目的:探讨高分辨磁共振血管壁成像在不同时期颅内动脉夹层评估中的应用效果.方法:选取2020年10月—2022年9月新疆医科大学第一附属医院收治的106例颅内动脉夹层患者,患者均应用高分辨磁共振血管壁成像检测,以临床结果为依据,统计患者检测结果并进行比较.结果:椎动脉颅内段病变、大脑中动脉段病变的急性期占比显著高于颈内动脉硬膜外段病变(P<0.01),大脑中动脉段病变的亚急性期占比显著高于椎动脉颅内段病变、颈内动脉硬膜外段病变(P<0.01),颈内动脉硬膜外段病变的慢性期占比显著高于椎动脉颅内段病变、大脑中动脉段病变(P<0.01).慢性期、亚急性期的内膜瓣、瘤样扩张/凸出检出率均显著高于急性期(P<0.01),慢性期患者的壁间血肿、血管壁局灶性增厚增强2级检出率显著低于亚急性期、急性期(P<0.01),急性期、亚急性期与慢性期的双腔检出率比较差异无统计学意义(P>0.05).急性期、亚急性期、慢性期患者的壁厚指数比较差异无统计学意义(P>0.05),急性期患者的狭窄百分比、血管壁增强相对信号强度、壁间血肿相对信号强度显著高于亚急性期、慢性期(P<0.01).结论:颅内动脉夹层应用高分辨磁共振血管壁成像诊断评估,有利于临床及时明确患者的病变部位,还可结合影像学表现和定量参数辅助临床明确患者的疾病分期,指导临床针对疾病分期进行对症治疗.

目的 探讨高分辨磁共振血管壁成像(high resolution magnetic resonance vessel wall imaging,HRMR-VWI)对脑静脉及静脉窦血栓(cerebral venous and sinus thrombosis,CVST)识别及分期的应用价值.方法 评估44例患者MRV及HRMR-VWI对血栓节段性诊断的准确性,比较急、慢性组血栓信号噪声比(signal-to-noise ratio,SNR)和对比噪声比(contrast-to-noise ratio,CNR)的差异.结果 确诊的131处血栓中,MRV准确识别123处,敏感度93.9％,特异度97.7％,Kappa值0.9023;HRMR-VWI准确识别125处,敏感度95.4％,特异度98.6％,Kappa值0.9343.急、慢性组血栓SNR 为 210.46±45.20 和 96.43±30.82,CNR 为 206.32±44.12 和 91.62±30.10,两组比较差异有统计学意义(P＜0.05).结论 HRMR-VWI是诊断脑静脉及静脉窦血栓形成的可靠的血栓直接成像技术,能清晰识别血栓并评估分期.

目的:研究3.0T磁共振T2× mapping成像技术定量评估膝关节骨性关节炎(OA)的临床价值及与西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分的相关性.方法:将我院于2017年4月～2019年12月期间收治的膝关节OA患者80例纳入研究.根据K-L分级标准将膝关节OA患者分成轻度组(K-L分级为Ⅰ～Ⅱ级)32例,重度组(K-L分级为Ⅲ～V级)48例.另取同期于我院进行体检的健康者30例作为对照组.所有受试者均接受3.0T磁共振T2x mapping扫描,比较各组膝关节不同部位软骨T2值、WOMAC评分以及血清炎症因子水平,以Pearson相关性分析膝关节OA患者膝关节不同部位软骨T2值和WOMAC评分的关系.结果:重度组膝关节不同部位软骨T2值均高于轻度组以及对照组,且轻度组膝关节不同部位软骨T2值均高于对照组(均P＜0.05).重度组各项WOMAC评分及总分均高于轻度组以及对照组,且轻度组各项WOMAC评分及总分均高于对照组(均P＜0.05).经Pearson相关性分析发现:膝关节OA患者膝关节不同部位软骨T2值和各项WOMAC评分及总分均呈正相关(均P＜0.05).重度组血清白介素-1β(Ⅱ-1ββ)、白介素-18(IL-18)、肿瘤坏死因子α(TNF-α)均高于轻度组以及对照组,且轻度组血清IL-1β、IL-18、TNF-o均高于对照组(均P＜0.05).结论:3.0 T磁共振T2× mapping成像技术定量评估膝关节OA的临床价值较高,且患者膝关节不同部位软骨T2值与WOMAC评分密切相关.

