脑干胶质瘤磁共振波谱分析

目的探讨磁共振波谱(Magnetic resonance spectroscopy,MRS)在脑干胶质瘤诊断中的意义。方法回顾性分析10例脑干胶质瘤的临床资料,肿瘤位于中脑1例,中脑脑桥1例,脑桥7例,延髓1例。均行MRS检查,对肿瘤区、肿瘤边缘区和正常对照区进行对照研究。结果MRS均显示肿瘤区N-乙酰天门冬氨酸(N-acetylaspartate,NAA)峰值下降,胆碱(Choline,Cho)峰上升。与肿瘤边缘区和正常对照区比较,肿瘤区NAA/Cr明显减低,Cho/Cr和Cho/NAA明显升高。星形细胞瘤4例,间变性星形细胞瘤1例,胶质母细胞瘤2例;另3例根据临床特点和影像学表现诊断为脑干胶质瘤。结论MRS可检测到脑干胶质瘤的代谢改变,具有无创、敏感、诊断准确的特点。     

难治性抑郁症患者海马代谢的磁共振质子波谱研究

目的 探讨难治性抑郁症患者双侧海马磁共振质子波谱(1H-MRS)的代谢特点.方法 运用1H-MRS成像系统检测16例难治性抑郁症患者(患者组)和16名健康对照者(对照组)双侧海马的N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)、肌醇(mI)及肌酸(Cr)4种代谢产物,分别计算双侧NAA/Cr、Cho/Cr及mI/Cr.采用配对t检验、独立样本t检验及偏相关分析进行统计处理.结果 对照组左侧海马NAA/Cr(1.43±0.19),明显高于右侧(1.21±0.10),P＜0.01.患者组双侧海马NAA/Cr的差异无统计学意义(P＞0.05),右侧海马NAA/Cr(1.44±0.31),明显高于对照组(1.21±0.10),P＜0.01.未发现患者组海马的任何代谢指标与病程及汉密尔顿抑郁量表(17项)评分的相关性(P＞0.05).结论 难治性抑郁症患者右侧海马代谢增强,双侧海马NAA/Cr不对称性消失.     

轻度认知损害患者氢质子磁共振波谱随访研究

目的回顾分析并总结轻度认知损害(MCI)患者认知功能转归及脑组织代谢物氢质子磁共振波谱(~1H-MRS)特点。方法采用简易智能状态检查量表(MMSE)和蒙特利尔认知评价量表(Mo CA)评价75例轻度认知损害患者和17例性别、年龄、受教育程度相匹配的正常对照者的认知功能,1H-MRS检测左侧海马和左侧额叶代谢物[包括N-乙酰天冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、肌醇(m I)、谷氨酸复合物(Glx)]表达变化。结果与正常对照者相比,轻度认知损害患者左侧海马和左侧额叶Glx/Cr比值均降低(P=0.030,0.030)。至随访结束时,MCI组7例(9.33%)进展为阿尔茨海默病、55例(73.33%)认知功能无变化、13例(17.33%)逆转为认知功能正常;正常对照组13例(13/17)认知功能功能无变化,2例(2/17)进展为轻度认知损害,无一例进展为阿尔茨海默病。不同认知功能转化亚组中仅MCI-MCI组患者Glx/Cr比值高于MCI-AD组(P=0.040)。结论左侧海马和左侧额叶Glx/Cr比值降低可能是轻度认知损害患者认知功能恶化较敏感的生物学指标,尚待扩大样本量、延长随访时间深入研究。     

