI资料,观察其影像学表现特征。结果 16例PACNS,9例单发,7例多发,MRI共检出45个病灶,其中位于幕上38个（38/45,84.44%）,脑干4个（4/45,8.89%）,脊髓2个（2/45,4.44%）,小脑半球1个（1/45,2.22%）。14例MRI表现为大片或斑片状影,2例表现为多发或单发肿块。病灶MR平扫呈T1WI低信号,T2WI高信号,FLAIR序列高信号;6例病灶内可见出血。16例DWI均呈高信号,其中ADC图呈高信号13例,低信号3例。病灶周围可见不同程度脑水肿。增强扫描14例可见强化,2例无明显强化。1例MRA检查可见左侧大脑前动脉A4段局限性狭窄。结论 PACNS的MRI表现复杂多样,需对病变影像学特征进行综合分析;肿块样PACNS与脑肿瘤鉴别困难。     

动脉瘤模型及病人脑动脉瘤的MRA与DSA对照研究

目的：探讨MRA评价脑动脉瘤的优势与不足。方法：用“静脉囊镶嵌法”将10只犬制成三种类型动脉瘤模型（单侧型、分叉型和末梢型）。术后2周分别进行MRA、DSA检查。30例临床及影像学证实的脑动脉瘤患者行常规MRI、MRA及DSA检查。结果：MRA对脑动脉瘤的敏感性为92%,结合原始断层图像和MRI,敏感性则高达98%。对于血栓性动脉瘤的检测,MRA优于DSA影像。结论：对于Willis环区动脉瘤MRA可取代常规血管造影。     

Primary angiitis of the central nervous system: emerging variants

BACKGROUND: Primary angiitis of the central nervous system (PACNS), a serious disease, has not featured prominently in the spectrum of multi-organ disease seen in vasculitis clinics. AIM: To evaluate the presentation, natural history and features of PACNS variants and compare to those of systemic vasculitides. DESIGN: Retrospective analysis. METHODS: Patients (n=105) presented during 1988-2003 to a tertiary regional vasculitis clinic receiving unselected disease types. Data were collected from a clinical database, patient and laboratory records. RESULTS: The frequency of PACNS presentation rose over the study period, compared with most of the other vasculitides. When PACNS was divided into small- and middle-sized vessel disease (SVD/MVD), their clinical courses differed substantially. SVD PACNS was responsive to immunosuppressive drugs, but relapsed during prolonged periods in all patients on maintenance immunosuppressives, or after withdrawal of treatment, causing recurrent, severe and irreversible CNS injury. MVD PACNS had isolated episodes at presentation, with a paucity of relapses during prolonged follow-up. DISCUSSION: Similarities between SVD PACNS and microscopic polyarteritis suggest the former may represent a limited form of the latter. MVD PACNS has a distinctly more benign relapse pattern than its multisystem counterpart polyarteritis nodosa. Acute-phase serology was useful in designating inflammatory processes at presentation of patients presenting with encephalopathy caused by SVD only, but were unhelpful in defining relapses in this form of PACNS, the definition of which in all cases rested on clinical assessment and MR scanning. Direct cerebral angiography was not diagnostic in any case of SVD PACNS; positive brain biopsy is diagnostically unequivocal, but the total clinical syndrome with imaging may establish a diagnosis with highest probability. In MVD PACNS, angiography with MR scan proved diagnostic. We suggest an algorithm for a rational, minimally invasive approach to investigation. In PACNS, SVD and MVD are important variants, and decisions about therapy should incorporate these distinctions.     

MRI评价肺动静脉瘘

目的　评价MRI、MRA等对肺部血管畸形的临床应用价值。方法　分析了 6例手术或血管造影证实的AVF病例的多种表现 ,其中男 5例 ,女 1例 ,采用 1.0T超导MRI仪 ,体线圈技术。分别行SE、2D TOF、3D TOF及cine MRI多种序列成像 ,共行 3 5次MRI和MRA等检查。结果　 6例AVF中共发现 9个病灶。 2例共 3个病灶在SE序列中可见大小不等流空信号 ,其余为等信号之软组织块影、边缘不规则 ;在梯度回波序列 (2D、3D TOF及cine MRI)中病灶均呈高信号或极高信号影 ,在2D TOF中可见到 5例病灶的供血动脉及 3例引流静脉 ;在 3D TOF中可见到 4例病灶的供血动脉及 2例引流静脉 ;在cine MRI序列中可见到 3例病灶供血动脉及 2例引流静脉 ,且cine MRI可见到 5例病灶内信号强弱变化同心动周期一致。结论　目前 ,MRI多种序列的结合应用 ,可以较准确地诊断AVF ,作为一种无创性诊断方法有一定临床应用价值。     