目的 探讨磁共振扩散加权成像(diffusion-weighted imaging,DWI)定量指标在脑泡型包虫病(cerebral alveolar echinococcosis,CAE)与脑转移瘤(brain metastases,BM)诊断及鉴别诊断中的价值.方法 收集2017年2月—2019年12月在新疆医科大学第一附属医院确诊为CAE患者19例(病灶数47个)与BM患者23例(病灶数36个),应用3.0T磁共振对两组患者进行常规脑MRI平扫、增强扫描及DWI(b值取1000 s/mm2)检查.分别测量CAE、BM病灶实质区、水肿区及对照区的表观扩散系数(apparent diffusion coefficient,ADC),采用SPSS26.0软件比较CAE和BM各感兴趣区ADC值的差异以及二者间差异,并用受试者工作特性曲线(receiver operator characteristics,ROC)分析ADC值对二者实质区、水肿区的诊断效能及阈值.结果 CAE实质区的ADC值高于BM实质区(P<0.05),CAE水肿区的ADC值低于BM水肿区(P<0.05);CAE与BM对照区ADC值比较差异无统计学意义(P>0.05).CAE实质区ADC值与水肿区对比差异无统计学意义(P>0.05),实质区/水肿区ADC值>对照区(P<0.05);BM各感兴趣区ADC值的差异有统计学意义,水肿区ADC值>实质区>对照区(P<0.05).CAE与BM实质区、水肿区之间的ROC曲线下面积分别为0.655、0.932,诊断阈值分别为0.99、1.20.结论 DWI参数能够定量反映CAE与BM的病变特征,并能为二者之间的鉴别诊断提供有价值的信息.

目的 探讨1H-MRS鉴别诊断脑泡型包虫病和脑转移瘤的价值.方法 收集经术后病理及临床随访确诊为脑泡型包虫病和脑转移瘤患者各20例,分别进行脑常规MR、增强和1 H-MRS扫描.测量脑泡型包虫病、脑转移瘤病灶实质区、病灶水肿区及对侧正常脑实质N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、乳酸和脂质峰(Lip+ Lac)峰值,并计算Cho/Cr、Cho/NAA、(Lip+Lac)/Cr.结果 脑泡型包虫病病灶实质区Cho、Cho/Cr、Cho/NAA显著低于脑转移瘤,Lip+ Lac、(Lip+ Lac)/Cr明显高于脑转移瘤(P均＜0.05).脑泡型包虫病与脑转移瘤病灶实质区Cr、NAA,水肿区Cho、Cr、NAA、Lip+ Lac、Cho/Cr、Cho/NAA、(Lip+ Lac)/Cr差异均无统计学意义(P均＞0.05).脑泡型包虫病实质区Cr、NAA峰及水肿区NAA显著低于对侧正常脑实质,实质区及水肿区Lip+ Lac、Cho/Cr、Cho/NAA、(Lip+ Lac)/Cr明显高于对侧正常脑实质(P均＜0.05).脑转移瘤病灶实质区Cho、Lip+ Lac、Cho/Cr、Cho/NAA、(Lip+ Lac)/Cr及水肿区Cho/NAA、(Lip+Lac)/Cr明显高于对侧正常脑实质,实质区NAA峰低于对侧正常脑实质(P均＜0.05).结论 1H-MRS技术可显示脑泡型包虫病和脑转移瘤病灶及病灶周围水肿区组织代谢的特点,为鉴别诊断提供客观依据.

目的 分析CT及磁共振诊断中枢神经系统感染的临床应用效果.方法 在我院选取2016年4月-2019年10月50例中枢神经系统感染患者和50例经过体检身体一切正常的体检者作为此次研究对象,将两组分为对照组和实验组.中枢神经系统感染患者为实验组,身体一切正常的体检者为对照组,两组患者都采用CT及磁共振进行检查,分析它们的检查结果和意义.结果 采用磁共振诊断人们有无中枢神经系统感染的准确率高于CT检查,误诊率低于CT检查,P<0.05具有统计学意义.结论 在临床对中枢神经系统感染患者的诊断中采用CT及磁共振诊断都对诊断有一定的意义和价值,但磁共振对中枢神经系统感染拥有更高的诊断准确率和更低的误诊率,在对中枢神经系统感染患者的诊断中可以采用CT和磁共振结合的方式进行诊断.

