Albumin and magnetic resonance imaging-liver volume to identify hepatitis B-related cirrhosis and esophageal varices

AIM:To investigate whether liver lobe volume and albumin(ALB) could predict the presence and severity of liver cirrhosis,and esophageal varices.METHODS:Seventy-one cirrhotic patients with hepatitis B and 21 healthy individuals were enrolled in this study.All the participants underwent abdominal enhanced magnetic resonance imaging to measure each liver lobe volume,and biochemical workup for testing ALB and Child-Pugh class.All cirrhotic patients underwent upper gastrointestinal endoscopy to show the presence of cirrhotic esophageal varices.Right liver lobe volume(RV),left medial liver lobe volume(LMV),left lateral liver lobe volume(LLV),and caudate lobe volume(CV) were measured using enhanced magnetic resonance imaging.The ratios of RV to ALB(RV/ALB),LMV to ALB(LMV/ALB),LLV to ALB(LLV/ALB) and CV to ALB(CV/ALB) were calculated.Statistical analyses were performed to determine whether and how the combination of liver lobe volume measured using magnetic resonance imaging and albumin could predict the presence and severity of liver cirrhosis,and the presence of esophageal varices.RESULTS:RV,LMV,LLV and CV decreased(r =-0.51-0.373; all P < 0.05),while RV/ALB increased(r = 0.424; P < 0.05),with the progress of Child-Pugh classof liver cirrhosis.RV,LMV,CV,LLV/ALB and CV/ALB could identify presence of liver cirrhosis; LLV and LMV could distinguish Child-Pugh class A from B; RV,LMV,LLV,CV,RV/ALB and LLV/ALB could distinguish class A from C; RV and LLV/ALB could differentiate B from C; and RV,RV/ALB and CV/ALB could identify presence of esophageal varices(all P < 0.05).Among these parameters,CV/ALB could best identify the presence of liver cirrhosis,with an area under receiver operating characteristic curve(AUC) of 0.860,a sensitivity of 82.0% and a specificity of 83.0%.LLV could best distinguish class A from B,with an AUC of 0.761,a sensitivity of 74.4% and a specificity of 73.1%.RV could best distinguish class A from C,with an AUC of 0.900,a sensitivity of 90.3% and a specificity of 84.5%.LLV/ALB could best distinguish class B from C,with an AUC of 0.900,a sensitivity of 93.8% and a specificity of 81.5%.RV/ALB could best identify esophageal varices,with an AUC of 0.890,a sensitivity of 80.0% and a specificity of 83.5%.CONCLUSION:The combination of liver lobe volume and ALB has potential to identify presence and severity of cirrhosis,and presence of esophageal varices.

Hepatic abnormal perfusion visible by magnetic resonance imaging in acute pancreatitis

AIM:to study the prevalence and patterns of hepatic abnormal perfusion(HAP)visible by magnetic resonance imaging(MRI)in acute pancreatitis(AP).METHODS:Enhanced abdominal MRI was performed on 51 patients with AP.these patients were divided into two groups according to the MRI results:those with signs of gallstones,cholecystitis,common bile duct(CBD)stones or dilatation of the CBD on MRI and those without.the prevalence,shape and distribution of HAP in the two groups were analyzed and compared.the severity of AP was graded using the MR severity index(MRSI).the correlation between the MRSI and HAP was then analyzed.RESULTS:Of the 51 patients with AP,32(63%)showed at least one sign of gallbladder and CBD abnormalities on the MR images,while 19(37%)showed no sign of gallbladder or CBD abnormalities.Nineteen patients(37%)had HAP visible in the enhanced images,including strip-,wedge-or patch-shaped HAP distributed in the hepatic tissue adjacent to the gallbladder and left and right liver lobes.there were no significant differences in the prevalence of HAP(χ2=0.305,P=0.581>0.05)or HAP distribution in the liver(χ2=2.181,P=0.536>0.05)between patients with and without gallbladder and CBD abnormalities.there were no significant differences in the MRSI score between patients with and without HAP(t=0.559,P=0.552>0.05).HAP was not correlated with the MRSI score.CONCLUSION:HAP is common in patients with AP and appears strip-,patch-or wedge-shaped on MRI.HAP on MRI cannot be used to indicate the severity of AP.

