患者男性,30岁,主因"突发肢体无力1月"于2020年8月收入我院神经内科.患者入院前1个月突发双下肢无力,需双手撑地站起,行走需扶墙.当时未就诊.此后患者双下肢仍觉力弱,可行走,不能跑跳;双下肢小腿后侧自觉发凉.发病后自觉劳累后无力感加重,存在"晨轻暮重".大便有无力感.既往无特殊病史.神经科查体患者左下肢肌力V级,肌张力无明显增高或减低.四肢腱反射活跃,双侧病理征阳性;双侧共济稳准.患者血、尿、便常规、生化检查、凝血功能、抗核抗体正常,同型半胱氨酸(HCY)214.54μmol/L(0～ 15 μmol/L).颅脑MRI检查示:双侧放射冠脱髓鞘病变(图1A、1B,见封三).颈椎MRI检查示:颈椎轻度退行性变(图2A、2B,见封三).肌电图:神经源性损害(右颈8-胸1根性,双侧L5-S1根性).完善相关基因检测,重点关注MTHFR基因,结果为阳性.

Objective:To explore the value of triple fusion positron emission tomography (PET)/MRI in location of epileptogenic focus in patients with focal cortical dysplasia (FCD).Methods:Three patients with refractory partial epilepsy, admitted to our hospital from December 2016 to June 2017, were chosen in our study. The raw MRI and PET images of these patients were processed using Freesurfer and FSL image processing softwares. After extraction and coregistration, precise PET/MRI fusion images were obtained; and the grey-white matter dividing line was highlighted on this fusion image to form triple-fusion images to observe the hypometabolic area and clarify the location.Results:Triple-fusion images of these 3 patients were acquired. In patient 1, a marked decrease in metabolism was noted in the gyrus region delineated by the gray-white matter boundary in the right cingulate gyrus. In patient 2, the area with slightly increased local signal in the right superior frontal gyrus (MRI FLAIR sequence) was the area with reduced metabolism. In patient 3, an area of local decreased metabolism was noted in the right cingulate gyrus. The preoperative evaluation of all 3 patients showed that the above areas were epileptic foci; the patients were followed up for 2 years after surgical resection, no clinical seizures occurred in all patients, and antiepileptic drugs were gradually stopped. All 3 patients were diagnosed as having FCD by postoperative pathology.Conclusion:Triple fusion PET/MRI is a powerful way to assist FCD diagnosis, especially for those FCD cases which are difficult to be diagnosed by other imaging methods, and has a potential clinical application value in epilepsy patients.

自从1895年伦琴发现X射线再到后来分子影像的出现,数字化医学影像学已经成为现代医学重要的手段和组成部分.在过去十年中,随着模式识别工具数量的增加和数据集大小的增加,医学图像分析领域呈指数发展[1].影像组学作为定量成像中新兴的领域,近年来越来越受到人们的关注,本文主要探讨总结了影像组学的基本概念及其在肺部疾病中的应用.

目的 探讨CTPA漏诊亚段肺栓塞(SSPE)的常见原因.方法 对临床确诊肺栓塞(PE)的91例患者的影像学资料进行回顾性分析,计算首诊CTPA、复诊CTPA及经查看肺通气/灌注(V/Q)显像结果后复诊CTPA对SSPE的检出率,并与V/Q显像结果进行比较.结果 91例PE患者中,3 494支亚段肺动脉显示清楚.肺V/Q显像对SSPE的检出率为19.00％(664/3 494),首诊CTPA的检出率为11.99％(419/3 494),差异有统计学意义(x2=65.59,P＜0.01);复诊CTPA检出率为13.62％(476/3 494),低于肺V/Q显像(x2=37.05,P＜0.01);查看肺V/Q显像结果后,复诊CTPA对SSPE的检出率为15.83％(553/3 494),与肺V/Q显像比较差异有统计学意义(x2=12.26,P＜0.01).结论 CTPA漏诊SSPE的原因主要包括亚段肺动脉观察困难、诊断水平较低和对慢性PE诊断困难.提高阅片医师注意力和针对性,并联合肺V/Q显像,可提高CTPA对SSPE的检出率.

Objective To investigate the clinical features and imaging findings of interstitial lung disease in antisynthetase syndrome（AS-ILD）and to compare the characteristics among AS specificities.Methods A total of 59cases with AS-ILD at our hospital during the last 5 years were retrospectively reviewed,including anti-Jo1 positive