精神疾病的质子磁共振波谱研究

本文简单介绍了脑质子磁共振波谱技术，并叙述其对一些精神疾病的研究现状和发展前景。     

精神疾病的质子磁共振波谱研究

本文简单介绍了脑质子磁共振波谱技术 ,并叙述其对一些精神疾病的研究现状和发展前景。     

初发抑郁症患者丘脑质子磁共振波谱分析

目的探讨未用药首发抑郁症患者丘脑的脑代谢有无异常。方法利用质子磁共振波谱分析技术(1H-MRS)检测20例未用药首发抑郁症患者和20名健康志愿者丘脑的多个代谢指标,包括乙酰天门冬氨酸盐(NAA)、谷氨酰胺和谷氨酸复合物(Glx)、胆碱复合物(Cho)、肌酸-磷酸肌酸复合物(Cr)等。结果与对照组相比,患者组双侧丘脑NAA/Cr下降,但只有右侧的差异有统计学意义(t=2.923,P<0.05);两组间各代谢值、Cho/Cr和Glx/Cr的差异无统计学意义(P>0.05);轻度抑郁组和重度抑郁组间比较,各代谢值的差异均无统计学意义(P>0.05)。结论初发抑郁症患者右侧丘脑可能存在神经元受损和线粒体代谢障碍。     

慢性精神分裂症患者双侧海马质子磁共振波谱成像研究

目的 利用质子磁共振波谱(~1H-MRS)研究慢性精神分裂症患者双侧海马生化物质的变化.方法 选择武警广东总队医院神经外科自2007年1月至2009年6月收治的慢性精神分裂症患者25例做为患者组,门诊体检正常志愿者25例为对照组,利用~1H-MRS测量2组成员双侧海马N-乙酰天门冬氨酸(NAA),胆碱复合物(Cho)和肌酸--磷酸肌酸复合物(Cr)含量,计算NAA/Cr和Cho/Cr的比值.结果 慢性精神分裂症患者双侧海马NAA/Cr的比值(左侧2.05±0.14,右侧1.98±0.17)低于正常对照组(左侧2.19±0.13,右侧2.17±0.14),差异有统计学意义(P<0.05);Cho/Cr比值(左侧1.30±0.12,右侧1.25±0.18)高于正常对照组(左侧1.04±0.15,右侧0.95±0.13),差异有统计学意义(P<0.05).结论 慢性精神分裂症患者双侧海马可能存在神经元的缺失或功能损伤,并且伴有膜磷脂代谢紊乱.     

抑郁症首次发病患者额叶三维磁共振氢质子波谱分析研究

目的探讨抑郁症首次发病患者额叶灰、白质可能存在的神经生化异常。方法对24例首次发病抑郁症患者(抑郁症20例,双相障碍抑郁发作者4例;抑郁症组)进行磁共振常规扫描及应用三维磁共振氢质子波谱(1HMRS)检查,测量双侧额叶背外侧白质和前部扣带回皮质的N-乙酰天门冬氨酸(NAA)、胆碱复合物(CHO)、肌醇(MI)和肌酸(CR)的绝对值,计算NAA、CHO、MI与CR的比值,并与21名正常对照者(对照组)作比较。结果(1)抑郁症组患者前额叶扣带回皮质CHO[(772±59)MMOL/L]、MI[(131±39)MMOL/L]的绝对值及CHO/CR(2·3±0·4)、MI/CR(0·39±0·14)均高于对照组[分别为(663±70)MMOL/L,(99±26)MMOL/L,2·0±0·4,0·30±0·01],差异均有统计学意义(P均<0·01);而NAA的绝对值及NAA/CR与对照组的差异无统计学意义(P>0·05)。(2)抑郁症组患者额叶背外侧白质内NAA、CHO、MI的绝对值以及NAA/CR、CHO/CR、MI/CR的比值与对照组的差异均无统计学意义(P均>0·05)。结论抑郁症患者额叶扣带回皮质的CHO、MI绝对值以及CHO/CR、MI/CR比值均增高。     

抑郁症首次发病患者海马磁共振质子波谱成像的研究

目的 探讨抑郁症首次发病患者海马的磁共振质子波谱(1H-MRS)代谢物质的变化.方法 对99例首次发病的抑郁症患者和26例健康对照组行磁共振常规扫描及1H-MRS检查,测量双侧海马N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)和肌酸(Cr)三种代谢物质,计算NAA/Cr和Cho/Cr比值.结果 抑郁症患者海马NAA/Cr左右侧比值(1.23±0.16;1.16±0.16)低于对照组NAA/Cr左右侧比值(1.38±0.23;1.31±0.26),差异有显著性(P<0.05);抑郁症患者海马体部Cho/Cr左右侧比值(1.19±0.14;1.18±0.12)高于对照组Cho/Cr左右侧比值(1.14±0.12;1.11±0.14),差异有显著性(P<0.05).对照组左右侧NAA/Cr和Cho/Cr比较差异无显著性(P>0.05).抑郁症组右侧NAA/Cr低于左侧,差异显著(P<0.05);左侧Cho/Cr高于右侧,差异不明显(P>0.05).结论 抑郁症患者可能存在双侧海马神经细胞代谢功能障碍,右侧神经细胞功能障碍较左侧明显.     