交叉异位融合肾影像学表现

目的 观察交叉异位融合肾影像学表现。方法 回顾性分析12例交叉异位融合肾资料,分析该病影像学表现。结果 12例交叉异位融合肾包括L型5例,下异位型(Ii型)、S型及块状型(O型)各2例,甜甜圈型或盘状型(C-C型)1例;均表现为一侧肾窝空虚而对侧肾形态、位置大致正常,异位肾跨过中线与对侧肾融合,8例右向左、4例左向右融合;异位肾输尿管均跨过中线,11例开口于对侧膀胱三角区、1例异位开口于前列腺。3例合并生殖系统畸形,其中单角子宫、双角子宫、隐睾各1例;2例合并下腔静脉异常,包括双下腔静脉、左下腔静脉各1例。结论 交叉异位融合肾具有特征性影像学表现;完整显示肾融合、输尿管走行及开口有助于准确诊断及分型。

儿童眼眶周淋巴管畸形合并静脉畸形误诊为动静脉畸形临床分析

目的探讨眼眶周淋巴管畸形的特点及误诊原因。方法回顾性分析2023年收治的儿童眼眶周淋巴管畸形合并静脉畸形误诊为动静脉畸形1例的临床资料。结果该例患儿出生后发现右眼肿胀,先后误诊为血管瘤和动静脉畸形,分别进行硬化治疗和动静脉畸形组织胶栓塞,症状有所缓解,但间断反复发作。经过完善磁共振成像检查和在超声引导下局部穿刺眶周囊腔术中抽出淋巴液确诊为淋巴管畸形合并静脉畸形。误诊时间11年。确诊后经过硬化治疗联合西罗莫司治疗后,患儿症状得到明显缓解,随访期间未再次复发。结论眶周淋巴管畸形合并静脉畸形易误诊,需要联合影像检查和多学科团队进行共同评估,减少误诊。

子宫动静脉畸形伴右侧卵巢静脉异常引流1例

目的探讨多种影像学检查诊断子宫动静脉畸形(UAVM)的临床价值。方法回顾性分析1例经手术病理证实的伴有右侧卵巢静脉异常引流的UAVM病人的临床特征及影像学表现,并复习相关文献。结果二维超声显示子宫肌壁回声不均,子宫肌壁多发迂曲条带状无回声区;彩色多普勒超声显示无回声区内丰富彩色血流信号;频谱多普勒超声显示同时存在动脉、静脉频谱波形。盆腔CT平扫无明显异常;盆腔CT血管成像显示子宫内多发迂曲扩张畸形血管影,以双侧髂内动脉为供血动脉;双侧卵巢静脉均增粗,右侧卵巢静脉于第2腰椎水平汇入右肾静脉。容积再现(VR)及最大密度投影(MIP)成像显示双侧增粗扩张的引流静脉。盆腔MRI平扫显示子宫体积增大,内见不规则混杂信号影,T1WI以等/低信号为主,T2WI以混杂高信号为主,伴有迂曲扩张流空血管影,病灶内见片状高信号出血灶;盆腔时间-空间标记反转脉冲(Time-SLIP)无对比剂血管成像显示UAVM供血动脉远端的动脉血成分呈高信号。结论联合多种影像学检查诊断子宫动静脉畸形不仅能显示罕见异常引流,评估UAVM,而且Time-SLIP无对比剂血管成像可以明确畸形血管团供血动脉远端动脉血成分,为后期的介入及手术治疗提供指导。

Fetal central nervous system anomalies: comparison of magnetic resonance imaging and ultrasonography for diagnosis

