Objective:To investigate the clinical, neuropsychological and regional cerebral blood flow (rCBF) characteristics in patients with psychiatric symptoms caused by nitrous oxide abuse.Methods:Twelve patients with psychiatric symptoms caused by nitrous oxide abuse were enrolled from February 2018 to February 2020 in the Department of Neurology, China-Japan Friendship Hospital and the First Hospital of Tsinghua University.All patients were scored with the brief psychiatric rating scale (BPRS), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). The SPECT/CT images were collected with low-energy and high-resolution collimator.After the pictures were reconstructed, 18 brain regions were automatically sketched and calculated by Database Comparison software.The statistical value of the difference between the general mean value of each brain region and that of the corresponding region of interest in the same age group was estimated.Results:(1)The clinical manifestations of 12 patients were anxiety, depression, hallucination, delusion, and 7 patients were accompanied by cognitive decline.(2)Neuropsychological examination: BPRS score was 57.83±11.15 (anxiety depression factor was 3.94±0.47; lacking active factor was 3.25±0.85; thinking disturbance factor was 3.21±1.27; activity factor was 2.28±0.56; hostility factor was 3.14±1.24). The score of self-knowledge impairment was 2.92±1.08, the score of inability to work was 4.50±1.17, the score of HAMD was 32.75±10.13, the score of HAMA was 18.67±5.80, the score of MMSE was 27.67±2.50, and the score of MoCA was 24.58±3.78.(3)SPECT showed that compared with the general mean value of the corresponding regions of interest of normal people, the patients showed hypoperfusion in the frontal lobe (7 patients, 58.30%) and the temporal lobe (8 patients, 66.70%).Conclusion:Nitrous oxide abuse has an obvious effect on rCBF.The psychiatric symptoms include anxiety, depression, hallucination, delusion and so on, which affect the ability to work and learn.SPECT has important value in the diagnosis of nitrous oxide abuse, and indicates changes in local brain functional activity.

Myelopathy with nitrous oxide presents as paralysis and numbness in limb extremities. In imaging, cervical spinal cord damage is common, accompanied by thoracic spinal cord damage. The horizontal axis is more common in the "inverted V-type". Treatment with high doses of vitamin B12 is effective.

Myelin protein zero (MPZ) is a major component of compact myelin in peripheral nerves. Mutations in MPZ have been associated with different Charcot-Marie-Tooth disease (CMT) phenotypes (CMT1B, CMT2I/J, CMTDI), Dejerine-Sottas syndrome, and congenital hypomyelination neuropathy. Here, we report phenotypic variability in a four-generation Chinese family with the MPZ mutation Asp121Asn. Genetic testing was performed on nine family members and 200 controls. Clinical, electrophysiological and skeletal muscle MRI assessments were available for review in six family members. A novel heterozygous missense mutation, Asp121Asn, was observed in five affected members of the family. Unaffected relatives and 200 normal controls were without the mutation. Four of the affected members of the family displayed late-onset, predominantly axonal sensory and motor neuropathy, pupil abnormalities, and progressive sensorineural hearing loss. One young affected member presented with Argyll-Robertson pupils and diminished deep tendon reflexes in the lower limbs. The MPZ mutation Asp121Asn may be associated with late-onset axonal neuropathy, early onset hearing loss and pupil abnormalities. Our report expands the number and phenotypic spectrum of MPZ mutations.

目的 探讨桥本脑病(Hashimoto's encephalopathy,HE)的发病机制、临床、影像学和病理学特点及预后.方法 回顾性分析1例经临床和病理证实的HE患者的临床资料及洽疗和预后情况.结果 该患者表现为卒中样发作,伴快速进展的认知功能障碍和癫痫;血清抗甲状腺抗体显著增高,头颅MRI可见双颞叶内侧、海马及左基底节区、放射冠多发斑片状长T1、长T2以及FLAIR高信号,白质为主,增强扫描无强化效应.MRS提示病灶区Cho峰略升高,NAA峰稍降低,Lac峰和Lip峰升高.脑组织病理结果示反应性胶质细胞增生,小血管周围淋巴细胞浸润,存在类空泡样及髓鞘崩解改变.经糖皮质激素冲击及口服维持治疗,症状及影像学明显好转.结论 HE是一种伴有抗甲状腺抗体水平增高、临床表现多样、激素治疗有效的脑病综合征,影像学可见皮质或皮质下异常病灶,病理学无特异性改变.

