磁敏感加权成像对弥漫性轴索损伤的诊断价值

目的：探讨磁敏感加权成像（SWI）对弥漫性轴索损伤（DAI）的诊断价值。方法对28例临床诊断DAI病例常规行TSE,液体衰减反转恢复（FLAIR）序列和磁共振扩散加权成像（DWI）及SWI扫描。结果SWI可显示23例DAI的颅内微小出血灶,表现为点状、条索状、类圆形或串珠状的低信号影,检出率82.1％,常规TSE序列检出率25.0％（7/28）,FLAIR序列检出率42.8％（12/28）,DWI序列检出率57.1％（16/28）。结论SWI能敏感地检出外伤后弥漫性轴索损伤患者的脑内小出血灶。     

磁敏感加权成像在脑出血中的应用价值

目的 探讨MRI磁敏感加权成像(SWI)在脑出血中的应用价值.方法 对12例经CT确诊的脑出血患者于发病2 d内及2周后分别进行MRI常规序列及SWI扫描,并进行血肿分期及对各序列的病灶显示率、微出血灶的分布和出血量评估.结果 在12例脑出血患者中,共发现33处出血灶.SWI、T,WI、T<,2>WI、Flair序列对...     

磁敏感加权成像对脑震荡的诊断价值

目的探讨磁敏感加权成像(suscepetiblity-weighted imaging,SWI)在轻型颅脑损伤脑震荡患者中检测出细小出血灶(microbleeds)的诊断意义。方法 37例颅脑CT检查阴性,考虑诊断为脑震荡的患者应用常规MRI及SWI进行检查(观察组),9例健康体检者也行常规MRI及SWI检查(对照组);分析2组应用常规MRI及SWI检查发现细小出血灶的阳性率、数量及分布。结果观察组37例患者中常规MRI发现细小出血灶者4例(10.8%),出血灶数量11个,SWI发现细小出血灶者11例(29.7%),出血灶数量43个,其中SWI检测出细小出血灶者11例中的7例MRI检查阴性,SWI检测出细小出血灶阳性率及数量明显高于MRI检查,差异有统计学意义(P0.05);对照组常规MRI及SWI均未发现细小出血灶。结论对脑震荡患者应用SWI检测较颅脑CT及常规MRI能更敏感地发现出血性病变,为明确患者的诊断提供影像学证据,具有很高的临床应用价值。     

3.0T磁共振磁敏感加权成像对脑血管畸形的诊断评价

目的探讨磁敏感加权成像（SWI）技术对脑血管畸形的诊断价值。方法对21例脑血管畸形行3．0T常规MRI和SWI检查，其中5例同时行时间飞跃法（TOF）磁共振血管成像（MRA）检查，1例CE—MRA检查，7例行静脉注射钆喷酸葡胺注射液（Gd—DTPA）常规增强扫描。SWI采用新的3D静态梯度回调采集（GRASS）序列覆盖全脑扫描，图像后处理采用美国通用电气公司4．2工作站及最小强度投影技术获得完整的静脉血管形态。结果在21例脑血管畸形中，包括动静脉畸形（AVM）4例，静脉畸形8例、海绵状血管瘤9例均在SWI清楚显示，其中4例AVM常规MRI和MRA与SWI情况基本一致：8例静脉畸形在常规MRI和MRA检查均未见显示，但5例增强扫描的图像有3例显示异常静脉畸形血管，与SWI所见一致；9例海绵状血管瘤常规Mill显示7例．且SWI所显示的瘤体轮廓比常规图像更加清楚。结论SWI在脑血管畸形的诊断中扮演重要的作用，特别是对小AVM、静脉畸形和海绵状血管瘤的早期检出和由此引起的出血或微出血评价有重要的价值。     

磁敏感加权成像在轻型颅脑损伤患者中的诊断价值

目的探讨磁共振磁敏感加权成像(SWI)对轻型颅脑损伤(MTBI)患者的诊断价值。方法回顾分析32例MTBI患者(格拉斯哥昏迷量表评分13~15分)的临床资料。患者伤后1周内给予头部CT、MRI及SWI检查,结合CT及相位图排除气体、血管和颅底伪影后,SWI图上的低信号为脑内挫伤出血灶。分别记录MRI常规序列和SWI探查到的病灶数目、发生部位,并结合临床症状进行分析。结果 SWI对脑外伤微小挫伤出血灶检查阳性率明显高于CT及MRI普通序列扫描,特别是在伤后出现晕厥昏迷史或持续性出现临床症状的患者中更为明显。结论 SWI比常规CT及MRI对MTBI患者脑内微小挫伤及出血灶的检出有更高的准确性和客观的诊断价值,并对指导临床治疗及判断预后有重大意义。     