Background Evaluation of fetal central nervous system （CNS） agenesis by ultrasonography （US） is frequently limited, but magnetic resonance imaging （MRI） has its own advantages and is gaining popularity in displaying suspected fetal anomalies. The purpose of this study was to explore the value of MRI in detecting fetal CNS agenesls. Methods Thirty-four women （aged from 22 to 35 years, average 27 years） with complicated pregnancies （16-- 39 weeks of gestation, average 30 weeks） were examined with a 1.5 T superconductive MR unit within 24 hours after ultrasonography. Half-Fourier acquisition single-shot turbo spin-echo （HASTE） T2-weighted imaging （T2WI） sequence were performed in all patients, and fast low angle shot （FLASH） T1-weighted imaging （T1WI） sequence were applied sequentially in seven of them. Comparison of the results was made between the MRI and US findings as well as autopsy or postnatal follow-up MRI findings. Results The gyms, sulcus, corpus callosum, thalamus, cerebellum, brainstem, and spinal cord of fetus were shown more clearly on T2-weighted MR images than on T1-weighted MR images. MRI corrected the diagnosis of US in 10 cases （10/34, 29.41%） and the diagnosis was missed only in 1 case （1/34, 2.94%）. Conclusion MRI has advantages to US in detecting fetal CNS anomalies and is a supplement to US in complicated pregnancies.

Abnormal spontaneous brain activity in patients with non-arteritic anterior ischemic optic neuropathy detected using functional magnetic resonance imaging

To the Editor: Non-arteritic anterior ischemic optic neuropathy (NAION), characterized by a sudden onset of unilateral painless visual loss and a swollen optic disc, is the most common form of acute optic neuropathy in patients over 50 years of age.[1] The pathogenesis of NAION remains unclear, but most histopathological studies support the concept of vasculopathic occlusion in the region of the short posterior ciliary arteries.[2] Functional magnetic resonance imaging (fMRI) is one of the most widely used non-invasive techniques for measuring brain function over time in vivo. To the best of our knowledge, only one study has investigated the effects of stimulating the affected eye in the extra-visual areas in NAION in humans.[3]However, this previous study only examined task-state fMRI, and lacked a measure of resting-state fMRI (rs-fMRI). Thus, it remains unclear whether regional spontaneous brain changes are limited to the visual system.

Regional brain structural abnormality in ischemic stroke patients:a voxel-based morphometry study

Our previous study used regional homogeneity analysis and found that activity in some brain areas of patients with ischemic stroke changed significantly. In the current study, we examined structural changes in these brain regions by taking structural magnetic resonance imaging scans of 11 ischemic stroke patients and 15 healthy participants, and analyzing the data using voxel-based morphometry. Compared with healthy participants, patients exhibited higher gray matter density in the left inferior occipital gyrus and right anterior white matter tract. In contrast, gray matter density in the right cerebellum, left precentral gyrus, right middle frontal gyrus, and left middle temporal gyrus was less in ischemic stroke patients. The changes of gray matter density in the middle frontal gyrus were negatively associated with the clin- ical rating scales of the Fugl-Meyer Motor Assessment （r = -0.609, P = 0.047） and the left middle temporal gyrus was negatively correlated with the clinical rating scales of the nervous functional deficiency scale （r = -0.737, P = 0.010）. Our findings call objectively identify the functional abnormality in some brain regions of ischemic stroke patients.

Gastric duplication cyst mimicking large cystic lymphangioma in an adult: A rare case report and review of the literature

BACKGROUND Gastric duplication cysts(GDCs)are a relatively uncommon congenital developmental abnormality,mainly occurring in infants but very rarely in adults.Because of the variability in clinical presentation,it is often quite challenging to diagnose GDCs in adults.We are presenting a case report of an adult diagnosed operatively as having a GDC with a literature review to summarize clinical and imaging features and the treatment selections of GDCs in adults so that doctors could have a comprehensive understanding of this disease and make a precise diagnosis and a suitable therapeutic decision for patients.CASE SUMMARY A 51-year-old man presented with recurrent epigastric pain and fullness for two years.No significant findings were noted during physical examination and routine blood tests were unremarkable.An abdominal ultrasound revealed a large cyst in the upper left abdominal quadrant.A following contrast-enhanced abdominal computed tomography(CT)scan demonstrated a hypodense cystic lesion between the spleen and stomach.The lesion had scattered calcification in the cyst wall without any significant enhancement.The lesion was initially thought to be a cystic lymphangioma.The patient underwent a surgical resection and intraoperatively it was noted that the lesion was closely adherent to the greater curvature of the stomach.Subsequently,a resection of the gastric mass along with a partial gastrectomy was performed.The patient recovered quickly with a complete symptomatic relief and did not show any further complications during the 8-month follow-up.CONCLUSION GDCs are quite rare in adults,with a multitude of symptoms,which is quite challenging for precise diagnosis before histological examination.Some imaging techniques involving CT,magnetic resonance imaging,and endoscopic ultrasound could provide valuable morphological features for differential diagnosis.