A 58-year-old man presented with intermittent white flashes in both eyes during the past year. Six years earlier (2004), the patients received a diagnosis of superior sagittal sinus (SSS) thrombosis on the basis of elevated intracranial pressure and imaging findings, for example, computed tomography, magnetic resonance imaging, magnetic resonance venography, and cerebral angiography, and was treated with urokinase and anticoagulatants. Symptoms resolved and the patient remained well until March 2009, when intermittent white flashes started to occur in both the eyes. The patient did not seek medical help until 1 year later (March 2010). Cerebral angiography (digital subtraction arteriography) revealed SSS thrombosis and a network of collateral venous circulation. Computed tomography and magnetic resonance imaging demonstrated a mass in the parietooccipital lobe that surrounded the SSS. Pathologic examination of the specimen removed during surgery revealed meningioma.

Objective: To investigate the changes in hip MR imaging, evaluate the frequency of hip involvement and compare the value of clinical symptoms, radiographs, and MR imaging in the detection of hip involvement in patients with ankylosing spondylitis (AS).Methods: Anteroposterior radiographs of the pelvis, MR imaging of the hip and clinical evaluation were undertaken in 58 patients with definite AS. All patients were followed up 3 years. Annual radiographs and clinical evaluation were carried out. The imaging data were independently assessed by two experienced radiologists who were blinded to patient identity and clinical characteristics. Based on the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-hip) scoring system, BASRI-hip scores >= 2 were defined as radiological hip involvement. On MR imaging, both acute and chronic inflammatory changes were considered positive signs for hip involvement. Symptomatic hip involvement was defined as current or past pain or limitation of the hip movement. The statistical analysis was performed using the chi(2) test for comparison of sensitivity among clinical symptoms, radiographs, and MR imaging in the detection of hip involvement and the Student's t-test for comparison of disease duration between with and without hip involvement. A P value <0.05 was considered to be statistically significant. For interpreting MRI and radiographs, the percentage of agreement between the two assessors and the kappa coefficients were calculated.Results: On MR imaging, positive changes were detected in 86 (74.1%) hips among 116 hips in all 58 patients. Joint effusion was observed in 73(62.9%) hips; 23 out of 27 patients who underwent fat-saturated contrast-enhanced T-1-weighted sequences had abnormal synovial enhancement in bilateral hips. The other abnormal MR findings included subchondral bone marrow edema in 35 (30.2%) hips, enthesitis in 22(19.0%) hips, fatty accumulation of the bone marrow in 28(24.1%) hips, bone erosive destruction in 32 (27.6%) hips, and joint-space narrowing in 4 (3.4%) hips. Based on the BASRI-hip scoring system, 68, 24, 18,6 and 0 hips had no, suspicious, mild, moderate or severe damage on conventional radiographs of the pelvis, respectively. Thirty-five hips in 20 patients had current or past pain or limitation. The proportion of hip involvement according to MR imaging, radiographs, and clinical symptoms was 74.1% (861116), 20.7% (241116), and 30.2% (351116), respectively. MR imaging yielded higher values than radiographs and clinical symptoms in the detection of hip involvement in patients with AS (chi(2) = 66.45 and 44.93, P <0.05). Interreader reliability for interpretation of findings was acceptable for both MRI and radiographs. During follow-up, radiological hip involvement were found in 10 hips with BASRI-hip scores <= 1 at baseline and clinical symptoms appeared in 15 sides of the original asymptomatic hip. On baseline MR imaging, inflammatory changes were seen in all hips which appeared symptoms and/or radiological involvement both at baseline and during follow-up.Conclusion: The proportion of hip involvement is much higher than that suggested by radiographic changes and clinical symptoms. MR imaging is superior to conventional radiographs and clinical symptoms in the detection of hip involvement. Joint effusion and synovial enhancement caused by synovitis are the commonest hip findings on MR imaging in patients with AS. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

