目的 分析三维非增强血管造影和斑块内出血成像(SNAP)序列上大脑中动脉(MCA)粥样硬化斑块的图像特征,并探讨其与临床症状的关系.资料与方法 回顾性分析76例动脉粥样硬化MCA狭窄患者的三维非增强血管造影、T1加权三维容积各向同性快速自旋回波序列和SNAP图像.根据患者有无急性脑血管事件发生分为症状组44例与无症状组32例.根据斑块主体的分布位置分为前壁、上壁、后壁及下壁斑块,比较两组患者斑块数目及位置差异,以及SNAP序列显示斑块内出血(IPH)的分布情况.结果 76例患者共发现位于MCA偏心斑块78处,症状组中IPH 33例(76.7％),明显多于无症状组的5例(14.3％),差异有统计学意义(P<0.001).症状组内分布在前、上、后、下壁斑块IPH例数分别为15例(83.3％)、14例(87.5％)、2例(50.0％)、2例(40.0％),症状组内前壁及上壁的IPH分布比率明显多于后壁及下壁(P<0.05),但前壁与上壁间IPH比较,差异无统计学意义(P>0.05).结论 MRI 3D SNAP序列可辅助评价症状性MCA粥样硬化性狭窄斑块易损特征,症状组IPH较无症状组更多见.

目的 探索心脏磁共振成像(CMR)评估特发性肺动脉高压(IPAH)患者右心导管(RHC)指标的简便方法.方法 对25例IPAH患者行CMR及RHC检查.使用自主开发的计算机软件在心尖四腔心层面测量并计算右心室腔7个水平舒张末期和收缩末期室间隔至右心室游离壁距离的变化值(SFDC),自心尖向心底方向分别命名为SFDC1～ SFDC7,测量并计算三尖瓣环收缩期位移(TAPSE).分析SFDC1～ SFDC7、TAPSE及SFDC1 ～ SFDC7和TAPSE的乘积分别与RHC测算的右心室心输出量(RVCO)、右心室心脏指数(RVCI)、右心室心搏指数(RVSI)、肺动脉平均压(PAMP)、肺血管阻力(PVR)倒数1/PVR的相关性.结果 所有CMR参数与PAMP均没有相关性(P＞0.05).SFDC5×TAPSE与其他RHC参数相关性最高(r分别为0.86、0.81、0.78、0.74,P＜0.001).TAPSE与RVSI呈中度相关(r=0.50,P=0.01).结论 CMR右心室SFDC5×TAPSE也许可以简便并准确地评估IPAH患者部分RHC指标.

目的 比较进食高蛋白高脂肪食物与空腹状态下MR胸导管成像(MRTD)图像质量的差异.方法 将70例继发性下肢淋巴水肿患者随机分为空腹组和高蛋白高脂肪组,分别应用重T2W水成像技术进行MRTD.将所获得的胸导管图像分成腹段、胸段下1/2、胸段上1/2、颈段,分别进行图像质量评分(0～2分),记录2组患者胸导管各段评分情况,并计算每幅图像4个节段总评分.采用秩和检验比较2组间各段评分差异,以独立样本t检验比较2组总评分.结果 2组胸导管显示满意率(4段总评分≥4分)均为97.14％(34/35),高蛋白高脂肪组和空腹组平均评分分别为(6.37±1.37)分和(6.43±1.40)分(t=0.17,P=0.86).2组间胸段下1/2、胸段上1/2和颈段评分差异均无统计学意义(P=0.28、0.40、0.05),腹段差异有统计学意义(P-0.01).结论 空腹或高蛋白高脂肪饮食于MR胸导管整体显示无差异,高蛋白高脂肪饮食对MRTD显示胸导管腹段效果更佳.