磁敏感成像诊断颅内多发海绵状血管瘤的价值

目的：探讨磁敏感加权成像（SWI）对颅内多发海绵状血管瘤的诊断价值。方法：采用SWI序列并与常规MRI扫描序列进行对照,对5例颅内多发海绵状血管瘤患者进行扫描,分析MR不同扫描序列对颅内多发海绵状血管瘤图像的区别。结果：5例患者中T1WI发现海绵状血管瘤病灶15个,T2WI发现病灶37个,T2 FLAIR发现病灶53个,SWI发现病灶179个。结论：MR SWI序列在颅内多发海绵状血管瘤显示方面具有较高敏感性,尤其对于小病灶的检出,应将其列入颅内多发海绵状血管病常规检查。     

磁敏感加权成像在脑海绵状血管瘤的定量分析

目的探讨磁敏感加权成像（SWI）序列对脑海绵状血管瘤诊断的敏感性,定量评价SWI序列较常规MRI序列及弥散加权成像（DWI）序列对脑海绵状血管瘤的诊断价值。方法回顾分析经临床及病理证实的27例脑海绵状血管瘤患者磁共振影像,对T1WI、T2WI、DWI及SWI序列在病灶检出数目、病灶面积方面进行测量。结果 T1WI检出病灶共31个,T2WI检出病灶35个,DWI检出病灶46个,SWI检出病灶106个。单个病灶最大面积：T1WI平均（0.80±0.38）cm^2,T2WI平均（0.96±0.43）cm^2,DWI平均（1.14±0.56）cm^2,SWI平均（1.43±0.61）cm^2。结果显示：SWI较T1WI、T2WI、DWI序列病灶检出数目多。在病灶面积显示方面,SWI序列明显优于T1WI、T2WI、DWI序列,且存在显著差异,P均〈0.05。结论SWI序列在检出脑海绵状血管瘤的病灶范围和数目方面明显优于T1WI、T2WI、DWI序列,具有重要临床应用价值。     

磁敏感加权成像在脑微出血诊断中的应用价值

目的探讨磁敏感加权成像在脑微出血诊断中的应用价值。方法选取我院收治的120例疑似脑微出血患者为研究对象,对120例疑似脑微出血患者分别行MRI常规序列扫描以及SWI序列扫描,对检出CMBs阳性例数、脑微出血灶位置分布情况、脑微出血灶数量的显示情况进行比较。结果 90例患者通过SWI检测均显示出磁敏感效应,SWI主要表现为条状、点状以及类圆形等,检出率为100%;86例常规序列检出CMBs阳性,检出率为76.5%,二者具有显著性差异(P0.05)。90例患者中通过T1WI序列扫描表示病灶显示不明显,通过T2WI序列扫描共检出232个低信号灶。SWI序列共检出1 392个低信号灶。结论磁敏感加权成像技术具有高度的敏感性,在现阶段的临床应用中可检出脑微出血的最佳序列,从而更好的为临床治疗提供参考。     

丘脑底核与帕金森氏病

帕金森氏病（ｐｏｒｋｉｎｓｏｎ＇ｓｄｉｓｅａｓｅ,ＰＤ）患者长期多巴胺治疗产生运动机能的波动和不自主的异常运动,治疗十分棘手。目前根据基底节生理功能的进展已向人们提供了多条新的治疗途径［１—４］。黑质—纹状体多巴胺能耗竭可能是由于丘脑底核（ｓｕｂｔｈ...     

脑深部电刺激治疗帕金森病的长期随访研究

目的长期随访一组采用双侧脑深部电刺激(DBS)丘脑底核(STN)的帕金森(PD)病人,为临床研究提供参考。方法 195例PD病人在我院接受了双侧STN-DBS手术。术中采用微电极记录STN的外放电信号,刺激电极测试病人症状改善情况及副反应阈值。分别在术前术后1年、3年和5年采用UPDRS评分评估PD病人开/关两种状态下的症状改善程度。结果术前对照,PD病人术后5年关状态运动评分改善率为60.3%;日常生活评分的改善率为54.2%。语言是运动评分中唯一没有改善的症状。异动症除外,术后1年开状态下运动评分没有显著改善。第1年和第5年开状态下运动迟缓、姿势障碍和步僵症状较术前均有加重。术后第5年异动症较术前明显改善。结论 PD病人双侧STN-DBS术后长期随访结果表明,关状态下运动评分和开状态下异动症均明显改善。术后第1年和第5年比较,行动迟缓、语言、姿势异常、步僵和认知功能的障碍均有加重。     