Objective To evaluate the utility of short tau inversion recovery (STIR) sequence in the diagnosis of hippocampal sclerosis ( HS).Methods Twenty-one patients with medial temporal lobe epilepsy without neoplasm lesions or injuries by conventional MRI sequence including T1WI,T2WI and FLAIR were included in this study.STIR imaging in axial,coronal and sagittal sequences was performed on these patients. Diagnosis of HS was based on the findings of hippocampal atrophy,alteration signal,disturbed internal structure and enlargement of the inferior horn. The findings shown on conventional MRI were compared with those on STIR sequence. Furthermore,the correlation of radiologic and histological findings was investigated in 6 patients operated for refractory seizures. Results On conventional MRI sequence,14 patients (66.7％) were confirmed with unilateral HS and 4 patients were suspected with unilateral HS. In contrast,all these 18 patients (85.7％) were confirmed with unilateral HS by STIR.Particularly,STIR sequence delineated the internal structure of hippocampus more clearly than conventional MRI sequences did. "C" shaped contour in subiculum-CA1-CA2 was revealed in normal hippocampus on STIR sequence and disappeared in HS,correlated to the pathology finding of loss of neuron in CA1 in resected tissues in 6 operated patients.The patients with HS also showed areas of hypodensity in CA4 on STIR,in accordance with pathologic findings of gliosis in this area in the 6 operated patients.Conclusion STIR sequence could depict the internal anatomical structure of hippocampus with high resolution superior to conventional MRI sequences,and can be of great value in the diagnosis of HS.

<正>膝关节是人体最大最复杂的关节,由股骨下端、胫骨上端和髌骨、韧带、半月板等组成,具有屈伸、内收外展、旋转等复杂运动。在日常的生理活动中,负重较大且活动较多,因此也是人体中退化较早、极易损伤的关节,如果不及时治疗,将导致生活质量下降甚至行走功能的丧失,所以早发现早诊断早治疗是非常重要的。

Objective To investigate the feasibility and accuracy of volumetric measurement of necrotic lesion using CT and MRI,and to assess the value of necrotic lesion volume in predicting collapse of the femoral head in patients with avascular necrosis of the femoral head(ANFH). Methods Comparison among CT,MRI and gross section was performed in 25 femoral heads of 18 patients who underwent total hip replacement for established ANFH.The volume of necrotic lesion was measured using fluid displacement.CT and MRI data were transferred to a computer to calculate the volume of necrotic lesion using software.One way ANOVA was used to compare the volumes of necrotic lesion measured by CT,MRI and gross section.A total of 62 patients (92 hips) who were diagnosed with ANFH but without collapse by CT were followed up 24 months.Student t-test was used to compare the ratio of the volumes of the necrotic lesion and entire femoral head in the hips with and without collapse and ROC curve analysis was carried out.Results CT and MRI coincided with gross section in the necrotic area,proliferative area and extralesional area.The volumes of the necrotic lesion measured by CT,MRI and gross section were ( 20.5 ± 5.2 ),( 21.4 ± 4.8 ),( 20.9 ± 5.2 ) cm3,respectively.There was no significant difference among the necrotic volumes measured by the three methods(F =0.185,P =0.831 ).In fifty-seven out of 92 hips,collapse of the femoral head occurred during the follow-up.The ratio of the volumes of the necrotic lesion and entire femoral head was higher in hips with collapse than in hips without collapse[ (34.5 ±9.3)％ vs.(23.4 ±8.4)％ ;t =5.749,P=0.000].The area under the ROC curve was 0.808. Conclusions The volume of the necrotic lesion plays an important role in the collapse of femoral head in patients with ANFH.Both CT and MRI can identify the shape and location of the necrotic lesion intuitively and stereospecifically and can determine the volume of the necrotic lesion accurately.