Research on Split Augmented Largrangian Shrinkage Algorithm in Magnetic Resonance Imaging Based on Compressed Sensing

This paper aims to meet the requirements of reducing the scanning time of magnetic resonance imaging （MRI）, accelerating MRI and reconstructing a high quality image from less acquisition data as much as possible. MRI method based on compressed sensing （CS） with multiple regularizations （two regularizations including total variation （TV） norm and L1 norm or three regularizations consisting of total variation, L1 norm and wavelet tree structure） is proposed in this paper, which is implemented by applying split augmented lagrangian shrinkage algorithm （SALSA）. To solve magnetic resonance image reconstruction problems with linear combinations of total variation and L1 norm, we utilized composite spht denoising （CSD） to split the original complex problem into TV norm and L1 norm regularization subproblems which were simple and easy to be solved respectively in this paper. The reconstructed image was obtained from the weighted average of solutions from two subprohlems in an iterative framework. Because each of the splitted subproblems can be regarded as MRI model based on CS with single regularization, and for solving the kind of model, split augmented lagrange algorithm has advantage over existing fast algorithm such as fast iterative shrinkage thresholding（FIST） and two step iterative shrinkage thresholding （TWIST） in convergence speed. Therefore, we proposed to adopt SALSA to solve the subproblems. Moreover, in order to solve magnetic resonance image reconstruction problems with linear combinations of total variation, L1 norm and wavelet tree structure, we can split the original problem into three subproblems in the same manner, which can be processed by existing iteration scheme. A great deal of experimental results show that the proposed methods can effectively reconstruct the original image. Compared with existing algorithms such as TVCMRI, RecPF, CSA, FCSA and WaTMRI, the proposed methods have greatly improved the quality of the reconstructed images and have better visual effect.

术前磁共振评价腹腔镜手术治疗剖宫产切口瘢痕缺陷相关异常子宫出血的价值及影响因素

目的:剖宫产率逐年上升,而剖宫产切口瘢痕缺陷的治疗具有较大挑战性。本研究旨在评估术前磁共振成像技术对于腹腔镜手术治疗剖宫产切口瘢痕缺陷相关异常子宫出血患者的临床价值并分析相关影响因素。方法:选择2018年至2022年在中南大学湘雅三医院妇科接受腹腔镜手术治疗剖宫产切口瘢痕缺陷相关异常子宫出血的患者共计57例,进行回顾性队列分析。将57例患者根据腹腔镜手术治疗剖宫产切口瘢痕缺陷相关异常子宫出血的术后临床治愈情况分为临床治愈组(n=28,49.1%)及非临床治愈组(n=29,50.9%)。对所有的受试者进行术后3个月的随访调查,通过logistic回归分析探讨患者的年龄、临床症状、孕产史、剖宫产史等基本临床信息、术前磁共振成像参数以及术后月经情况等与腹腔镜手术治疗剖宫产切口瘢痕缺陷相关异常子宫出血的临床治愈率的相关性。结果:2组患者的年龄、前次剖宫产年龄、怀孕次数、前次剖宫产时间、腹腔镜术前T2信号磁共振评估的子宫位置、缺陷长度、缺陷宽度、缺陷残余肌层厚度、缺陷邻近子宫肌层厚度及缺陷距宫颈外口距离等参数的差异均无统计学意义(均P>0.05)。患者的异常子宫出血症状出现时间(P=0.036,OR=1.019,95%CI 1.002~1.038)和术前磁共振成像的缺陷深度(P=0.010,OR=5.793,95%CI 1.635~25.210)是影响临床治愈率的危险因素。结论:患者异常子宫出血症状出现时间及术前磁共振评估的缺陷深度是腹腔镜手术治疗剖宫产切口瘢痕缺陷相关异常子宫出血临床治愈的影响因素,术前磁共振对于判断本病预后具有一定的临床意义。