轻度阿尔茨海默病患者磁共振成像及磁共振氢质子波谱研究

目的　探讨磁共振成像 (magneticresonanceimaging,MR)及磁共振氢质子波谱 (1H magneticresonancespectroscopy ,1H MRS)对轻度阿尔茨海默病 (Alzheimerdisease ,AD)患者的早期诊断。方法　对 18例临床确诊轻度AD患者和 2 0名正常对照者的MR及1H MRS进行分析 :MR上观察两组的海马回钩间距 (AB)及同层颅腔左右径 (CD)并计算两者间 (AB/CD)的比值 ;对两组额、颞叶区行1H MRS检测 ,得到N 乙酰天门冬氨酸 (N acetylaspartate ,NAA)峰、肌酸 (creatine ,Cr)峰、胆碱 (choline ,Cho)峰的积分值及计算NAA/Cr、NAA/ (Cr Cho)。对 2组检测值 ( x±s)行t检验。结果　AD组的AB =(2 7 5 3± 2 1)mm ,AB/CD =(0 2 2± 0 0 5 )mm及额、颞叶的NAA分别是 32 74± 4 72和35 38± 3 5 2 ,颞叶的NAA/Cr=2 4 6± 0 4 3,与正常对照组比较均有统计学差异 (P <0 0 5 )。用ROC法找出诊断阈值并联合应用诊断早期AD ,敏感性为 87% ,特异性为 94 %。结论　海马回钩间距及其与同层颅腔左右径比值的增大 ;额、颞叶NAA的减少 ,尤其是颞叶NAA的减少有助于对轻度AD患者的早期诊断。     

Magnetic resonance imaging and brain-stem auditory evoked potentials in neuro-Behcet's disease

We studied central nervous system lesions in patients with neuro-Behcet's disease using magnetic resonance imaging (MRI) of the brain and recording of brain-stem auditory evoked potentials (BAEPs). MRI revealed abnormal findings in seven of eight patients. MRI studies demonstrated extensive regions with high intensity signal in the brain stem and/or basal ganglia on T2-weighted images obtained during the acute stage of the disease in three patients. One of these patients had a strongly gadolinum-enhanced round lesion in the lower pons. In four of the other five patients with chronic disease, brain-stem atrophy was observed on T1-weighted images. Atrophic changes were more severe in the brain stem than in the cerebellum. Abnormal BAEPs were observed in three patients and consisted of prolongation of interpeak latency of waves III-V and defects of wave III or V. Abnormal BAEPs were recorded in patients with severe inflammatory changes or progression of atrophic changes in the brain stem. Our findings show that MRI and BAEPs are useful in detecting the presence and assessing the degree of neurological involvement in patients with neuro-Behcet's disease.     

Cure of a man with solitary abscess of the brain-stem

Summary A 25-year-old man with lung abscess and signs of an abscess in the rostral brain-stem was cured by large doses of antibiotics and stereotactic aspiration of the abscess.     