目的 探讨强直性脊柱炎(AS)脊柱受累的MRI表现,评价Romanus病灶对AS的诊断和鉴别诊断的价值.方法 对51例AS患者的下胸椎和腰椎MRI资料进行回顾性分析.选取同时期年龄和性别与本组AS相匹配,因机械性腰背痛行下胸椎和腰椎MRI检查的51例患者作为对照组.结果 51例AS中32例(62.7%)MRI显示异常,异常表现包括Romanus病灶28例(共182个病灶)、Andersson病灶13例、脊椎关节炎8例、韧带骨赘5例、椎间盘突出或膨出3例.51例机械性腰背痛患者中35例MRI显示异常,其中椎间盘突出或膨出34例、Romanus病灶9例(共13个病灶)、Andersson病灶6例.AS患者Romanus病灶发生率明显高于机械性腰腿痛患者(χ2=15.31,P<0.05),且AS所致Romanus病灶常多发,好发于胸腰椎交界区;而机械性腰背痛患者Romanus病灶常单发,且好发于下腰椎.以Romanus病灶数目≥2或≥3为标准,诊断AS的敏感性分别为52.9%(27/51)和43.1%(22/51),特异性分别为94.1%(48/51)和98.0%(50/51).结论 在AS的脊柱改变中Romanus病灶发生率最高,AS所致Romanus病灶常多发、好发于胸腰椎交界区,Romanus病灶≥2时诊断AS有较高的特异性.

目的 探讨低剂量64层CT测定冠状动脉钙化积分的可重复性.方法 43例冠状动脉钙化的患者连续进行2次64层螺旋CT扫描,管电流分别为100 mAs和55 mAs,其余参数不变,由2名放射科医生测定钙化积分,计算前后2次扫描差值;同时测量升主动脉的CT值的均数及标准差.结果 2次扫描在观察者和观察者内部差值的绝对值多数在50以内(分别为81.4%和86.5%).低剂量扫描对不同测量者无明显统计学差异(P=0.883和0.952);取平方根转换后均具有明显相关(r均为0.998).采用管电流55 mAs,所测均数与2倍标准差之和低于130 HU,可将辐射剂量降低0.6 mSv.结论 低剂量前门控64层CT钙化积分扫描在降低辐射剂量的同时,图像满足测量需要,具有较高的可重复性.

<正>目前对颈椎疾病的影像学常规检查方法有:X线、CT、磁共振成像(magnetic resonance imaging,MRI)等,而MRI具有较高的组织对比度,可行多方位多序列成像,且无电离辐射,尤其在矢状面可以直观的了解椎间盘、椎管内硬膜囊和椎间孔脂肪受压的程度和范围,因此成为颈椎疾病主要的检查方法。

Objective To evaluate the value of MRI in detecting spinal inflammatory lesions in patients with spondyloarthropathy(SpA),and to compare the involvement frequency of different vertebral units.Materials and Methods Thirty eight patients with SpA,included 19 patients with ankylosing spondylitis(AS) and 19 patients with undifferentiated SPA(uSpA) were performed lower thoracic spine and lumbar spine(from T8 to S1) MR examination.MRI was underwent on 1.5 Tesla with a dedicated spine coil.T1-weighted,T2-weighted,short tau inversion recovery(STIR) sagittal sequences of the spine were obtained in all patients,of which fat-saturated contrast-enhanced T1-weighted sequent was performed in 23 patients.One vertebral unit was defined as the region between two virtual lines drawn through the middle of each vertebral body.The percentage of inflammation seen in each vertebral unit was compared.Results Definite spinal inflammatory lesions were detected in 21 of 38 patients(55.3%),including acute or chronic spondylitis in 14 cases,spondylodiscitis in 10 cases,spondylarthritis in 7 cases,syndesmophyte in 4 cases.The frequency of involvement in patients with AS was higher than that in uSpA(73.7% vs 36.8%,P﹤0.05).The inflammation found in vertebral units of T8/9,T9/10,T10/11,T11/12,T12/L1,L1/2,L2/3,L3/4,L4/5,and L5/S1 were 2.6%,10.5%,15.8%,26.3%,39.5%,28.9%,28.9%,28.9%,7.9%,and 7.9%10.5%,15.8%,26.3%,39.5%,28.9%,28.9%,28.9%,7.9%,and 7.9%.Conclusion MRI is an ideal tool for assessment of spine inflammatory changes in patients with SpA.The vertebral unit of T12/L1 is the most often affected vertebral unit.