Exploring the Abnormal Brain Regions and Abnormal Functional Connections in SZ by Multiple Hypothesis Testing Technique

Schizophrenia(SZ)is one of the most common mental diseases.Its main characteristics are abnormal social behavior and inability to correctly understand real things.In recent years,the magnetic resonance imaging(MRI)technique has been popularly utilized to study SZ.However,it is still a great challenge to reveal the essential information contained in the MRI data.In this paper,we proposed a biomarker selection approach based on the multiple hypothesis testing techniques to explore the difference between SZ and healthy controls by using both functional and structural MRI data,in which biomarkers represent both abnormal brain functional connectivity and abnormal brain regions.By implementing the biomarker selection approach,six abnormal brain regions and twenty-three abnormal functional connectivity in the brains of SZ are explored.It is discovered that compared with healthy controls,the significantly reduced gray matter volumes are mainly distributed in the limbic lobe and the basal ganglia,and the significantly increased gray matter volumes are distributed in the frontal gyrus.Meanwhile,it is revealed that the significantly strengthened connections are those between the middle frontal gyrus and the superior occipital gyrus,the superior occipital gyrus and the middle occipital gyrus as well as the middle occipital gyrus and the fusiform gyrus,and the rest connections are significantly weakened.

Predictors of bowel damage in the long-term progression of Crohn’s disease

BACKGROUND Crohn’s disease(CD)is a chronic inflammatory bowel disorder that progresses to bowel damage(BD)over time.An image-based index,the Lémann index(LI),has been developed to measure cumulative BD.AIM To characterize the long-term progression of BD in CD based on changes in the LI and to determine risk factors for long-term progression.METHODS This was a single-center longitudinal cohort study.Patients who had participated in prospective studies on the accuracy of magnetic resonance imaging using endoscopy as a gold standard and who had a follow-up of at least 5 years were reevaluated after 5-12 years.RESULTS Seventy-two patients were included.LI increased in 38 patients(52.8%),remained unchanged in 9 patients(12.5%),and decreased in 25 patients(34.7%).The small bowel score and surgery subscale significantly increased(P=0.002 and P=0.001,respectively),whereas the fistulizing subscale significantly decreased(P=0.001).Baseline parameters associated with BD progression were ileal location(P=0.026),CD phenotype[stricturing,fistulizing,or both(P=0.007,P=0.006,and P=0.035,respectively)],disease duration>10 years(P=0.019),and baseline LI stricturing score(P=0.049).No correlation was observed between BD progression and baseline clinical activity,biological markers,or severity of endoscopic lesions.CONCLUSION BD,as assessed by the LI,progressed in half of the patients with CD over a period of 5-12 years.The main determinants of BD progression were ileal location,stricturing/fistulizing phenotype,and disease duration.

儿童脾脏淋巴管畸形的影像学特征

[目的]探讨儿童脾脏淋巴管畸形的影像学特征.[方法]回顾性分析本院2010年1月至2020年12月经病理学检查证实的9例脾脏淋巴管畸形患儿的临床资料,8例于本院行CT平扫及增强,1例在外院行CT平扫增强及本院M RI平扫增强.观察并分析脾脏淋巴管畸形的部位、分型、形态、边界、大小、有无钙化、分隔、密度/信号及强化方式等.[结果]3例位于脾脏包膜下,6例位于脾脏周边及深部;病理检查结果显示,4例为巨囊型,3例为微囊型,2例为混合型;3例呈分叶状,6例呈大小不等类圆形;3例边界模糊,6例边界尚清晰,其中1例单发病灶边缘小点条状钙化灶.7例CT平扫呈低密度影,1例呈稍高密度影,微囊型呈"蜂窝状"改变,6例CT增强示分隔及囊壁轻度强化,1例病变中心及边缘稍强化,1例实性部分呈明显不均匀强化,1例病变呈稍长T_(1)稍长T_(2)信号,增强实性部分呈渐进性强化.[结论]儿童脾脏淋巴管畸形呈单发或多发病变,其CT和MRI表现具有一定的特征性,绝大部分呈低密度影或囊性信号,少部分密度或信号不均匀,囊壁可见钙化,其分隔及囊壁轻度强化,实性部分可不均匀强化或渐进性强化,有助于脾脏淋巴管畸形的诊断.

