目的 观察我国0～14岁儿童发育期间垂体形态学变化.方法 纳入1 400例0～14岁儿童,每岁各100例(男、女各50例);基于头颅3D-T1WI测量腺垂体上下径、前后径、左右径及垂体柄长度,计算其上下径/前后径比值和腺垂体体积,观察垂体各参数与年龄的相关性及其随年龄增长的变化趋势.结果 随年龄增长,儿童腺垂体上下径、前后径、左右径及体积基本呈逐渐增大,而垂体柄长度呈减小趋势.男性与女性儿童腺垂体上下径、前后径、左右径,垂体体积及垂体柄长度差异均无统计学意义(P均＞0.05).儿童腺垂体上下径、前后径、左右径及其体积均与年龄呈高度正相关(r均＞0.9,P均＜0.001),垂体柄高度与年龄呈高度负相关(r＞0.9,P＜0.001).结论 随年龄增长,0～14岁儿童腺垂体上下径、前后径、左右径及其体积基本呈逐渐增大、而垂体柄长度呈减小趋势.

目的 探讨儿童甲状腺CT值与甲状腺功能状态的关系及其临床应用价值.方法 回顾性分析行颈部或胸部平扫CT检查并在3个月内行甲状腺功能检查患儿资料.按照血清促甲状腺激素(TSH)水平分为正常组、降低组和升高组.采用单因素方差分析比较3组甲状腺CT值差异,并进行ROC曲线分析.结果 共纳入115例患儿,其中血清TSH水平正常组67例,降低组33例和升高组15例.血清TSH水平降低组和升高组甲状腺CT值分别为(93.98±21.09)HU 和(96.53±14.45)HU,低于正常组的(107.37±16.13)HU(F=7.346,P=0.001).ROC曲线分析显示,甲状腺CT密度cut-off值为86.75 HU时,敏感性为92.5％,特异性为45.8％.结论 甲状腺功能异常时甲状腺CT值下降,甲状腺CT值(cut-off值为86.75 HU)可作为儿童甲状腺功能异常的早期预警指标.

Objective To explore the relationship between MRI findings and defecation function after laparoscopic?assisted anorectal pull?through for anorectal malformations. Methods A retrospective cohort study focused on the findings of MRI performed after laparoscopic?assisted anorectal pull?through for anorectal malformations and no spinal deformity was present in all patients who are currently older than 3 years. Forty?two patients aged from 3 to 16 years (median age was 4 years), whom accepted operation at 3 months to 13 years old(median age was 5 months), and MRI was carried out in 2 to 5 months after operation (median time was 3 months). The MRI manifestations including the relationship between the anorect and the high muscle complex(RAHMC), anorectal angle(AA); the relationship between the anorect and the low muscle complex(RALMC), the rectal maximum diameter(RMD), the fat tissue interposition(FTI) and the development of pelvic floor muscle(PFM) were reviewed and summarized. Statistically, the differences of MRI manifestations in different defecation function index, including the degree of voluntary bowel movements, soiling, constipation and Krickenbeck score were evaluated respectively with Chi?square test or rank sum test. Results statistically, There was significant differences among the groups with different degree of voluntary bowel movements, soiling and Krickenbeck score in the RAHMC (P<0.05), and AA was correlated with the degree of voluntary bowel movements, soiling, constipation and Krickenbeck score(P<0.05), but no significant differences was found among the groups with different defecation function index in the RALMC, the RMD, the FTI and the development of PFM(P>0.05). Conclusions The deviation of the anorect from the high muscle complex which showed in the postoperative MRI pictures suggested the poor prognosis, and well?developed pelvic floor muscles which indicated in the MRI was not the sufficient predictor for good outcome. Postoperative anorectal angle obtained in the MRI can be used as an objective indicator of prognosis.