<正>临床上慢性髋关节疼痛的病因较多,髋臼唇的损伤是引起髋关节疼痛的原因之一,易导致关节内软骨病变,并且是髋关节发生骨关节炎的先兆,有研究表明髋臼唇损伤在顽固性髋痛者中占55%[1]。常规MRI很难观察到髋臼唇及软骨结构,由于没有可靠的影像学诊断方法,诊断往往被延误。

OBJECTIVE:To detect and track the presence of magnetically labeled bone marrow stromal cells (MSCs) in vivo with magnetic resonance imaging (MRI) after autologous transplantation.METHODS:The cultured and SPIO-labeled MSCs were transplanted into dog femoral head. The dog received regular MRI re-examination at post-operation. Samples were harvested at different weeks for analysis.RESULTS:The labeled cells showed an obviously low intensity of signal change in MRI. There were lots of labeled cells in the transplant area and more bone formation than the controls.CONCLUSION:The labeled cells can be visualized in vivo by MRI examination after transplantation into femoral head. The transplanted MSCs survive in vivo and increase bone formation.

Objective:To investigate the value of MRI and CT in pre-operation assessment for artificial cochlear implantation.Methods:All cases performed MRI examinations by GE Signa Excite 0.35T MRI system before artificial cochlear implantation operation.3D-FIESTA axial scan of inner ear were reconstructed by MIP,MPR and VR methods;performed spiral CT from the external auditory canal to the petrous part of the temporal bone by Toshiba Aquilion 16,slice thickness 1mm,slice interval 1mm,pitch 15,with bone algorithm,5mm-intensive reconstruction in both ears.Results:MR findings showed normal structure of cochlear nerve and labyrinth in 59 cases(118 ears),cochlear malformations in 3 cases,stenosis of internal auditory canal in 3 cases,absence of cochlear nerve in 1 case,vestibular and cochlear aqueduct enlargement in 7 cases,and brain white matter disease in 7 cases.Conclusion:MRI and CT play important roles in pre-operation assessment for absolute contraindications and relative contraindications.It can help doctor to select suitable ear and reduce risks of operation.

OBJECTIVE:To investigate the relationship between imaging and pathological findings of avascular necrotic of the femoral head (ANFH).METHODS:A comparison among of conventional radiography, computerized tomography (CT), magnetic resonance imaging (MRI), gross section and pathological examinations was performed in 20 femoral heads in 15 patients undergoing total hip replacement for established ANFH.RESULTS:ANFH involved the anterosuperior aspect of femoral head in all hips. Necrotic femoral heads consisted of cartilage, necrotic area, reactive repaired area and extralesional area. The reactive repaired area surrounded necrotic area. Imaging findings: 1) on conventional radiography and CT, as compared with the extralesional area, the necrotic area appeared to be of an equal density (11), a lower density (7) and a higher density (2) On MRI, the necrotic areas revealed adipose intensity (3), blood like intensity (1), aquatic intensity (2), fibrous intensity (9) and non-homogeneous intensity (5); 2) the reactive repaired area separated the necrotic and extralesional areas. Both on plain radiography and CT, the reactive repaired area showed a sclerotic band surrounding the necrotic area and a hypo-density inner line adjacent to sclerotic band was seen in 11 femoral heads on CT and 7 on conventional radiography. A band of low signal in the proliferative zone was seen on MRI in all hips and a rim of high signal intensity inside the low-signal margin (double-line sign) was seen in 3 hips on T2W images.CONCLUSION:Conventional radiography, CT and MRI can display the grossly discernable necrotic, reactive repaired and extralesional areas accurately. Characteristic imaging findings are observed in the reactive repaired area.