振幅整合脑电图联合头颅磁共振成像对晚期早产儿神经行为发育异常的预测价值

目的 探讨出生后3 h及3 d振幅整合脑电图(aEEG)联合出生后2周头颅磁共振成像(MRI)对晚期早产儿矫正胎龄40周时神经行为发育异常的预测价值。方法 选择2021年1月至2022年12月新乡医学院第一附属医院新生儿科收治的60例晚期早产儿为研究对象,患儿出生后即转入本院新生儿重症监护室进行治疗并行aEEG监测,每天监测至少3 h,连续监测3 d;于出生后2周时行头颅MRI检查,并于矫正胎龄40周时进行新生儿行为神经检查(NBNA)评分。采用Kruskal-Wallis H检验分析aEEG分级、头颅MRI检查颅内出血(ICH)分级和脑白质损伤(WMD)分级与NBNA评分的一致性;采用受试者操作特征曲线、敏感度、特异度、阴性预测值、阳性预测值评估aEEG及头颅MRI对神经行为发育异常的预测价值。结果 60例晚期早产儿中,NBNA评分>35分43例,≤35分17例;出生3 h时aEEG正常4例(6.7%),轻度异常29例(48.3%),重度异常27例(45.0%);出生3 d时aEEG正常21例(35.0%),轻度异常24例(40.0%),重度异常15例(25.0%);ICH分级:无出血27例(45.0%),Ⅰ~Ⅱ度ICH 26例(43.3%),Ⅲ~Ⅳ度ICH 7例(11.7%);WMD分级:无白质损伤31例(51.7%),轻中度损伤22例(36.7%),重度损伤7例(11.7%)。出生后3 h、3 d时aEEG分级与NBNA评分具有显著一致性(H=6.790、20.200,P<0.05);且ICH分级、WMD分级与NBNA评分之间具有显著一致性(H=20.374、14.591,P<0.05)。出生后3 h、3 d aEEG单独或联合出生后2周头颅MRI对矫正胎龄40周时神经行为发育异常均有预测价值(P<0.05)。单独出生3 d aEEG分级预测神经行为发育异常的曲线下面积(AUC)显著大于出生3 h aEEG分级(P<0.05);单独出生后2周头颅MRI预测神经行为发育异常的AUC大于出生后3 d aEEG分级(P<0.05);aEEG联合头颅MRI对早产儿神经行为发育异常的AUC大于单独aEEG、头颅MRI,且出生后3 d aEEG联合出生后2周头颅MRI对晚期早产儿矫正胎龄40周龄神经行为发育异常的AUC最大(P<0.05)。结论 早期aEEG分级与MRI检测相结合可提高对晚期早产儿神经发育异常的预测价值。

