摘要：脊髓亚急性联合变性（subacute combined degeneration of the spinal cord,SCD）是由于维生素B12吸收或代谢障碍引起的神经系统变性疾病。亚急性或慢性起病,最常累及颈胸段脊髓。MRI检查能清晰显示病灶、明确病灶范围,笔者回顾性分析5例经临床确诊的SCD患者的MRI影像及临床资料,旨在探讨MRI对SCD的诊断价值。
摘要：Objective To investigate the feasibility of using 3.0 T diffusion-weighted MRI for the evaluation of radio-chemotherapy effect on esophageal squamous cell carcinoma. Methods 18 patients with esophageal squamous cell carcinoma were recruited for the study. Concurrent radio chemotherapy was carried out on these patients. Routine MRI scan and DWI were performed on these patients before treatment as well as 1、3、5、and 10 weeks after the treatment. To measure and observe the changes of ADC values in esophageal carcinoma. The effect of the therapy was evaluated according to the RECIST standard. Results Among 18 patients, there are 4 who were unable to follow up. In the rest 14 patients, there are 2 with complete response(14.3﹪), 9 with partial response(64.3﹪), 3 with stable disease(21.4﹪), and 0 with lesions in progress(0﹪). Except that 2 patients with complete response ADC measurement was no longer applicable, in 12 patients when b = 600、800 and 1000 s/mm2, ADC values were(1.62 ± 0.23)× 10-3 mm2/s、(1.42 ± 0.25)× 10-3 mm2/s、(1.21 ± 0.27)×10-3 mm2/s respectively before treatment, and(2.77 ± 0.46)× 10-3 mm2/s(、2.61 ± 0.48)× 10-3 mm2/s and (2.37 ± 0.49)× 10-3 mm2/s after tenth week of the therapy. The difference was statistically significant(P = 0.000). Conclusion 3.0 T MR diffusion-weighted imaging in esophageal cancer could help evaluate the curative effects of concurrent radio chemotherapy.%目的：利用3.0 T MR弥散加权成像评价食管鳞状细胞癌放化疗的疗效。方法对18例食管鳞状细胞癌患者采用放疗行同步化疗，并于放化疗前及放化疗第1、3、5、10周行常规MRI平扫及DWI检查，测量并观察食管癌灶ADC值的变化。疗效根据RECIST标准评价。结果18例食管鳞状细胞癌患者，除4例失访外，14例中完全缓解2例（14.3﹪），部分缓解9例（64.3﹪），病变稳定3例（21.4﹪），病变进展0例（0﹪）。除2例完全缓解患者因病灶消失无法测量ADC值外，12例治疗前，在b值分别取600、800和1000 s/mm2时，食管癌灶ADC值分别是（1.62 ± 0.23）× 10-3 mm2/s、（1.42 ± 0.25）× 10-3 mm2/s、（1.21 ± 0.27）× 10-3 mm2/s，同步放化疗后第10周ADC值分别是（2.77 ± 0.46）× 10-3 mm2/s、（2.61 ± 0.48）× 10-3 mm2/s、（2.37 ± 0.49）× 10-3 mm2/s，ADC值较治疗前明显升高，差异均有统计学意义（P = 0.000）。结论3.0 T MR弥散加权成像对食管鳞状细胞癌放化疗的疗效评价具有一定价值。
摘要：目的：探讨海洛因成瘾对大脑皮层厚度的影响及海洛因使用年限与皮层厚度的关系。方法对18例海洛因成瘾者（HDI组）及15例健康志愿者（HC组）进行Philips 1.5 T MR扫描获取高分辨T13D全脑结构图；利用FreeSurfer软件对图像进行分析，检测HDI组皮层厚度的异常改变。结果①基于顶点的分析结果显示，HDI组皮层厚度变薄的区域主要位于双侧额上皮层、左侧额中皮层尾部、右侧脑岛和右侧颞上皮层。皮层增厚的区域主要位于双侧舌回、左侧顶上皮层、左侧颞极、右侧枕叶外侧皮层、右侧顶下皮层和右侧楔叶；②基于感兴趣区的分析，HDI组较HC组患者左侧额上沟、左侧楔前叶、左侧距状沟、左侧侧副沟、右侧枕颞内侧和舌回皮层变薄；③HD组中右侧额上皮层和右侧脑岛的皮层厚度与海洛因使用年限呈负相关。结论海洛因成瘾者存在大脑皮层厚度改变，且吸毒年限可能是导致脑结构改变的重要影响因素。%ObjectiveTo study the effects of heroin exposure on cortical thickness and the relationship between cortical thickness and the duration of heroin use. Methods In this study, we acquired 3D high-resolution T1 weighted brain structural magnetic resonance imaging(MRI)data from 18 heroin-dependent individuals (HDIs)and 15 healthy controls(HCs)using a 1.5 T MR scanner(Phillips). Using FreeSurfer, we detected abnormalities in cortical thickness in the HDIs. Results①Based on a vertex-wise analysis, the HDIs showed significantly decreased cortical thickness in the bilateral superior frontal, left caudal middle frontal, right superior temporal, and right insular regions compared to the HCs; and significantly increased cortical thickness in the left superior parietal, bilateral lingual, left temporal pole, right inferior parietal, right lateral occipital, and right cuneus regions. ②A subsequent ROI-wise analysis showed that, HDIs had a decreased cortical thickness in the left superior frontal sulcus, left precuneus gyrus, left calcarine sulcus, left anterior transverse collateral sulcus, and the right medial occipital-temporal and lingual sulcus. These regions partially overlapped with the areas identified using the vertex-wise analysis.③In addition, we found that the thickness in the right superior frontal and right insular regions was negatively correlated with the duration of heroin use. Conclusion These results provide compelling evidence for cortical abnormality in HDIs and also suggest that the duration of heroin use may be a critical factor associated with the brain alteration.