Blink reflex in patients with an ischaemic lesion of the brain-stem verified by MRI

The electrically elicited blink reflex was investigated in 25 patients with ischaemic lesions of the pons or the medulla oblongata. Only patients with a lesion on MRI appropriate to the clinical syndrome were included. Twenty patients had an infarction of the pons, bilateral in 5. Additional 5 patients had an infarction of the dorsolateral medulla oblongata. Patients with hemispheric lesions were excluded. Four of the 5 patients with Wallenberg's syndrome showed delayed R2 components to stimulation ipsilateral to the lesion. Additional loss of the ipsilateral R1 component was observed in 1 patient. Fifteen of the 20 patients with pontine infarctions had pathological blink reflexes. All 6 patients with a unilateral pons lesion and an abnormality of R1 had this abnormality on the side contralateral to the lesion. In 3 cases with bilateral pontine infarction R1 was abnormal on one side or on either side. Of 11 patients with a normal R1, 6 had isolated abnormalities of R2 without consistent correlation to the side of the lesion. We conclude that abnormalities of the blink reflex are of minor localizing value in pontine infarction. This may be explained by the fact that a pontine infarction affects either the reflex arch itself or descending pathways that have a modulating influence on the reflex arch. Infarctions of the medulla oblongata, however, have characteristic abnormalities that have already been described.     

Influence of magnetic resonance imaging on somatosensory and brain-stem auditory evoked potentials in man

Summary There is still a need to prove that even static magnetic fields up to 1.5 T used in magnetic resonance imaging (MRI) are biologically safe and harmless for humans. Recordings of median and ulnar nerves and brain-stem auditory evoked potentials in 20 patients were completed prior to and after MRI investigation of the central nervous system. Neither the somatosensory nor the auditory evoked potentials exhibited any significant change of latencies, interpeak latencies or amplitudes. Since these electrophysiological parameters are highly dependent on the quality of nerve conduction and integrity of information processing in various nuclei, it may be assumed that MRI causes no lasting changes in either respect.     

Effects of acute ovarian hormone suppression on the human brain: an in vivo 1H MRS study

A previous proton magnetic resonance spectroscopy ((1)H MRS) study carried out by our group indicated that post-menopausal women who started taking oestrogen therapy (ET) at or around the menopause had a significantly lower choline (Cho) concentration in the hippocampus and parietal lobe than those who were ET na?ve, suggesting that long-term ET positively modulates neuronal/glial membrane turnover in older females. The objective of the current study was to determine whether neuronal membrane turnover is modulated by sex hormones in younger women following a pharmacologic challenge that induced acute ovarian hormone suppression. We carried out an in vivo(1)H MRS study in a group of 10 premenopausal women pre- and post-8 weeks of acute ovarian suppression with a Gonadotrophin Releasing Hormone analogue (GnRHa) (two Zoladex 3.6 mg implants). We report that young women, post-ovarian suppression, had a significant increase in Cho concentration (and Cho/Cr ratio) in the dorsolateral prefrontal cortex (DLPFC). They also showed a trend to a significant increase in Cho concentration in the hippocampus. This supports our previous findings and adds to the evidence that neuronal/glial membrane metabolism is affected by sex hormones in women.     

MRS对微创血肿清除术后的评估研究

目的观察脑出血患者保守治疗及微创血肿清除术治疗后的磁共振波谱(MRS)表现,探讨血肿周围脑组织改变及微创血肿清除术的临床价值。方法将20例高血压性脑出血患者随机分为2组,微创血肿清除手术组(微创组)和保守治疗组(对照组)各10例,所有病例均于发病后9～11d行常规MR及MRS检查。结果对照组血肿周围NAA/Cr值与对侧相应区的NAA/Cr值有显著性差异(P<0.01),前者较后者降低(12.6±7.4)%,其中4例可见到明确的乳酸峰;微创组血肿周围NAA/Cr值与对侧相对应区的NAA/Cr值亦有显著性差异(P<0.05),前者较后者降低(7.4±6.8)%;微创组血肿周围NAA/Cr值与对照组有显著性差异(P<0.05)。结论血肿周围NAA/Cr降低反映了血肿周围神经元损伤;微创血肿清除术能改善脑出血后的脑水肿形成。     