目的 探讨心理护理能否改善肝脏MR动态增强扫描的图像质量.方法 连续选取进行肝脏MR动态增强扫描的患者60例,随机分为对照组(30例)和实验组(30例).对照组进行MR检查时采用常规的护理方法,实验组在常规护理的基础上实施心理护理干预.记录2组患者的呼吸、脉搏,使用状态焦虑量表(S-AI)评分评价注射对比剂前患者即刻的心理状态,对动态增强扫描的5组图像的质量进行主观评分.结果 实验组患者的呼吸、脉搏及S-AI评分低于对照组(P＜0.05).实验组动态增强扫描的前3组图像质量的主观评分高于对照组(P＜0.05);实验组与对照组动态扫描的第4、5组图像的主观评分差异无统计学意义.结论 心理护理能够减轻肝脏MR增强扫描患者紧张、焦虑的心理状态,提高患者对检查的依从性,改善动态扫描前3组图像质量.患者有效屏气时长无改善,动态增强扫描的第4、5组图像质量无提高.

Objective To analyze the MR imaging classification of parenchymal tuberculosis,to explore the value of DCE-MRI quantitative parameters in differentiating parenchymal tuberculosis from brain metastases.Methods The conventional MRI and DCE-MRI were performed in 59 cases (28 cases with parenchymal tuberculosis,and 31 cases with brain metastases),the MRI findings and enhancement characteristics were retrospectively summarized.DCE-MRI quantitative parameters were measured from solid enhanced nodules,the rim of ring-like enhanced lesions,including Ktrans、Kep、Ve and iAUC.Data was statistically analyzed by using t test or u test.Results Parenchymal tuberculosis had 337 lesions.102 lesions were evenly enhanced nodules,69.6％ of the lesions were less than 3.0 mm,25.5％ of the lesions were between 3.0 mm to 1.0 cm.235 lesions showed ring-like contrast enhancement,and the rim had uniform thickness,32.4％ of the lesions were between 3.5mm to 5.0 mm,45.5％ of the lesions were between 5.0 mm to 1.0 cm,22.1％ of the lesions were more than 1.0 cm.Brain metastases have 285 lesions.102 lesions were heterogeneously enhanced nodules,27.0％ of the lesions were less than 3.0 mm,73.0％ of the lesions were more than 3.0mm.211 lesions showed uneven ring-like enhancement,84.8％ of the lesions were more than 5.0 mm.The Kep of the solid nodules and ring wall of parenchymal tuberculosis were (0.158 ± 0.064)min-1 and (0.156 ± 0.066) min-1,they were lower than the brain metastases (t =-2.518、-2.407,P ＜ 0.05).The Ve of the solid nodules and ring wall of parenchymal tuberculosis were 0.465 ± 0.170 and 0.527 ± 0.174,they were higher than the brain metastases (Z =2.399、4.666,P ＜ 0.05).When Kep and Ve of the enhancing ring wall were 0.166 min-1 and 0.431,the sensitivity of differentiating these two diseases was 70.7％ and 70.6％,the specificity was 57.4.％ and 68.0％ respectively.Conclusion According to the lesion size and MRI enhanced features of parenchymal tuberculosis,lesions can be classified into three types:miliary,nodules and tuberculoma.It conforms to the pathological features of tuberculous nodules.Measuring the Kep and Ve values is helpful in differential diagnosis of parenchymal tuberculosis and brain metastases.

Purpose:To investigate the imaging features of primary malignant melanoma (MM) in the nasal cavity,and to improve the clinical diagnosis.Methods:Imaging findings of 13 patients with pathologically confirmed MM were retrospectively reviewed.The age,gender,location,size,bone destruction,density or signal intensity,enhancement characteristics of all lesions were evaluated.Results:There were 8 women and 5 men in 13 patients,their mean age was 70.8 years old.Twelve cases occurred in unilateral nasal cavity and 1 case occurred in bilateral nasal cavity.Adjacent bone absorption and bone destruction were shown in twelve cases (12/13).CT scans showed that the tumors were with soft-tissue density.Compared to the signal intensity of gray matter of the brain,9 cases (9/12) demonstrated iso-intensity or hypo-intensity on T2WI,2 cases (2/12) demonstrated obviously hyper-intensity on TlWI,and 10 cases (10/12) appeared iso-intensity or hypo-intensity on T1WI.Apparent enhancement was shown in 3 cases (3/12),and slight or moderate enhancement was shown in 9 cases (9/12).Conclusion:The location of tumor,invasion of bone and the adjoining structures can be well defined by CT and MRI.Primary malignant melanoma in the nasal cavity shows characteristic MR signal intensity (iso-or hyposignal intensity on T2WI,and with slight or moderate enhancement),which may provide valuable information for diagnosis.However,the diagnosis of atypical malignant melanoma (hyper-signal intensity on T2WI) still depend on the pathology result.

