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可逆性后部白質腦病綜合征一例

帕金森病腦鐵沉積的影像學研究進展

近年來腦鐵異常沉積作為帕金森病（Parkinson disease，PD）發病機制之一受到廣泛關注。應用影像學技術，尤其是 MRI 技術，對 PD 的腦結構和功能影像的研究報道較多。其中，尤以針對 PD 腦鐵沉積的研究眾多，但目前腦鐵在 PD 中的異常沉積的影像學研究的結論不一致，且腦鐵異常沉積在早期診斷 PD 中是否具有應用價值仍有爭議。該文就目前 PD 中腦鐵沉積的影像學研究及腦鐵沉積與 PD 臨床相關性研究進行了綜述。

Evaluation of Brachial Plexus with MRI

摘要:目的: 探討臂叢神經磁共振成像的技術方法及其可行性。 方法 :對15例正常志愿者行雙側臂叢神經成像:包括常規快速自旋回波序列T1加權(T1W/TSE)、快速自旋回波序列T2加權(T2W/TSE)、快速自旋回波序列T2加權加SPIR脂肪抑制(T2W/SPIR)冠狀位掃描以及彌散加權背景抑制成像序列(DWIBS)軸位掃描。 結果 :T1W/TSE、T2W/TSE、及T2W/SPIR對臂叢節后神經同層顯示率分別為533%、567%和833%;DWIBS MIP重建圖像對臂叢神經的全貌顯示較為完整、清晰、直觀;T1W/TSE、T2W/TSE、T2W/SPIR及DWIBS MIP重建圖像的對比噪聲比分別為109±09、107±13、185±68和299±133,T2W/SPIR序列和DWIBS MIP重建圖像的對比噪聲比明顯高于T1W/TSE和T2W/TSE序列。 結論 :T2W/SPIR序列對臂叢神經的同層顯示率及圖像的對比噪聲比明顯高于常規T1W/TSE、T2W/TSE序列, DWIBS MIP重建圖像能夠顯示臂叢神經的全貌,兩者為臂叢神經成像較為有效的技術方法,對于臂叢神經病變的診斷即具有十分重要的意義。Abstract: Objective: To determine the optimal sequences of brachial plexus with MRI. Methods : Fifteen volunteers were underwent MRI on 15T scanner, the Sequences of T1W/TSE/COR, T2W/TSE/COR, T2W/SPIR/COR and Diffusionweighted imaging with background body signal suppression were performed. Results : The display rates of brachial plexus postganglionic segment nerve showing at the same slice were 533%, 567% and 833% on T1W/TSE/COR, T2W/TSE/COR, T2W/SPIR/COR. Brachial plexus on DWIBS MIP were clear and complete. Contrastnoise ratio of four sequences was 109±09, 107±13, 185±68 and 299±133,respectively. Contrastnoise ratio of T2W/SPIR/COR and DWIBS MIP was significantly higher than that of the other two sequences. Conclusion : Display rate of brachial plexus and contrastnoise ratio of images on T2W/SPIR/COR were higher than those of routine sequences. Image of DWIBS MIP can show the outline of brachial plexus clearly. The two sequences were reliable and effetive techoniquic in diagnosis of brachial plexus lesion.

影像學診斷在宮頸癌分期中的應用

【摘要】　宮頸癌的發病率居國內女性生殖系統惡性腫瘤的首位。臨床檢查以婦科檢查為主，有一定的主觀性和局限性。陰道鏡下行宮頸組織活檢病理學檢查，對宮頸癌前病變較為實用，準確率較高。因此，宮頸組織活檢病理學檢查是確診宮頸癌的金標準。B型超聲、CT及MRI影像檢查在宮頸癌的診斷、分期及治療計劃制定和療效評價中起著越來越重要的作用。現就各種影像學檢查在宮頸癌中的診斷及分期予以綜述。