目的 通过与常规MRI及临床表现的对比观察,探讨动态增强MRI在幼年特发性关节炎髋关节股骨头骨髓水肿评估中的应用价值,获得检测骨髓水肿的敏感量化指标.方法 收集确诊为JIA的患儿9例作为病例组,收集10例因其它疾病进行盆腔或髋关节增强MRI的患儿作为对照组.收集患儿的动态增强(DCE) MRI参数、常规MRI、临床表现及红细胞沉降率(ESR)、C反应蛋白(CRP)检测结果,其中DCE数据包括冠状位股骨头最大单层面和股骨头容积测量数据,具体为最大强化率(ME％),强化峰值时间(TTP)和血流量(BF).为避免年龄等因素的干扰,本组对以上数据进行转换,选择同一患儿双侧髋关节各参数的差异率进行分析.最大单层面参数以下角标max表示,股骨头容积参数以下角标vol表示.采用两独立样本t检验比较病例组与对照组间DCE-MRI各参数的差异;并对常规MRI双侧股骨头骨髓信号无异常病例,根据临床有无4字征进行分组,探讨组间DCE-MRI各参数的差异;此外,对DCE参数与炎性指标的相关性进行分析.结果 病例组与对照组DCE参数比较,两组间股骨头最大单层面的MEmax(t =4.805,P＜0.001)和股骨头容积TTPvol(t =2.785,P=0.011)、BFvol(t=3.885,P=0.001)存在显著性差异.常规MRI双侧股骨头骨髓信号无异常病例中,4字征阳性组和阴性组比较,组间MEmax(t =3.049,P=0.007)和BFvol(t =2.089,P=0.041)具有统计学差异.实验室数据的相关分析显示ESR与DCE-MRI中的MEmax(相关系数r=0.532,P=0.016)具有显著相关性.结论 DCE-MRI能够较常规MRI更为早期敏感地检测到JIA受累关节的骨髓水肿情况,尤其股骨头MEmax和BFvol在检测过程中最为敏感,比临床查体及实验室检查更加精准.

Objective:To evaluate and develop MRI scoring system for the hip in juvenileidiopathicarthritis.Materials and Methods:WeusedWanfangandPubMed to identify relevant published articles. We proposed a new MRI scoring method for the hip in JIA based on relevant articles. Retrospective studies of 92 JIA patients with hip involvement were analysed from January 2011 to June 2014. The intra-reader and inter-reader agreement (evaluated by intra-class correlation coefficients, ICCs) were determined for scores of MRI. Results:Only 5 literatures were qualified. Except joint effusion and total scores, Other lesions of developed MRI scoring method had good reliability, ICC>0.60, P>0.05. We got reversible and irreversible MRI signs. Reversible MRI signs:synovial hypertrophy, joint effusion, bone edema. Irreversible MRI signs: bony erosion, cartilage loss, epiphysis lesion, joint space narrowing, muscular inflammation. There was no differences between subtypes of JIA in hip MRI scorings, oligoarticular JIA scorings were 6 (0—17), systemic JIA scorings were 5 (0—21), polyarticular (rheumatoid factor negative) scorings were 7 (1—19), polyarticular (rheumatoid factor positive) scorings were 8 (1—15), enthesitis related&nbsp;JIA scorings were 4 (2—5). Arthritis or subclinical-arthritis of hips could be detected much earlier. Especially in history of arthritis of 4 or fewer joints group (χ2=16.80, P<0.01) and in history of arthritis of 5 or more joints group (χ2=4.792, P=0.029). Conclusions:Developed MRI scoring method proved to be a simple and highly reliable assessment score in the evaluation of JIA disease of the hips.

Objective To investigate the regional homogeneity (ReHo) changes of internet addiction (IA) adolescents using resting-state fMRI. Methods Twelve internet addiction adolescents and 12 healthy volunteers matched with age, gender and education level were collected from capital institute of pediatrics from October 2014 to August 2015. Mini-mental state examination was done for all subjects. Regional homogeneity of rs-fMRI were evaluated and compared between the two groups by using independent sample t-test. The correlation between ReHo values in different brain regions and hours spent online per week of the IA group was analyzed. Results Compared with normal controls, the adolescents with IA showed significant increased hours online per week (P<0.01). They also showed significant decreased ReHo in the left postcentral gyrus (129 voxels, t=4.45), left inferior parietal lobule (156 voxels, t=5.02) and left inferior frontal gyrus (117 voxels, t=4.14). No increased ReHo region was found in the whole brain. The correlation analysis showed negative correlation between the hours spent online per week and the ReHo values of the left postcentral gyrus(r=-0.874,P<0.05), left inferior parietal lobule(r=-0.746,P<0.05), and left inferior frontal gyrus(r=-0.695,P<0.05). Conclusion Adolescents with internet addiction have great ReHo alterations in many brain regions, which were linked to the degree of internet dependency.