双侧丘脑底核电刺激治疗原发性帕金森病

目的 探讨双侧丘脑底核(STN)电刺激(DBS)对原发性帕金森病(PD)的治疗效果及手术方式。方法 应用MRI扫描、手术计划系统及微电极导向技术进行靶点定位,对15例病人行双侧丘脑底核电极植入及锁骨下刺激器植入,术后1～2周打开刺激器,术后1个月到2年随访评价。结果 全部15例病人术后肢体僵直、震颤及运动迟缓等症状明显缓解,UPDRS运动评分和日常生活能力评分均有显著下降(P<0.01),左旋多巴服用量也有不同程度的减少,无严重或永久并发症发生。结论 双侧STN电刺激手术治疗原发性PD,可全面改善病人症状,尤其是中线症状的改善更为明显;可通过调节刺激参数达到最佳治疗效果并避免副反应的发生;病人服药量减少,是一种安全有效的治疗方法。     

Functional imaging of subthalamic nucleus deep brain stimulation in Parkinson's disease

Deep brain stimulation of the subthalamic nucleus is an accepted treatment for the motor complications of Parkinson's disease. The therapeutic mechanism of action remains incompletely understood. Although the results of deep brain stimulation are similar to the results that can be obtained by lesional surgery, accumulating evidence from functional imaging and clinical neurophysiology suggests that the effects of subthalamic nucleus‐deep brain stimulation are not simply the result of inhibition of subthalamic nucleus activity. Positron emission tomography/single‐photon emission computed tomography has consistently demonstrated changes in cortical activation in response to subthalamic nucleus‐deep brain stimulation. However, the technique has limited spatial and temporal resolution, and therefore the changes in activity of subcortical projection sites of the subthalamic nucleus (such as the globus pallidus, substantia nigra, and thalamus) are not as clear. Clarifying whether clinically relevant effects from subthalamic nucleus‐deep brain stimulation in humans are mediated through inhibition or excitation of orthodromic or antidromic pathways (or both) would contribute to our understanding of the precise mechanism of action of deep brain stimulation and may allow improvements in safety and efficacy of the technique. In this review we discuss the published evidence from functional imaging studies of patients with subthalamic nucleus‐deep brain stimulation to date, together with how these data inform the mechanism of action of deep brain stimulation. © 2011 Movement Disorder Society     

Mortality in patients with Parkinson's disease treated by stimulation of the subthalamic nucleus.

Subthalamic nucleus (STN) stimulation improves motor disability and quality of life in patients with advanced Parkinson's disease (PD). Short-term mortality is low, but little is known about long-term mortality. We assessed mortality and causes of death in 171 consecutive PD patients treated by STN stimulation. Surgery was performed after a median lagtime of 13 years from PD onset at a median age of 57 years. The median follow-up after surgery was 41 months. Sixteen patients died 8 to 83 months after neurosurgery. Poorer cognitive function was the only predictive factor for mortality (standardized mortality ratio = 2.9; 95% confidence interval [CI], 1.6-4.7; P < 0.0001). Based on a historical comparison of 118 operated patients with 39 nonoperated patients from a different population, survival among operated patients was not better (hazard ratio = 1.2; 95% CI, 0.7-2.1).     

The subthalamic nucleus,oscillations, and conflict

The subthalamic nucleus (STN), which is currently the most common target for deep brain stimulation (DBS) for Parkinson's disease (PD), has received increased attention over the past few years for the roles it may play in functions beyond simple motor control. In this article, we highlight several of the theoretical, interventional, and electrophysiological studies that have implicated the STN in response inhibition. Most influential among this evidence has been the reported effect of STN DBS in increasing impulsive responses in the laboratory setting. Yet, how this relates to pathological impulsivity in patients' everyday lives remains uncertain. © 2015 International Parkinson and Movement Disorder Society     

丘脑底核电刺激治疗帕金森病的临床应用

目的探讨丘脑底核(STN)脑深部电刺激术(DBS)治疗帕金森病(PD)的手术方法和脉冲发生器的程控调节。方法行STN DBS治疗PD61例,其中单侧30例,双侧31例。采用磁共振扫描结合微电极记录技术进行靶点定位。术后用UPDRS运动评分评价刺激效果。结果术后随访6～36个月,平均11.3个月。脉冲发生器开启时,在“关”状态下,UPDRS运动评分改善率5.2%;在“开”状态下,UPDRS运动评分改善率20.7%,未发现任何并发症。结论STN DBS能有效控制PD症状,手术并发症少,术后可调节参数,已成为治疗PD的重要手术方法。     

Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech.