目的 应用MRCT扫描及多平面重组(MPR)技术,探讨贝尔面瘫患者面神经管解剖特点与发病机制之间的关系.方法 回顾性分析49例贝尔面瘫患者的MSCT影像资料,原始数据传至工作站进行MPR后处理,分别获得双侧颞骨同层显示面神经管迷路段、膝状神经节段及鼓室段的斜轴位图像,对患侧及健侧面神经管迷路段、膝状神经节段及鼓室段宽度分别进行同层测量,采用配对t检验进行比较.结果 其中2例患者单侧面神经管斜轴位MPR未能同层显示面神经的三段骨管结构,MPR同层显示率为98.0％(96/98).47例患者纳入测量,患侧面神经管迷路段、膝状神经节段、鼓室段内径平均值分别为(0.89±0.19)mm(0.60 ～1.49 mm)、(3.07 ±0.21)mm(2.66 ～3.80 mm)、(1.08 ±0.18)mm(0.72～1.44 rmm);健侧面神经管迷路段、膝状神经节段、鼓室段内径平均值分别为(0.94 ±0.17) mm (0.73 ～ 1.55 mm)、(3.22±0.27)mm (2.05～3.95 mm)、(1.11±0.16)mm (0.80～1.57mm).患侧面神经管迷路段、膝状神经节段内径较健侧窄,差异存在统计学意义(P＜0.05).结论 MSCT扫描及其MPR技术能够最大程度同层面对称显示双侧面神经管情况,贝尔面瘫患者面神经管迷路段、膝状神经节段骨管相对较窄可能是贝尔面瘫患者发病的解剖学基础.

Objective To evaluate the value of MRI in diagnosing primary hyperparathyroidism(PHPT), and analyze different results of multiple imaging modalities in the diagnosis of parathyroid lesion.Method Totally 32 PHPT lesions in 30 patients with surgery resection were analyzed retrospectively. There were 28 cases with MRI scan (with or without enhancement); 29 cases with 99mTc-MIBI dual-phase SPECT scan, 28 cases with ultrasonographical exam; 27 cases with combination of MRI and 99mTc-MIBI dual-phase SPECT examination. Using pathological results as the gold standard, the accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappavalue of the three imaging modalities.Result There were 28 cases of parathyroid adenoma (30 lesions); 2 cases of parathyroid hyperplasia (2 lesions). The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, Kappavalue: MRI were 94.69％, 83.33％, 98.80％, 96.15％, 94.25％, 0.858;99mTc-MIBI dual-phase SPECT were 94.87％, 86.21％, 97.73％, 92.59％, 95.56％, 0.859; ultrasonography were 89.38％, 70.00％, 96.39％, 87.50％, 89.89％, 0.709; combination of MRI and 99mTc-MIBI dual-phase SPECT examination were 99.08％, 96.55％, 100.00％, 100.00％, 98.77％, 0.976.Conclusion MRI is an effective tool for diagnosis of PHPT. Combination of MRI and 99mTc-MIBI dual-phase SPECT examination can provide better diagnostic accuracy of PHPT.

目的 应用MR相位对比成像评价永存三叉动脉(PTA)合并一侧颈内动脉发育不良患者PTA内血流状态.方法 对2009年4月至2015年11月发现的5例PTA合并单侧颈内动脉发育不良患者行磁共振相位对比法电影成像(CinePC)检查,采用Q-Flow测量PTA血流方向、平均流速及平均流量.结果 PTA合并一侧颈内动脉发育不良时的其血流方向与单纯PTA相反,表现为由后循环经PTA至颈内动脉闭塞侧大脑前循环;PTA平均流速(9.77 ±0.92) cm/s,平均流量(0.82 ±0.41) ml/s.结论 当合并一侧颈内动脉发育不良时PTA内血流方向会发生反转,由后循环向前循环供血,MR相位对比技术可以无创性地对这一血流变化进行定性、定量观察.