目的 探讨苍白球T1值诊断新生儿急性胆红素脑病(ABE)的价值.方法 对10例ABE(ABE组)、11例高胆红素血症足月新生儿(高胆组)和13名正常新生儿(对照组)行常规T1WI和T1 mapping成像.T1 mapping成像采用6个不同反转时间的IR-FSE序列,取其平均值,得到量化T1图,选取双侧苍白球为ROI,测量其T1值,以方差分析比较3组间苍白球T1值的差异.对ABE组苍白球T1值与血清间接胆红素的峰值进行Pearson相关性分析,并于生后6个月对患儿发育情况进行评估.结果 常规T1WI显示,ABE组中10例双侧苍白球表现为对称性高信号;高胆组7例表现为高信号,4例为等信号;对照组13名均为等信号.ABE组、高胆组、对照组苍白球T1值分别为(652.40±16.25)ms、(676.45±17.21)ms、(684.08±10.20)ms,差异有统计学意(F=27.97,P＜0.01);ABE组苍白球T1值与对照组、高胆组间差异均有统计学意义(P均＜0.05),而高胆组与对照组间差异无统计学意义(P=0.08). ABE组苍白球T1值与血清间接胆红素峰值无相关性(r=-0.28,P=0.23).经过积极治疗,ABE组患儿生后6个月时均无明显神经心理发育障碍.结论 苍白球T1值测量能够提供量化客观依据,结合临床,可为早期诊断新生儿ABE提供帮助.

幼年性黄色肉芽肿(juvenile xanthogranuloma,JXG)是一种非郎格汉斯细胞组织细胞增生症,绝大多数表现为皮肤多发黄棕色丘疹或结节.病变累及中枢神经系统,且临床首发症状为中枢性尿崩症(central diabetes insipidus,CDI)的JXG病例国内尚未见报告,现将本院经活检病理证实的l例儿童JXG病例报告如下.患儿女性,初诊年龄5岁,因无明显诱因出现多饮多尿1个月入院.体格检查:体重15.8 kg,身高106 cm,体重指数14.1 kg/m2,发育良好,营养中等,神志清晰,皮肤光滑,无黄染,全身淋巴结无肿大,双眼睑无水肿、充血,双侧瞳孔等大等圆,对光反射灵敏,口唇无紫绀,颈软,气管居中,双侧甲状腺无肿大,无阴毛腋毛,病理发射未引出。

Objective To detect the differences of grey matter volume between the patients with mental retardation (MR) presented clinically as operation deficit (OD) or as language deficit (LD) and the children with typical normal development using optimal VBM.The developmental connections between brain gray matter and language or operation skills were examined.Methods Magnetic resonance imaging was obtained from 9 children with mental retardation presented as OD predominantly and 11 children with mental retardation presented as LD mainly,as well as the age-matched control group (11 and 14 normal children,respectively) on a 1.5 T scanner.Voxel-based morphometry analysis with an optimization of spatial segmentation and normalization procedures was applied to compare the volume of grey matter between the two groups (OD VS.control; LD VS.control).Statistically,the total and local gray matter volumes were compared between the two groups with t test.Results The total gray matter volume of OD group was [(1.030 ± 0.078) × 106 mm3].Compared to that of controls [(0.984 ± 0.058) × 106 mm3],it was increased significantly (t =-2.6,P ＜ 0.05).And the gray matter volume in the posterior cingulated gyrus,left superior prefrontal gyrus,left cuneus,left middle prefrontal gyrus and the body of left caudate nucleus showed significantly increased.Meanwhile,the total gray matter volume of the MR children presented as LD [(1.002 ± 0.068) × 106 mm3] showed significantly increased(t =-3.0,P ＜ 0.05) compared with that of control group [(0.957 ±0.057) × 106 mm3].The gray matter volume in bilateral thalami,the left inferior temporal gyrus,the left inferior frontal gyrus,and the left cerebellum of the LD group was more than that of normal children.Conclusion As revealed by VBM,there are differences in alterations of gray matter volume between MR children presented with OD and with LD relative to control.