二價錳離子增強磁共振視神經活體示蹤的實驗研究

MRI Diagnosis and Differential Diagnosis of Cerebral Military Tuberculosis

【摘要】 目的 探討粟粒性腦結核及與其需要鑒別疾病的MRI特點。 方法 2007年12月-2009年10月，對11例粟粒性腦結核患者的MRI平掃及增強表現進行分析，總結其MRI特征性表現。 結果 病史上粟粒性腦結核多存在血行播散型肺結核，平掃表現為多發小片影，增強后表現為彌漫分布的小環狀或結節狀強化灶，大小趨向一致，多為2 mm左右，可合并結核性腦膜炎及腦積水。 結論 粟粒性腦結核的MRI平掃表現不典型，增強表現有一定特征性，認識其特點可以和其它常見的顱內多發病變進行鑒別。【Abstract】 Objective To analyze the MRI appearances of cerebral military tuberculosis and other diseases that need to differentiate. Methods From December 2007 to October 2009, the MRI appearances of 11 cases on the plain scan and the enhanced MRI scan after injection of Gd-DTPA were reviewed and summarized. Results The cases of cerebral military tuberculosis usually had the history of military pulmonary tuberculosis, showed multiple lesions in fragments on plain scan, and the lesions distributed diffusely after enhancement, showed as ring form or nodosity. The size tended to be uniform, often 2 mm in diameter approximately. Tuberculosis meningitis and hydrocephalus could accompany. Conclusion The manifestation of plain MRI is not typical, and the enhancement MRI is imperative. Some characteristic appearances can be found after injection of Gd-DTPA, and these characteristic appearances could be helpful to differentiate with other multiple intracranial diseases.

Dynamic Enhanced MRI in the Diagnosis of Endometrial Carcinoma

【摘要】 目的 探討MRI動態增強掃描在子宮內膜癌手術前診斷中的價值。 方法 回顧分析2008年2月-2010年3月38例經手術病理證實為子宮內膜癌患者的動態增強MRI檢查資料，判斷內膜癌子宮肌層和宮頸浸潤情況，與病理結果對照，計算T2WI及動態增強序列診斷肌層及宮頸浸潤的敏感度、特異度、準確度等，分析兩種序列診斷準確度有無差異；計算內膜癌組織與子宮肌層在動態增強各期的對比信噪比，并分析其在各期間有無差異。 結果 動態增強序列診斷內膜癌肌層和宮頸受侵的敏感度、特異度、陽性預測值、陰性預測值分別為96.8%、85.7%、96.8%、85.7%和85.7%、91.7%、85.7%、91.7%；動態增強序列診斷內膜癌深肌層浸潤的準確度為94.7%，顯著高于T2WI診斷深肌層浸潤的準確度78.9%（Plt;0.05）；平衡期內膜癌組織與子宮肌層的對比信噪比顯著高于動脈期和靜脈期（Plt;0.01）。 結論 MRI動態增強掃描能夠在手術前準確的判斷內膜癌肌層及宮頸浸潤，有助于子宮內膜癌治療方式的選擇。【Abstract】 Objective To investigate the role of dynamic-enhanced MRI in the diagnosis of endometrial carcinoma. Methods Thirty-eight patients with endometrial carcinoma confirmed by surgicopathology undergone dynamic-enhanced MRI scans were analyzed retrospectively. The invasion in myometrium and uterine cervix were analyzed. The tumor and myometrium contrast-to-noise ratios during different phases of dynamic imaging were calculated. MR imaging findings were compared with pathologic findings. Sensitivity, specificity, diagnostic accuracy, positive and negative predictive values of MR imaging in depicting myometrial and cervical infiltration were calculated. Results Respective sensitivity, specificity, and positive and negative predictive values in assessing myometrial infiltration were 968%,85.7%,96.8%,85.7%;those for cervical infiltration were 85.7%,91.7%,85.7%,91.7%,respectively. The diagnostic accuracy (94.7%) of dynamic imaging in depicting deep myometrial infiltration were significantly higher than that of T2WI (78.9%) (Plt;0.05).There was a significant improvement in tumor and myometrium contrast-to-noise ratios during the equilibrium phase compared with the arterial and venous phases (Plt;0.01). Conclusion Dynamic-enhanced MRI is highly accurate in preoperative diagnosis of endometrial carcinoma, which will benefit for the treat of endometrial carcinoma.

Evaluation of Dynamic Contrast-Enhanced MRI and Diffusion Weighted Imaging in Judging the Therapeutic Effect on Hepatocellular Carcinoma after Transcatheter Arterial Chemoembolization

