【摘要】 目的 探討腦后部可逆性腦病綜合征（posterior reversible encephalopathy syndrome，PRES）的臨床及MRI表現，提高對PRES的認識。 方法 回顧性分析2007年1月-2010年12月期間5例PRES患者的MRI資料并進行追蹤隨訪。5例PRES患者中男1例，女4例，腎性高血壓及產后子癇各1例、妊娠高血壓3例。5例均行MRI多序列平掃檢查及彌散加權成像（diffusion weighted imaging，DWI），其中4例同時行磁共振血管造影（magnetic resonance angiography，MRA），2例行MRI增強檢查。 結果 5例發病時均有高血壓，以突發頭痛、子癇或癲癇發作、意識障礙及視覺障礙為臨床特點，及時正確治療后癥狀于3~5 d左右消失，1例遺留肢體功能障礙。MRI顯示5例多發病灶主要位于雙側頂枕葉皮質下白質內，額葉及顳葉后部各2例，兩側小腦及腦干1例，皮質受累2例，病變呈長T1、長T2信號、液體衰減反轉恢復序列呈高信號，5例患者病灶DWI圖呈高或等信號，表觀彌散系數（apparent diffusion coefficient，ADC）圖呈略高信號；1例頂葉及1例基底節區部分病灶DWI圖呈高信號，ADC圖呈低信號，提示彌散受限。2例增強無強化，腦膜呈線狀強化。隨訪MRI顯示3例病灶完全消失。1例左側基底節區部分病灶發展為腦梗死。 結論 PRES是一種臨床-影像綜合征，正確認識這一綜合征對其早期診斷和治療具有非常重要的意義。MRI能夠提供較為可靠明確的診斷，其擴散成像對判斷PRES預后亦很有價值。【Abstract】 Objective To investigate the clinical features and MRI manifestations of patients with posterior reversible encephalopathy syndrome (PRES), in order to improve its recognition. Methods From January 2007 to December 2010, MRI data of 5 patients with PRES were retrospectively analyzed and the patients were followed up. Among them, one was male and four were female. There were one case of postpartum eclampsia, one of renal hypertention, and 3 of pregnancy-induced hypertension. All the five patients were examined by MRI diffusion weighted imaging (DWI), among whom four underwent additional magnetic resonance angiography (MRA) and one underwent enhanced MRI. Results All the five patients with PRES had hypertension and their clinical symptoms were characterized by sudden occurrence of headache, eclampsia or seizure of epilepsy, altered mental status, and visual disturbances. Clinical symptoms vanished about 3-5 days after prompt and appropriate treatment except one case of residual body function failure. MRI scanning demonstrated multifocal subcortical white lesions in bilateral parieto-occipital lobes in five patients, in bilateral frontal lobes in two patients, in bilateral post temporal lobes in two patients, in bilateral cerebellum in one patient, and in bilateral brainstem in one patient, and cortical involvement occurred in one patient. Lesions appeared as hyperintense signals on fluid attenuated inversion recovery (FLAIR) and T2-weighted images, hypointense signals on T1-weighted images, normal or increased intensity on DWI, and mild hypointensity on apparent diffusion coefficient (ADC) maps. Some lesions in parietal lobes or basal ganglia showed hyperintensity on DWI and isointensity on ADC maps. The lesions in two patients appeared unenhanced with gadolinium enhancement and the meninges assumed the linear strengthening. Follow-up MRI showed that foci in three patients vanished completely, and the focus in the left basal ganglia in one patient developed into cerebral infarction. Conclusions PRES is a clinical-neuroradiological transient condition. Correctly understanding this syndrome is meaningful for its early diagnosis. MRI can provide a more reliable diagnosis, and its proliferation image formation is also valuable in predicting the PERS prognosis.
目的:研究空蝶鞍綜合征(ESS)患者的X線、CT、MRI表現,探討三種診斷方法在ESS的診斷價值。材料與方法:32例ESS具有完整的X線、CT、MRI及臨床資料。結果:X線、CT、MRI均能發現蝶鞍擴大,X線不能分辨鞍內結構;CT可顯示垂體萎縮,識別75％的垂體柄,有少量偽影干擾,觀察細節受影響;MRI完全顯示鞍區解剖結構及信號變化。結果:MRI是ESS的最佳影像學診斷手段。
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.