颅内多发病灶的立体定向活检术后病理学结果与MRS结果的比较分析

目的探讨立体定向活检术及磁共振波谱成像（MRS）在颅内多发病灶定性诊断中的临床价值。方法回顾性分析37例经MRI、MRS和立体定向活检术后病理学检查确诊的颅内多发病灶患者的临床资料,其中行有框架定向活检术22例,无框架神经导航定向活检术15例。结果 37例均获得明确病理学诊断,其中低级别胶质瘤19例,高级别胶质瘤8例,淋巴瘤3例,多发脱髓鞘3例,炎性病灶2例,转移癌2例。术后出现癫痫发作1例,活检靶点少量出血1例。病理学诊断与MRS诊断符合率为83.8%（31/37）,误诊率为16.2%（6/37）。结论 MRS在颅内多发病灶的诊断中具有较高的准确性,但仍有一定的误诊率;立体定向活检术微创、安全,在颅内多发病灶的诊断中具有决定性的意义;MRS的代谢变化在活检术靶点选择上具有一定的指导价值。     

Combined application of MRS and DWI can effectively predict cell proliferation and assess the grade of glioma: A prospective study

In order to assess combined application of MRS and DWI for prediction cell proliferation and grade diagnosis of glioma, We prospectively collected the Cho/Cr, Cho/NAA, Cr/NAA of MRS and tumor parenchyma ADC (ADC_T), contralateral mirror brain tissue ADC (ADC_H), rADC (rADC = ADC_T/ADC_H). According to postoperative pathology, the patients were divided into two groups: LGG group and HGG group, compared differences of age, gender, Ki67, MRS, DWI between two groups. Next, we analyzed the correlation between MRS, DWI and Ki67. On this basis, the sensitivity and specificity of MRS, DWI and MRS combined with DWI (MRS + DWI) in diagnosis of glioma grade were evaluated. The differences of Ki67, Cho/Cr, Cho/NAA, Cr/NAA, ADC_T, rADC between LGG group and HGG group were statistically significant (p = 0.000, 0.000, 0.000, 0.008, 0.000, and 0.000 respectively). From ROC curve, area under the curve (AUC), sensitivity and specificity of Cho/Cr, Cho/NAA, Cr/NAA, ADC_T, rADC, PRE (MRS + DWI) were (0.901, 86.7%, 85.7%), (0.876, 80.0%, 82.1%), (0.704, 63.3%, 71.4%), (0.862, 82.1%, 83.3%), (0.820, 75.0%, 76.7%), (0.920, 86.7%, 89.3%), respectively. Fisher's linear discriminant functions results suggest: Y₁ = -20.447 + 3.46•X₁ + 17.141•X₂ (LGG), Y₂ = -19.415 + 4.828•X₁ + 14.543•X₂ (HGG). Our study suggested that MRS and DWI can effectively predict cell proliferation preoperative. MRS combined with DWI can further improve sensitivity and specificity in assessing the grade of glioma.     

Valproate-induced encephalopathy: assessment with MR imaging and 1H MR spectroscopy

The anticonvulsant agent valproate (VPA) may cause hyperammonemic encephalopathy. Magnetic resonance imaging (MRI) and proton MR spectroscopic (MRS) findings in a patient with VPA-induced hyperammonemic encephalopathy are described. MRI showed a metabolic-toxic lesion pattern with bilateral T2-hyperintense lesions in the cerebellar white matter and in the globus pallidus. MR spectroscopic findings were indistinguishable from hepatic encephalopathy with severe depletion of myoinositol and choline and with glutamine excess. N-Acetylaspartate levels were moderately decreased. Quantitative MRS gave detailed insight into alterations of brain metabolism in VPA-induced encephalopathy.     

磁共振氢质子波谱成像在胶质母细胞瘤诊断中的应用

目的 探讨磁共振氰质子波谱成像(~1H-MRSI)在胶质母细胞瘤诊断中的应用价值.方法 经手术病理证实的29例胶质母细胞瘤,术前均行常规MRI及~1H-MRSI检查,根据常规MRI及~1H-MRSI特点预测其病理性质.并总结出本组病例~1H-MRSI特点.结果 29例中,术前预测正确25例,典型的胶质母细胞瘤的~1H-MRSI表现为NAA明显降低,Cho升高,肿瘤内或边缘Cr/NAA比率显著升高,出现Lac峰.结论 肿瘤内或边缘Cr/NAA比率显著升高是胶质母细胞瘤的主要特征,术前~1H-MRSI能为胶质母细胞瘤的诊断提供较高的诊断价值.