摘要：ObjectiveTo investigate the application value of using a combination of rCBF brain SPECT and MRI for the localization of intractable epilepsy. Methods 52 patients with intractable epilepsy were recruited.. Ictal and interictal SPECT, together with MRI, were performed before the suregeries on these patients. Subtraction was performed between Ictal and interictal SPECT images. The areas that changed the most on the difference image were considered to be the epilepsy foci. These results were also compared with the MR images. The diagnosis based on a combination of both SPECT and MRI were then compared with the pathology results after surgery. Results Among the 52 patients there were 41(78.85﹪)positive cases based on the SPECT result (blood perfusion decreased); in these patients the number of episodes was significantly reduced after surgery, some even experienced no episodes after surgery. 38 cases of MRI(73.08﹪)patients with hippocampal sclerosis or lesions. With a combination of MRI and SPECT the total effective rate reached 88.46﹪. Conclusions An evaluation based on both of the two examination methods had a higher positive rate of localizing epileptogenic focus than that based on a single image, which is very helpful to the clinical application of pre-surgery localization and in turn resulted in a better surgery result.%目的：探讨SPECT脑血流灌注显像和MRI综合评价癲痫灶定位的临床价值。方法对52例拟手术的癫痫患者行发作期和发作间期脑血流灌注显像，并做减影处理，发作期与发作间期减影处理后变化最显著部位考虑为致痫灶。同期进行MRI检查，结合诊断结果与手术后病理结果进行比较分析。结果52例患者中，SPECT显像阳性者41例（78.85﹪），主要表现为局部脑血流灌注减低，经手术后患者发作次数明显减少或无发作。MRI检查阳性者38例（73.08﹪），患者有海马硬化或病灶。MRI结合SPECT显像阳性者为46例（88.46﹪）。结论两种检查手段综合评价对定位致痫灶较单一影像有更高的阳性率，对术前定位有较高的临床应用价值，尤其是两者检查定位一致者，手术效果较好。
摘要：ObjectiveTo investigate the CT and MRI features of yolk sac tumor in order to improve the diagnostic accuracy. MethodsCT and MRI findings of 7 cases of pathologically confirmed yolk sac tumor were analyzed retrospectively. Plain and enhanced CT scan were performed in 3/7 cases. MRI plain and enhanced scan in 3/7 cases, and only MRI plain scan in 1/7 cases. Alpha fetal protein(AFP)concentration in serum was measured for all cases prior to the surgery. ResultsIn all cases there were unilateral ovarian masses. 5 cases in the left side, and 2 in the right side. The maximum diameter of masses were 6.0 ~ 20.1 cm. The average maximum diameter was 13.5 cm. CT images showed: all the tumors were mixed solid and cystic, and predominantly cystic, with clear boundary and uneven density. The solid part of mass was moderate enhanced. 2 cases showed tortuous tumor vessels inside the tumor, there was no obvious calcification. MR images showed: the tumors in all 4 cases were huge space occupying masses with clear boundary. Among them, 3 cases were mixed solid and cystic with heterogeneous signal, cystic necrosis area inside. The solid part of the 3 cases was obviously enhanced. The other 1 case showed cystic, with several solid nodules in the cystic wall and cavity. The average serum AFP concentration of all cases was 28, 823 μg/L with a range of 602 ~ 48, 214 μg/L. ConclusionOvarian yolk sac tumors have specific CT and MRI characteristics. Correct diagnosis can be made combined with the clinical features and serum AFP concentration before the operation.%目的：探讨卵巢卵黄囊瘤（YST）CT及MRI影像学特征，以提高对该病影像学诊断的准确率。方法回顾性分析7例经手术后病理证实的卵巢卵黄囊瘤的CT、MRI资料，其中3例术前行CT平扫及增强扫描，3例行MRI平扫与增强扫描，1例行MRI平扫。7例术前均检测血清AFP浓度。结果 所有病例均为单侧发病，左侧5例，右侧2例，肿瘤最大径6.0 ~ 20.1 cm，平均最大径13.5 cm。CT表现：3例为巨大类圆形囊实性包块，以囊性成分居多，边界清楚，密度不均匀，实性部分均呈轻中度强化，2例见纡曲肿瘤血管影，肿瘤内部均未见明显钙化灶。MR表现：4例为类圆形巨大占位，边界清楚，3例为囊实性改变，信号混杂，其内可见囊变坏死；1例以囊性成分为主，囊壁及囊腔内有数个实性结节，3例实性部分均明显强化。病理表现：镜下观察肿瘤组织结构复杂，瘤细胞排列多样，背景基质疏松，可见特征性Schiller-Dural小体，瘤组织内可见散在分布的透明小体。7例术前血清AFP均明显升高602 ~ 48,214μg/L，平均28,823μg/L。结论 卵巢卵黄囊瘤具有一定的CT、MR特征，结合临床资料及血清AFP，术前可做出正确诊断。