Cryptogenic stroke (CS) accounts for 25% of ischemic stroke. The etiology of undetermined stroke is unclear leading to untargeted secondary prevention, high recurrence rate, so the clinical burden of cryptogenic stroke is substantial. Cardiac magnetic resonance (CMR) imaging can identify more occult cardiac embolism that cannot be identified by standard cardiac assessment based on its excellent spatial resolution and contrast, three-dimensional imaging capacity and ability to depict soft tissues, to accelerate the initiation of optimal secondary prevention and improve the prognosis of patients. This review summarizes the application of CMR in the field of CS in recent years. Based on the latest evidence of diagnosis and management strategies, this paper proposes a cardiac diagnostic examination plan for CS patients, thereby improving the secondary prevention strategy of CS patients and improving their quality of life.
ObjectiveTo help junior radiologists and surgeons better interpret MRI images of rectal cancer.MethodThe guidelines, expert consensus and research progress on the application of MR imaging in rectal cancer in recent years were reviewed.ResultsRectal MR had the ability to accurately evaluate a number of important findings that may impact patient’ management, including distance of the tumor to the mesorectal fascia, presence of extramural vascular invasion, and presence of lymph nodes.ConclusionsRectal MRI is an important basis for clinical staging and multidisciplinary diagnosis and treatment of rectal cancer. Surgeons and radiologists must master the key imaging anatomical basis and clinical practice points in order to accurately interpret the image information of MRI in rectal cancer.
ObjectiveTo construct a map of cerebral cortex thickness in Idiopathic Generalized Epilepsy (IGE) diagnosed at the first visit, using T1-weighted brain magnetic resonance imaging and advanced image analysis software. MethodsHigh-resolution three-dimensional T1 images were obtained from 27 IGE patients diagnosed at the first visit and 29 normal controls in Shouguang People's Hospital from January 1, 2022 to December 31, 2021. The location recognition calculation system of the Freesurfer software was used to calculate the values of cortical thickness in each brain region, and the cortical thickness values were transformed into a brain atlas using the image analysis software. A differential brain atlas was generated using the two-sample t-test to analyze the difference in cortical thickness between IGE patients and normal controls. Paired t-test was used for within-group comparison to explore changes of cortical thickness laterality. ResultsIn the IGE brain atlas, the brain regions with higher cortical thickness were the right left temporal pole, the right left entorhinal cortex, the head of the right anterior cingulate gyrus, the right and left insular lobe, the right and left middle temporal gyrus, the right inferior temporal gyrus, the head of the left anterior cingulate gyrus, the left tail of the anterior cingulate gyrus, the left inferior temporal gyrus, the left and right fusiform gyrus, and the left frontal pole. The areas with lower cortical thickness were the right and left paracalcaric gyrus, the right and left cuneiform lobe, the left and right lingual gyrus, the left and right posterior central gyrus, the left lateral occipital gyrus, and the right and left superior parietal gyrus. The distribution of cortical thickness of the IGE group was comparable to the cortical thickness atlas of the normal control. Compared with normal control, the areas with changes of cortical thickness in the IGE group were bilateral superior frontal gyrus, bilateral posterior central gyrus, bilateral anterior central gyri, bilateral lingual gyri, left cuneiform lobe, bilateral entorhinal cortex and temporal pole. The brain areas with laterality of cortical thickness between hemispheres in the IGE group were the tail of anterior cingulate gyrus, cuneiform lobe, inferior parietal gyrus, lateral occipital gyrus, posterior central gyrus, head of anterior cingulate gyrus, and superior marginal gyrus. Compared with normal control, the IGE group has decreased number of brain regions with laterality of cortical thickness. ConclusionThe present study revealed the distribution and laterality of cerebral cortical thickness map in early idiopathic generalized epilepsy, which provides imaging structural basis for brain research in the future.
【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.
ObjectiveTo systematically review the diagnostic efficacy of abbreviated magnetic resonance imaging sequence (AMRI) screening for hepatocellular carcinoma (HCC). MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect studies on the diagnostic efficacy of AMRI screening for HCC from inception to March 2022. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies; then, meta-analysis was performed by using Stata 16.0 software. ResultsA total of 15 studies involving 2 823 participants were included. The results of meta-analysis showed that combined sensitivity and specificity of AMRI for HCC were 0.85 (95%CI 0.83 to 0.87) and 0.93 (95%CI 0.90 to 0.94). Subgroup analysis showed that, the combined sensitivity and specificity of NC AMRI and HBP AMRI were 0.84 (95%CI 0.81 to 0.87), 0.92 (95%CI 0.88 to 0.95) and 0.88 (95%CI 0.84 to 0.91), 0.93 (95%CI 0.91 to 0.94), respectively. The combined sensitivity and specificity of T2+DWI+HBP in HBP AMRI had the highest diagnostic efficacy. ConclusionCurrent evidence shows that all AMRI protocols have acceptable sensitivity and specificity for HCC screening. Among them, T2+DWI+HBP protocol shows the highest diagnostic efficiency. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.