HR-MRI联合血清PAR-2和PAGln水平对急性脑梗死患者复发的预测价值

目的探讨高分辨率MRI(HR-MRI)联合血清蛋白酶激活受体2(PAR-2)和苯乙酰谷氨酰胺(PAGln)检测对急性脑梗死(ACI)患者复发的预测价值。方法收集127例ACI患者的临床资料,根据患者出院1年内是否复发将其分为复发组34例和未复发组93例。采用ELISA法测定血清PAR-2和PAGln水平,HR-MRI测定斑块面积、斑块负荷、管腔狭窄率、重构指数和标准化管壁指数,多因素logistic回归分析影响ACI患者复发的因素,ROC曲线分析HR-MRI联合血清PAR-2和PAGln水平对ACI患者复发的预测效能。结果与未复发组相比,复发组患者血清PAR-2和PAGln水平、斑块负荷、管腔狭窄率升高(P<0.05)。血清PAR-2和PAGln水平较高以及斑块负荷较高是ACI患者复发的独立危险因素(P<0.05)。血清PAR-2、PAGln水平和斑块负荷单独预测ACI患者复发的AUC分别为0.852、0.860和0.785,联合预测的AUC为0.941,高于单独预测(P<0.05)。结论ACI复发患者血清PAR-2和PAGln水平升高,HR-MRI联合血清PAR-2和PAGln水平可以更好地预测ACI患者复发。

重度阻塞性睡眠呼吸暂停患者脑静息态镜像同伦连接的分析

目的应用静息态功能MRI技术探讨重度阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)患者大脑半球间基于体素的镜像同伦连接(voxel-mirrored homotopic connectivity,VMHC)变化。材料与方法前瞻性分析重度OSA患者资料及年龄、性别和受教育程度相匹配的健康对照各50例,收集其临床资料、神经心理量表评分及头颅MRI数据。比较两组间大脑VMHC值的差异,基于差异脑区行种子点功能连接(functional connectivity,FC)分析,并将差异有统计学意义的脑功能指标与临床变量和神经心理量表评分行相关分析。结果与健康对照组相比,重度OSA患者认知评分减低,抑郁及焦虑评分增高,双侧距状回和顶上回VMHC值减低,其与双侧舌回、右侧枕中回及左侧颞中回等多个脑区间FC异常(高斯随机场多重比较校正,体素水平P<0.001,簇水平P<0.05)。重度OSA患者双侧距状回VMHC值与呼吸暂停低通气指数负相关(r=-0.31,P=0.027),与平均血氧饱和度(oxygen saturation of blood,SaO2)正相关(r=0.30,P=0.033);双侧顶上回VMHC值分别与平均和最低SaO2呈正相关(r=0.29,P=0.039;r=0.31,P=0.028),左侧顶上回与角回间的FC值与平均SaO2呈正相关(r=0.29,P=0.041)。结论重度OSA患者存在认知功能受损及潜在抑郁和焦虑风险,其双侧距状回和顶上回半球间功能协同性受损及FC异常可能是重度OSA患者脑损害的重要神经生理机制。

单次激发快速自旋回波厚层重水序列在胎儿肺部发育畸形诊断中的应用

目的探讨单次激发快速自旋回波厚层重水(SSFSE Thick Slab)序列在胎儿肺部发育畸形诊断中的应用价值。资料与方法前瞻性收集2019年1月—2020年6月在广东省妇幼保健院经超声检查诊断或可疑胎儿肺部发育异常并行MRI的110例孕妇资料,采用胎儿常规快速扫描序列行单次激发快速自旋回波(SSFSE)、快速成像稳态采集(FIESTA)、快速反转恢复运动抑制(FIRM)、扩散加权成像(DWI)扫描,再行SSFSE Thick Slab序列扫描。将MRI诊断结果与(引)产后或病理随访结果进行比较,分析常规序列与SSFSE Thick Slab序列结合常规序列对胎儿肺部病变的诊断确定性。以病理为“金标准”,分析MRI对肺部病变的诊断效能。结果110个胎儿MRI肺部检查中,82个(引)产后或病理随访明确诊断,其中支气管肺隔离症(BPS)12例[MRI正确诊断11例,误诊为先天性肺气道畸形(CPAM)1例],CPAM 59例(MRI正确诊断58例,误诊为BPS1例),先天性肺过度膨胀4例(MRI正确诊断1例,误诊为CPAM 3例),支气管源性囊肿2例(MRI正确诊断2例),肺发育不全1例(MRI正确诊断1例),CPAM合并BPS 3例(MRI正确诊断3例),支气管源性囊肿合并先天性肺过度膨胀1例(MRI正确诊断1例)。8个随访证实儿童健康病例中(MRI诊断为CPAM 7例,BPS 1例)。常规序列与SSFSE Thick Slab序列结合常规序列对胎儿肺部诊断确定性分析:由胎儿常规序列(SSFSE、FIESTA、FIRM、DWI)诊断确定66例,不确定24例,不确定病例分别为BPS 3例,CPAM 19例,CPAM合并BPS 2例;由胎儿常规序列结合SSFSE Thick Slab序列诊断确定77例,不确定13例,不确定病例分别为BPS 2例,CPAM 10例,CPAM合并BPS 1例;两组比较,差异有统计学意义(χ^(2)=4.116,P=0.042)。MRI诊断胎儿肺部病变的敏感度为93.9%,特异度为0,准确度为85.6%,阳性预测值为90.1%,阴性预测值为0。结论SSFSE Thick Slab序列在胎儿肺部含水量高的疾病中表现为特征性高信号,结合胎儿常规序列能提高胎儿肺部疾病的诊断确定性,可作为胎儿肺部常规序列的补充序列。