目的 通过测量骶髂关节面下骨髓T2值,探讨T2mapping对强直性脊柱炎早期骶髂关节病变的诊断价值.方法 收集我院36例初步诊断为强直性脊柱炎的患者为病例组,24例健康体检者为对照组,分别测量病例组骶髂关节面下病变区及周围相对正常区、对照组骶髂关节面下骨髓的T2值,采用两独立样本t检验对两组骶髂关节面下骨髓的T2值进行统计分析,并采用配对t检验对病例组病变区及周围相对正常区骨髓的T2值进行分析.结果 与对照组相比,病例组骶髂关节面下骨髓T2值明显升高,差异有统计学意义(P＜0.01).病例组中病变区比周围相对正常区骨髓T2值升高,差异有统计学意义(P＜0.01).结论 T2mapping序列通过测量骨髓T2值的变化,可以更早的发现强直性脊柱炎患者早期骶髂关节的病变.

Objective To investigate the magnetic resonance diffusion weighted imaging (DWI)quantitative indicators ADC,EADC in the study of cerebral alveolar echinococcosis marginal zone.Methods Collected 11 cases (23 lesions)diagnosed as cerebral alveolar echinococcosis during July,2009-March,2013 in our hospital,and applied 3.0T superconductive MRI apparatus to conduct whole brain conventional MR scan, enhanced scan,multi-voxel 1 H-MRS and DWI checks,DWI gradient sensitive factor b value were chosen 1 000 s/mm2 .The apparent diffusion coefficient (ADC), exponential apparent diffusion coefficient (EADC)in CAE lesion parenchyma,0 - 10 mm edema,10 - 20 mm edema and the contralateral corre-sponding parts of the brain parenchyma (control zone)were measured.Results ADC values in parenchy-ma,marginal zone were higher than the control zone,and gradually increased away from CAE parenchyma lesions,while EADC values gradually lower.The differences of ADC and EADC values in Parenchyma le-sions,marginal zone compared to the control zone were statistically significant (P <0.05);the differences of ADC in between 10-20 mm marginal lesion parenchyma and 0-10 mm marginal ,was statistically sig-nificant (P <0.05);the differences of ADC and EADC in between 0-10 mm marginalzone and parenchy-ma was not statistically significant.Conclusion DWI technique can reflect and evaluate CAE feature in le- <br> sion parenchyma and marginal zone,which could not only contribute to differential diagnosis of CAE before surgery,but define the range of CAE infiltration zone,that will provider objective imaging evi-dences for establishing the surgery plan and prognosis analyzing .

Objective To evaluate the value of different higher b value magnetic resonance imaging technol-ogy on the application of early diagnosis of ischemic cerebral infarction.Methods The data of 32 patients with acute and sub-acute cerebral infarction were analyzed,the conventional MR sequence and DWI se-quence were played on 3.0T,the apparent diffusion coefficient (ADC)of the cerebral infarction and the contralateral normal area were measured and the relative ADC were calculated.Results With the increase of b value,the lesions were more clear and it is easier to found the smaller lesions,and the ADC values of lesion group and the control group were decrease significantly (P <0.05).With the same b value,the ADC values of lesion group was lower than the one of control group significantly (P <0.05).Conclusion Com-pared with conventional MRI,DWI has a high diagnostic value for early ischemic cerebral infarction,and the higher b value could be more sensitive to smaller lesions.

硫酸链霉素由于杀菌力强，临床上作为治疗各型结核病的首选药物，但由于毒副反应较大，易引起过敏。现报道１例发生严重过敏反应的病例，以引起同行们的注意。１病例介绍杨某，女，３５岁。于１９９７年１１月３日入院，主诉咳嗽、咳脓痰、胸部钝痛３月余，入院诊断为Ⅲ型...