Objective To evaluate the accuracy and reproducibility of the cardiac magnetic resonance (CMR) imagingderived left ventricular septal-to-free wall curvature ratio by CAD drawing software for prediction of the right ventricular systolic pressure (RVSP) in patients with idiopathic pulmonary arterial hypertension (IPAH).Methods Twenty patients with IPAH confirmed by right-side heart catheterization (RHC) underwent CMR imaging.Two doctors measured interventricular septal curvature (CIVS) and left ventricular free wall curvature (CFW) at end systole by using a third-party CAD drawing software and derived the curvature ratio (CIVS/CFW).Pressure rise of IVS (dPIVS) and pressure rise of FW (dPFW) derived from RHC and systemic systolic blood pressure was used to derive the dP ratio (dPIVS/dPFW).Interobserver and intraobserver curvature ratio measurements agreement was assessed by using Bland-Altman analyses.Linear regression analysis was performed to assess the relationship between curvature ratio and dP ratio.A regression equation was derived.By using this equation,the RVSP was computed in every patient,and the agreement between CMR-and RHC-derived RVSPs was assessed by using Bland-Altman analysis.Results A direct linear correlation between curvature ratio and dP ratio was observed (r =0.93).Bland-Altman analysis revealed moderate agreement between CMR-and RHC-derived RVSPs (mean difference =7.8 ± 12.1 mm Hg).Conclusion CMR-derived curvature ratio by CAD drawing software was a simple,fast,accurate and reproducible index for estimation of RVSP in patients with IPAH.

变异性脑胶质瘤是中枢神经系统最常见的、预后较差的原发性恶性肿瘤，占颅内肿瘤的50%~60%，即使给予传统的手术联合放、化疗的综合治疗，低级别胶质瘤病人的平均存活时间仅为3~5年，而高级别胶质瘤为1~2年，其治疗一直是神经外科领域的研究热点。由于胶质瘤具有浸润性生长的特性，手术难以彻底切除，临床传统的治疗策略是在手术切除大部分瘤体的基础上，采用放疗、化疗等多种手段抑制、杀灭瘤床周围的肿瘤细胞，以延长患者的生存期。近年来发展起来的靶向治疗更是为胶质瘤的治疗提供了一种全新的有效途径。对脑胶质瘤手术后各种后续治疗的疗效观察一直是临床研究的重点内容，这对临床医生正确选择下一步治疗方案至关重要。

目的 分析与慢性淋巴水肿相关的软组织恶性肿瘤的MRI表现.方法 回顾性分析8例慢性淋巴水肿相关的软组织恶性肿瘤的临床资料及MRI表现.结果 病变发生于上臂5例,前臂1例,小腿1例,足部1例.5例血管肉瘤T1WI呈中等信号,T2WI表现为低信号,增强后显著强化.2例原发性皮肤弥漫大B细胞淋巴瘤表现为明显突出于皮肤表面的分叶状等T1稍长T2信号软组织肿块,其内短T2分隔明显强化.1例黏液炎性纤维母细胞肉瘤边缘光滑,T1WI呈稍低信号,T2WI呈高信号.结论 慢性淋巴水肿所致局部免疫缺陷可引发多种软组织恶性肿瘤,MRI上其共同特点为皮肤及皮下软组织结节,其中血管肉瘤病灶多发且显著强化有助于与其他肿瘤的鉴别.

1 脑脊液流动的研究背景 对脑脊液流动的研究在20世纪40年代早期即已开始[1,2].经核素脑池造影、X线电影脑池及脑室造影和颅内压监测等方法的研究,一般认为脑脊液循环有两种运动形式.

Objective To explore the value of magnetic resonance imaging (MRI) and cine magnetic resonance imaging (eine-MRI) in evaluating the open status of orifieium fistulae after the third ventriculostomy in patients with noncommunicating hydrocephalus. Method Apply the magnetic resonance imaging (MRI) and cine magnetic resonance imaging (cine-MRI) method to determine stoma rates and flows in 128 patients with noncommunicating hydrocephalus after endoscopic third ventriculostomy, what's more, we also made it the follow-up method. Second look exploration might be necessary for patients whose clinical symptoms did not ease well or symptoms of intracranial hypertension recurred in the follow-up period, accuracy of cine-MRI in determining the open status of orificium fistulae could be analyzed combined with the intraoperative exploration and results of cine-MRI examination. Result Clinical symptoms in 3 cases did not ease welt, and cine-MRI demonstrated that the flow of cerebrospinal fluid through stoma was good and the stoma was open during the second look exploration; intracranial hypertension recurred in 16 cases, and cine-MRI demonstrated that rates and flows of cerebrospinal fluid in stomas reduced greatly, the stomas was blocked or obviously narrowed, which would regress after the second ostomy. Coincidence rate of cine-MRI and exploration was 100%. Conclusion Cine-MRI can actually reflect the open status of orificium fistulae after the third ventriculostomy, and further, it will become the gold standard for evaluation of the open status for orificium fistulae after ostomy and an important follow-up method.