双垂体伴性早熟1例

女性患儿,6岁10个月,1年前发现双侧乳腺增大,均可触及质硬结节;出生时发现“口咽部畸胎瘤”“右侧腹股沟斜疝”“上腭裂”“房间隔缺损”,均经外科手术或经导管房间隔缺损封堵术治疗后好转。查体:上腭见长约1 cm瘢痕;双侧乳腺发育,右侧腹股沟区见长约2 cm瘢痕,心脏听诊未闻及明显杂音。实验室检查:雌二醇179 pg/ml,孕酮0.35 ng/ml,促黄体生成素8.42 mIU/ml,促卵泡激素20.40 mIU/ml,垂体泌乳素16.60 ng/ml。超声:于左、右乳分别探及7 mm×41 mm及10 mm×45 mm腺体样回声(图1A);提示性早熟可能。因乳腺发育及激素水平升高,临床疑诊垂体瘤可能,遂行颅脑MR检查,于鞍区见2个对称、等大(8.80 mm×0.64 mm×0.26 mm)的垂体,内部信号均匀,分别以垂体柄与下丘脑相连,神经垂体部分未见明确显示(图1B、1C);增强扫描2个垂体均见明显均匀强化(图1D);提示双垂体(duplication of the pituitary gland,DPG)。临床诊断:DPG、性早熟。

胎盘下血管异常MRI分型预测胎盘植入疾病类型的价值

目的:比较不同类型胎盘植入性疾病(PAS)的MRI征象,基于关键MRI征象对PAS类型进行预测。方法:回顾性分析经手术或病理证实的85例PAS患者的临床及MRI资料,比较粘连组(27例)、植入组(29例)与穿透组(29例)MRI征象的差异。采用多元Logistic回归分析胎盘下血管异常对PAS类型的预测价值。结果:粘连组、植入组、穿透组三组间胎盘膨出、前置胎盘、胎盘下血管异常、胎盘内暗带的发生率差异均有统计学意义(P<0.05)。植入组与穿透组比较,完全型前置胎盘(82.8%)、Ⅳ型胎盘下血管异常(75.9%)的发生率高于植入组(分别为51.7%、27.6%),差异具有统计学意义(P<0.05),其余征象的发生率差异无统计学意义(P>0.05);Ⅱ型胎盘下血管异常的发生率在三组间差异无统计学意义(P>0.05)。多元Logistic回归分析结果显示,植入组与穿透组比较时,Ⅲ型胎盘下血管异常提示胎盘植入的概率明显增高(P<0.05),而Ⅳ型血管异常提示胎盘穿透的概率明显增加(P<0.05);植入组与粘连组比较时,胎盘下血管异常不能预测其分型(P>0.05)。结论:不同PAS类型中前置胎盘、胎盘膨出、胎盘下血管异常及胎盘内暗带等四种MRI征象的发生率差异具有统计学意义,其中Ⅲ、Ⅳ型胎盘下血管异常能够预测PAS类型,胎盘下血管异常对术前预测PAS类型有一定价值。