动脉瘤性蛛网膜下腔出血的影像学特征及早期临床诊断

目的探讨动脉瘤性蛛网膜下腔出血(SAH)的影像学特征及早期病因学诊断方法,并客观评价其优缺点。方法对115例动脉瘤性SAH采用CT、CTA、MRI、MRA、DSA等影像学检查并结合病史、临床表现进行早期临床诊断。结果115例SAH均在急性出血期内(7天)被早期诊断,其中有96例患者在7天内被DSA检查诊断为动脉瘤,早期病因诊断率83.5%,另19例在7天后二次造影诊断。全组9例行MRA,6例发现动脉瘤;12例行CTA,9例发现动脉瘤。结论采用CT及DSA可以对动脉瘤性SAH进行早期病因学诊断;该方法安全、准确,对动脉瘤性SAH的早期诊断、早期治疗具有重要的应用价值。     

弥散张量成像在脑白质病变中的应用价值初探

ThisstudyperformedacombinedconventionalanddiffusiontensorMRimagingfrom10multiplesclerosis,10multiplelacunarinfarction,3cysticercosis,1angiitis,1morphinistand10healthycontrolvolunteerstoinvestigatedmorphologicandquantitativeindex.1Subjectsandmethods1.1SubjectsTwenty-fivepatientsandtenhealthycontrolvol-unteersunderwentacombinedconventionalanddiffusiontensorMRimagingduringoneyear.Thepatientsincludetenmultiplesclerosis(7womenand3men)whoseagewasfrom17to48years,themediandurationofthediseasewas1yea…     

Diffusion—tensor magnetic resonance imaging in brain white matter diseases

Objective To evaluate the usefulness of diffusion-tensor MR imaging in brain white matter diseases.Methods A combined conventional and diffusion tensor MRI were obtained from 10 multiple selerosis,10 multiple lacunar infarction,3 cysticercosis,1 angiitis, 1morphinist and 10 healthy control volunteers.After oblaining mean diffusivity (D) and fractional anisotropy images and image coregistration,the corelations of the lesions and the white matter pathways were investigated.D and A values were measured form four big lesions which can be seen in T2WI and compared to contralateral white matter.Also D and AI value of four different anatomic locations of normal-appearing white matter regions were measured in all patients and controls.Results Whereas the lesions of infarction,cysticercosis and angiitis were in and outside the white matter pathways,all plaques of multiple sclerosis were inside the whit matter pathways.The brain white matter lesions by 1 morphinist were beside the lateral ventricle with big pachy appearance,which was partly inside white matter.For MS,D value was higher in lesion than contorl white matter. But for other diseases,D value could be seen higher or lower compared to healthy side.Ai values were lower in all lesions,D valuewas higher and AI was lower in normal appearing brain white matter when comparing MS to other cases or healthy control volunteers.Conclusion Diffusion tensor MR images can determine the correlations of the lesions and brain white matter pathways.The changes of D and AI values can improve specificity in differential diagnoses though quanti6tatively analyzing the tissue damage in lesions and normal-appearing brain white matter.     

MRI对脑血管畸形的诊断价值

目的：评价ＭＲＩ在脑血管畸形诊断中的价值。材料和方法；本文选择经ＭＲＩ平扫加增强检查，并经过手术、磁共振血管造影（ＭＲＡ）或减影血管造影（ＤＳＡ）证实的脑血管畸形４０例，分析其ＭＲＩ特征。结果：ＭＲＩ表现可分为直接征象与间接征象。结论：ＭＲＩ对脑血管畸形有定性定位诊断价值，特别是适用于血管造影生的隐匿性血管畸形。