【摘要】　目的　探討磁共振動態增強掃描及磁共振彌散加權成像（diffusion weighted imaging，DWI）對肝癌經導管動脈內化學栓塞（transcatheter arterial chemoembolization，TACE）治療后的腫瘤殘余及復發的判斷價值。　方法　2009年1月-2010年10月，對28例經證實的肝癌患者在TACE治療前、治療后3~7 d及治療后1~2個月、3~6個月行磁共振動態增強及DWI掃描，動態測量表觀彌散系數（apparent diffusion coefficient，ADC）值，與數字減影血管造影（digital substraction angiography，DSA）檢查對照，評價動態增強掃描及DWI對腫瘤殘留或復發的檢出能力。〖HTH〗結果　對腫瘤殘余及復發的顯示，動態增強掃描靈敏度為90.0%，特異度為96.9%；DWI靈敏度為96.7%，特異度為93.8%；動態增強掃描與DWI相結合的靈感度為100.0%，特異度為99.5%；DSA靈敏度和特異度分別為96.7%、100.0%。TACE治療前所有腫瘤實質的ADC值為（1.134±0.014）×10-3 mm2/s；TACE治療后3~7 d ADC值為（1.162±0.016）×10-3 mm2/s；TACE治療后1~2個月碘油沉積較好，無明顯殘余或復發病灶的ADC值為（1.175±0.015）×10-3 mm2/s，3~6個月后隨訪病灶ADC值為（1.179±0.017）×10-3 mm2/s；TACE治療后1~2個月碘油沉積不完全或無明顯沉積病灶ADC值為（1.147±0.016）×10-3 mm2/s，3~6個月后隨訪病灶實質平均ADC值（1.142±0.012）×10-3 mm2/s。　結論　將動脈增強掃描與DWI相結合可提高對TACE治療后肝癌殘余及復發判斷的靈敏度及特異度；對腫瘤組織平均 ADC值的動態測量、觀察可及早判斷腫瘤復發的可能性。【Abstract】　Objective　To evaluate the dynamic contrast-enhanced MRI and diffusion weighted imaging (DWI) in judging the remnant and recurrence on hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). 　Methods　Between January 2009 and October 2010, 28 patients with HCC underwent dynamic contrast-enhanced MRI and DWI before and after TACE 3-7 days, 1-2 months and 3-6 months, respectively, and the apparent diffusion coefficient (ADC) value of the tumor were also measured at above mentioned time points. The sensitivity and specificity of dynamic contrast-enhanced MRI and DWI in diagnosis of residual tumor and recurrent cancer was qualitatively evaluated by comparing with the DSA results.　Results　Compared with DSA, the sensitivity and specificity of dynamic contrast-enhanced MRI were 90.0% and 96.9% by revealing the remnant and recurrence of HCC, while the sensitivity and specificity of DWI were 96.7% and 93.8% respectively. Combining dynamic contrast-enhanced MRI and DWI the sensitivity and specificity were improved to 100.0% and 99.5%, respectively. The mean ADC value of tumor before and after 3-7 days of TACE were (1.134±0.014)×10-3 and (1.162±0.016)×10-3 mm2/s, respectively. The mean ADC value of tumor without and with remnant and recurrence after 1-2 months and 3-6 months follow up were (1.175±0.015)×10-3, and (1.179±0.017)×10-3 mm2/s; (1.147±0.016)×10-3 and (1.142±0.012)×10-3 mm2/s, respectively.　Conclusions　Combining dynamic contrast-enhanced MRI and DWI could improve the sensitivity and specificity to detect the remnant and recurrence of HCC after TACE. Measuring the ADC value during follow up of HCC patients after TACE could predict the probability of tumor recurrence.

Clinical Value of Diffusion Weighted Imaging in the Diagnosis of Placenta Increta

ObjectiveTo discuss the value of diffusion weighted imaging (DWI) in the diagnosis of placenta increta. MethodsThe clinical data of 42 patients with placenta increta admitted to Sichuan Provincial Hospital for Women and Children between May 2012 and January 2014 were retrospectively analyzed. All the patients were examined by prenatal magnetic resonance scans and DWI scans for subsequent comparison between ADC of the local convex placental region and ADC of the normal placental region and between the results of the two imaging methods. ResultsADC of the implantation area was significantly different from that of the normal placenta, so it could be used as a quantitative index. DWI had a higher sensitivity of diagnosis than conventional MRI. ConclusionCompared with conventional magnetic resonance imaging, DWI is more valuable in the clinical diagnosis of placenta increta, which provides a reliable basis for clinical treatment.

MRI manifestations of juvenile-onset ankylosing spondylitis

Objective To explore the MRI features of juvenile-onset ankylosing spondylitis (JoAS) for improving the level of diagnosis and therapy. Methods MRI findings of JoAS in 25 patients confirmed by clinical and laboratory results between October 2010 and September 2014 were retrospectively analyzed. Results There were a total of 67 locations of lesion in the 25 cases, including 19 in sacroiliac joint, 21 in hip joint, 6 in ischial tuberosity, 6 in crista iliaca, 9 in knee joint, 4 in ankle joint, and 2 in foot. MRI showed 63 locations with bone marrow edema, 36 with joint effusion, 26 with bone destruction, and 19 with enthesitis. Conclusions Bone marrow edema is the most common MRI manifestation of JoAS, and the main bone destruction is middle axis joint. MRI is sensitive but not specific to lesions, so differential diagnosis is needed and helpful.