Levodopa (L-dopa) and subthalamic nucleus (STN) stimulation treatments have been associated with both improvement and exacerbation of dysarthria in Parkinson's disease (PD). We report four cases illustrating variant responses of dysarthria to dopaminergic and STN stimulation therapies. Patients' motor disability and dysarthria were perceptually rated by the Unified Parkinson's Disease Rating Scale (UPDRS) in four conditions according to medication and STN stimulation. Dedicated software packages allowed acquisition and analysis of acoustic recordings. Case 1, who had a severe off period aphonia, experienced improvement of speech induced by both levodopa and STN stimulation. In Case 2, both treatments worsened speech due to the appearance of dyskinesias. Case 3 had a dysarthria exacerbation induced by STN stimulation with parameters above optimal levels, interpreted as current diffusion from the STN to corticobulbar fibers. In Case 4, dysarthria exacerbation occurred with stimulation at an electrode contact located caudally to the target, also arguing for current diffusion as a potential mechanism of speech worsening. The presented cases demonstrated variant effects in relation to L-dopa and STN stimulation on speech. It seems that motor speech subcomponents can be improved like other limb motor aspect, but that complex coordination of all speech anatomical substrates is not responsive to STN stimulation. These hypotheses may be helpful for better understanding and management of STN stimulation effects on motor speech and skeleton-motor subsystems.     

Lifetime of Itrel II pulse generators for subthalamic nucleus stimulation in Parkinson's disease.

The efficacy of bilateral subthalamic nucleus (STN) stimulation in Parkinson's disease (PD) is well-established but little is known about the lifetime of implanted pulse generators (IPG). To investigate the lifetime of the bilaterally implanted Itrel II(R) (Medtronic, Minneapolis) pulse generator, the first 49 consecutive patients with PD having been operated on at our center for bilateral STN chronic stimulation were reviewed with noting of the stimulation parameters in use prior to IPG replacement. The mean electrical voltage was 3.2 +/- 0.3 V, mean pulse width was 65 +/- 10 mus, and mean frequency was 145 +/- 16 Hz. Replacement of an IPG was anticipated in 25% due to unilateral low-battery signaling, or end of life. In either case, replacement of the contralateral IPG was undertaken simultaneously. The mean IPG lifetime was 83 +/- 14 [40-113] months. The IPG lifetime correlated with the total electrical energy delivered (P = 0.002, r = -0.496). Unilateral IPG end-of-life generally led to subacute worsening of contralateral parkinsonism. In 25% of patients, there was also a worsening of axial symptoms leading to potential medical emergencies such as falls (10%), aspiration pneumonia (10%), or psychosis (5%). A close monitoring of patients and an anticipation of IPG replacement in the case of a low-battery signal are recommended.     

丘脑底核电刺激术治疗帕金森病的疗效

目的评估丘脑底核脑深部电刺激(STN-DBS)对帕金森病的临床疗效。方法回顾性分析应用STN-DBS手术治疗的32例帕金森病病人的临床资料,在术前、术后3个月分别采用统一帕金森病评定量表(UPDRS)、抑郁自评量表(SDS)和症状自评量表(SCL-90)进行随访评估、心理状况问卷调查和分析。结果脉冲发生器开启后,32例病人的UPDRS日常活动和运动功能在"关"状态,平均改善率为51.7%和60.9%;在"开"状态下,平均改善率21.4%和22.3%。20例病人术前SDS评分50分,其SCL-90的抑郁、焦虑、躯体化、人际敏感、敌对、恐怖和偏执7个因子显著高于中国常模(P0.05)。术前与术后SCL-90抑郁、躯体化、恐怖、焦虑、精神病性因子有显著性差异(P0.05),人际敏感、偏执、敌对和强迫等因子无显著性差异(P0.05)。结论 STN-DBS可以改善帕金森病病人的运动功能,提高日常生活能力,还可以明显改善帕金森病伴抑郁病人的心理状况,是安全有效的治疗方法。