Objective To describe the MRI findings of spinocerebellar ataxia (SCA) and discuss the value of MRI in the diagnostic of SCA. Materials and Methods Two sufferers and four other asymptomatic members of a same family with SCA were performed brain routine MRI and single-voxel 1H-MR spectroscopy (MRS) with a stimulated echo acquisitionmode sequence (STEAM) in the cerebellar vermis. The two sufferers were performed diffusion tensor imaging (DTI). The shape and signal intensity of the central nervous system were observed. The integrality of the transverse pontine fibers were showed on the DTI colour FA images and the NAA/Cr rates and Cho/Cr rates of the cerebellar vermis were calculated. Results The cerebellar vermis and bilateral cerebellar hemispheres of the two sufferers from SCA were atrophic, more obviously in the vermis. Midline high signal intensity was demonstrated in the pontine base on two consecutive T2WI in the two sufferers from SCA. The transverse pontine fibers showed incompletely on DTI colour FA image at the level of superior cerebellar peduncle in the two sufferers from SCA. The NAA/Cr rates in the cerebellar vermis were mildly decreased in the two sufferers from SCA, compared with the reference value, and were on the low side of the reference value in one family member with mild physical sign and one asymptomatic family member. In other two asymptomatic family members, the NAA/Cr rates in the cerebellar vermis were close to the average of the reference value. The Cho/Cr rates in the cerebellar vermis were in the range of the reference value in all the family members. Conclusion Various of MRI techniques might reflect the main pathologic findings of SCA, and can provide clues as to the diagnosis of SCA.

Objective To study the valve of time-resolved imaging of contrast kinetics(TRICKS)in the diagnosis of extremity musculoskeletal neoplasms.Methods First,22 cases of extremity musculoskeletal neoplasms were scanned with conventional sequences.Second,contrast medium was injected and TRICKS was performed,then enhanced images were obtained in axial plane,sagittal plane and coronal plane.The overall image quality and the demonstration of neoplasms were analyzed,and the qualitative diagnosis was compared with surgical and pathological results.Results TRICKS was successfully performed in all patients.TRICKS demonstrated the arterio-venous structures dynamically.The qualitative diagnosis was consistent with surgical and pathological results.Conclusion The operation of TRICKS is simple,and it can observe arterio-venous structures without interfere enhanced scan.TRICKS should be a conventional sequence in the examination of extremity musculoskeletal diseases.

Objective To study the influence of maple oil consumption on MRI examination by using MRS and R2* measurement. Methods Maple oil was compared with normal bean oil by 1H MRS examination under same condition. Five healthy volunteers took 10 ml maple oil simultaneously one time a day and repeated in 5 consecutive days. MR examinations were performed before the oil taken and 30 minutes after, including axial T2, coronal FIESTA and axial multi-echo GRE for R2* calculation (8 echoes). Water drinking and bean oil drinking were also included on a separate day for comparison. Liver, muscle, intestine's R2* value (in Hz) were measured with identical ROI. Two healthy volunteers who took Maple oil for 2 years were examined by routine MR protocol. Results From 1H MRS data, maple oil had identical chemical compound as bean oil, but higher none saturated lipid concentration. Also the line width of the CH2 peak of maple oil was 44% bigger than normal bean oil, which was possible due to regional field inhomogeneity caused by its ingredient. For the short term oil taken group, the R2* values of liver and muscle did not have statistical difference before and after oil taken, but noticeable mental artifact could be observed in intestinal area and its R2* value increased after oil taken. No statistical differences during the water drink and bean oil drink examination. For the long-term oil taken group, the center frequency of liver was much bigger than other patients or volunteers. Conclusion From R2* value, we can easily tell that short-term consumption of maple oil is in gastrointestinal system. From the long-term study group, it is possible that part of maple oil will be transported and stored in liver system, which causes the shift of center frequency. The effected ingredient and its pathway are under investigation.