Objective To elucidate the clinical and MRI features of reversible posterior encephalopathy syndrome(PRES) in children and adolescents,and to analyze the similarities and differences between children and adults in etiological factors,pathogenesis and MRI characteristics.Methods Clinical records and MR scanning results of 8 children with PRES were analyzed retrospectively.Results All of 8 children suffered from underlying diseases,including systemic lupus erythematous(n=2),acute lymphoblastic leukemia(n=1),scleroderma(n=1),nephrotic syndrome(n=3) or idiopathic epilepsy(n=1),and were treated with glucocorticoid,immunosuppressant or cytotoxic drug.MR showed the lesions were symmetrical and mainly involved the subcortical regions of parietal-occipital lobes and portion cortical,presenting as low signal on T1WI and high signal on T2WI and T2 FLAIR sequence.The lesions also appeared in temporal lobe,frontal lobe,basal ganglia,brainstem and cerebellum.Clinical conditions improved in all of 8 children after effective therapy,and MRI abnormalities disappeared completely in 4 cases.Conclusion Glucocorticoid,immunosuppressant or cytotoxic drug will be the crucial causations of PRES in children and adolescents.MRI features is helpful for diagnosis of PRES.

Objective To detect brain structural difference between children with unexplained mental retardation and children with typically normal development. Methods The high-resolution magnetic MR imaging were obtained from 21 children with unexplained mental retardation and 30 age-matched control children without intellectual disabilities. Voxel-based morphometry analysis with an optimization of spatial segmentation and normalization procedures were applied to compare differences of gray matter volume between the two groups. The total and regional gray matter volume were compared between the two groups with independent t test. Meanwhile, correlation was conducted to analyze the relationship between the total gray matter volume and intelligence quotient (IQ) with partial correlation test. Results The total gray matter volume was significantly increased in the mental retardation children [(1. 012 ±0. 079) × 106 mm3]in relative to the controls [(0. 956 ± 0. 059) × 106 mm3, t = - 2. 80, P ＜ 0. 05]. Compared to controls,children with unexplained mental retardation showed significantly increased gray matter volume in different regions, including the bilateral thalami, the bilateral superior frontal gyri, the bilateral gyri rectus, the bilateral temporal poles, the right inferior frontal gyrus, right parahippocampal gyrus and the right cerebellum. No correlation was detected between the total gray matter volume and IQ in children with mental retardation (r = 0. 078 ,P ＞ 0. 05). Conclusions VBM would detect the gray matter abnormalities that were not founded in routine MR scanning. The increase of gray matter volume in the frontal-thalamus network might indicate the delayed maturation of the brain development. This might be one of the causations of mental retardation in children.

OBJECTIVE:To explore the normal aerification of paranasal sinuses in Chinese children with magnetic resonance imaging.METHODS:Two hundred and eighty Chinese children aged from 17 days to 14 years without any symptoms related to sinusitis were statistically analyzed in MRI features, including counting the number of paranasal sinus pneumatization and the maximum axial and sagittal area of the left maxillary.RESULTS:The pneumatization rate of maxillary sinus was 85% in children aged from 0 to 1 years. Until 3 years the pneumatization rate of maxillary sinus was 95% and there was no significant difference in boys and girls (χ(2) = 0.741, P = 0.389). The pneumatization rate of maxillary sinus reached 100% after 4 years old. The pneumatization rate of ethmoid sinus was 100% in this study. The pneumatization rate of sphenoid sinus was 0 within 1 year old, 49% within 4 years old and 100% after 7 years old. There was no significant difference in boys and girls on the pneumatization rate of sphenoid sinus (χ(2) = 2.452, P = 0.117). The pneumatization rate of frontal sinus was 0 within 5 years old, 62% within 9 years old and 95% after 10 years old. There was no significant difference in boys and girls on the pneumatization rate of frontal sinus (χ(2) = 0.124, P = 0.724). The axial and sagittal maximum area of maxillary sinus was (689.28 ± 221.79) and (659.76 ± 263.31) mm(2) in girls and (668.13 ± 206.38) and (638.60 ± 207.67) mm(2) in boys. The differences were significant (t = -19.78, P < 0.001; t = -19.89, P < 0.001).CONCLUSION:The study of the development and normal aerification of paranasal sinuses of children can help radiologist make correct diagnosis of paranasal sinuses in children.

幼年性黄色肉芽肿(juvenile xanthogranuloma,JXG)多发生于婴幼儿及儿童,绝大多数病例单独发生于皮肤[1],合并或孤立发生于全身其他器官(皮肤外)受累者非常罕见[1-2],累及中枢神经系统者仅占该病的1％～2％[3].我院收治经病理证实的2例JXG患儿,均出现中枢神经系统受累,现报道如下。