<正>1病例介绍患者女,46岁。2009年7月因"右髋痛6个月"入院。6年前诊断为"干燥综合征";3年前因合并肾小管酸中毒,口服甲泼尼龙60mg/d,共40d,停用激素约2周后出现左侧臀部及腹股沟区明显疼痛,于外院诊断为"双侧股骨头坏死",未行特殊治疗。患者经卧床休息,1周后疼痛明显缓解,之后偶有左腹股沟区隐痛;19周后X线片复查示左侧股骨头外侧及邻近区骨量减少,关节间隙正常,右侧股骨头未见明显异常,未行治疗。6个月前患者无明显诱因右侧臀部疼痛,性质同左侧,活动加重,休息后缓解;疼痛呈进行性加重,逐渐行走困难。

Objective To investigate the clinical diagnosis and the results of arthroscopic treatment for acetabular labrale tears. Methods From November 2008 to December 2009, 21 patients with unilateral acetabular labrale tears underwent hip arthroscopy were entered in the study, including 9 males and 12 females with an average age of 37.1 years. Physical examination, X-ray examination and magnetic resonance arthrography (MRA) were carried out preoperatively to make the definite diagnosis. Of 21 cases, including labrale debridement in 14 cases, labrale debridement plus femoral osteoplasty in 5 cases and labrale repair plus osteoplasty in 2 cases. Patients were followed-up either by telephone inquiring or out-patient interview.The visual analogue scale (VAS) and Harris hip score were recorded before operation and 6 months after operation respectively. Results All 21 patients showed a positive Fadir impingement sign on the affected hips,meanwhile 15 cases showed a positive Fabir impingement sign, and positive McCarthy test was observed in 9cases. X-ray film showed 11 cases have cam type impingement, among which 6 combined with pincer type impingement. Two cases had acetabulum retroversion alone. On MRA images, signals of contrast agent infiltration in anterior superior quadrant which indicated labrale tear were observed among all cases. All labrale tears were confirmed under arthroscopy. All patients were followed up for average 11.6 months (range, 6-19).The symptoms were obviously released after operation. The VAS decreased from (5.3±1.3) preoperatively to (1.4±-0.9) 6 months postoperatively. The mean Harris hip score improved from (63±9) preoperatively to (84±10) 6 months postoperatively. All the differences had statistical significance. Conclusion Acetabular labrale injury has a close correlation with femoroacetabular impingement. Impingement test and MRA have a high sensitivity and accuracy on clinical diagnosis of labrale tears. Arthroscopic debridement, repair and osteoplasty for labrale tears give a good early outcomes.

Objective To investigate the application value of MR rthrography (MRA) in the diagnosis of acetabular labral tears. Methods Fifteen patients with a high degree of suspected acetabular labral tears received fluoroscope-guided injection of the contrast media into the hip joint ( hip arthrography) and fat-saturated spin-echo T1-weighted images were obtained in the coronal, sagittal, oblique-axial and radial planes. Hip arthroscopy was performed on 12 of them. Results Labral tears which were diagnosed in 11 patients by hip MRA were confirmed at hip arthroscopy. One patient showed no MRA indication of labral tear, also showed normal on arthroscopy. Tear in the anterior-superior quadrant 10 cases of 12 joints ( 12/13), posterior-superior quadrant 1 case of a joint (1/13). In 11 patients who underwent arthroscopy, hip MRA diagnosed 3 (3/13) joints labral tears in coronal planes, 10 (10/13) joints in sagittal planes and 13 (13/13) labral tears in axial-oblique and radial planes. In 15 patients with 20 hip joints, 5 cases 6 joints (6/20) with normal acetabular sublabral sulcus were performed. Conclusions MR arthrography of hip is a reliable method in the diagnosis of acetabular labral tears. Scanning method should be included fat-saturated spin-echo T1-weighted images in sagittal and oblique-axial planes or sagittal plus radial planes. The diagnosis of tor posterior-inferior quadrant should pay attention to the existence of a normal variation.