Three-dimensional-arterial spin labeling perfusion correlation with diabetes-associated cognitive dysfunction and vascular endothelial growth factor in type 2 diabetes mellitus rat

BACKGROUND Type 2 diabetes mellitus(T2DM) has been strongly associated with an increased risk of developing cognitive dysfunction and dementia.The mechanisms of diabetes-associated cognitive dysfunction(DACD) have not been fully elucidated to date.Some studies proved lower cerebral blood flow(CBF) in the hippocampus was associated with poor executive function and memory in T2DM.Increasing evidence showed that diabetes leads to abnormal vascular endothelial growth factor(VEGF) expression and CBF changes in humans and animal models.In this study,we hypothesized that DACD was correlated with CBF alteration as measured by three-dimensional(3D) arterial spin labeling(3D-ASL) and VEGF expression in the hippocampus.AIM To assess the correlation between CBF(measured by 3D-ASL and VEGF expression) and DACD in a rat model of T2DM.METHODS Forty Sprague-Dawley male rats were divided into control and T2DM groups.The T2DM group was established by feeding rats a high-fat diet and glucose to induce impaired glucose tolerance and then injecting them with streptozotocin to induce T2DM.Cognitive function was assessed using the Morris water maze experiment.The CBF changes were measured by 3D-ASL magnetic resonance imaging.VEGF expression was determined using immunofluorescence.RESULTS The escape latency time significantly reduced 15 wk after streptozotocin injection in the T2DM group.The total distance traveled was longer in the T2DM group;also,the platform was crossed fewer times.The percentage of distance in the target zone significantly decreased.CBF decreased in the bilateral hippocampus in the T2DM group.No difference was found between the right CBF value and the left CBF value in the T2DM group.The VEGF expression level in the hippocampus was lower in the T2DM group and correlated with the CBF value.The escape latency negatively correlated with the CBF value.The number of rats crossing the platform positively correlated with the CBF value.CONCLUSION Low CBF in the hippocampus and decreased VEGF expression might be crucial in DACD.CBF measured by 3D-ASL might serve as a noninvasive imaging biomarker for cognitive impairment associated with T2DM.

Three-dimensional arterial spin labeling and diffusion kurtosis imaging in evaluating perfusion and infarct area size in acute cerebral ischemia

BACKGROUND Early thrombolytic therapy is crucial to treat acute cerebral infarction,especially since the onset of thrombolytic therapy takes 1-6 h.Therefore,early diagnosis and evaluation of cerebral infarction is important.AIM To investigate the diagnostic value of magnetic resonance multi-delay threedimensional arterial spin labeling(3DASL)and diffusion kurtosis imaging(DKI)in evaluating the perfusion and infarct area size in patients with acute cerebral ischemia.METHODS Eighty-four patients who experienced acute cerebral ischemia from March 2019 to February 2021 were included.All patients in the acute stage underwent magnetic resonance-based examination,and the data were processed by the system’s own software.The apparent diffusion coefficient(ADC),average diffusion coefficient(MD),axial diffusion(AD),radial diffusion(RD),average kurtosis(MK),radial kurtosis(fairly RK),axial kurtosis(AK),and perfusion parameters post-labeling delays(PLD)in the focal area and its corresponding area were compared.The correlation between the lesion area of cerebral infarction under MK and MD and T2-weighted imaging(T2WI)was analyzed.RESULTS The DKI parameters of focal and control areas in the study subjects were compared.The ADC,MD,AD,and RD values in the lesion area were significantly lower than those in the control area.The MK,RK,and AK values in the lesion area were significantly higher than those in the control area.The MK/MD value in the infarct lesions was used to determine the matching situation.MK/MD<5 mm was considered matching and MK/MD≥5 mm was considered mismatching.PLD1.5s and PLD2.5s perfusion parameters in the central,peripheral,and control areas of the infarct lesions in MK/MD-matched and-unmatched patients were not significantly different.PLD1.5s and PLD2.5s perfusion parameter values in the central area of the infarct lesions in MK/MD-matched and-unmatched patients were significantly lower than those in peripheral and control areas.The MK and MD maps showed a lesion area of 20.08±5.74 cm^(2) and 22.09±5.58 cm^(2),respectively.T2WI showed a lesion area of 19.76±5.02 cm^(2).There were no significant differences in the cerebral infarction lesion areas measured using the three methods.MK,MD,and T2WI showed a good correlation.CONCLUSION DKI parameters showed significant difference between the focal and control areas in patients with acute ischemic cerebral infarction.3DASL can effectively determine the changes in perfusion levels in the lesion area.There was a high correlation between the area of the infarct lesions diagnosed by DKI and T2WI.

Pulsed arterial spin labeling effectively and dynamically observes changes in cerebral blood flow after mild traumatic brain injury

Cerebral blood flow is strongly associated with brain function, and is the main symptom and diagnostic basis for a variety of encephalopathies. However, changes in cerebral blood flow after mild traumatic brain injury remain poorly understood. This study sought to observe changes in cerebral blood flow in different regions after mild traumatic brain injury using pulsed arterial spin labeling. Our results demonstrate maximal cerebral blood flow in gray matter and minimal in the white matter of patients with mild traumatic brain injury. At the acute and subacute stages, cerebral blood flow was reduced in the occipital lobe, parietal lobe, central region, subcutaneous region, and frontal lobe. Cerebral blood flow was restored at the chronic stage. At the acute, subacute, and chronic stages, changes in cerebral blood flow were not apparent in the insula. Cerebral blood flow in the temporal lobe and limbic lobe diminished at the acute and subacute stages, but was restored at the chronic stage. These findings suggest that pulsed arterial spin labeling can precisely measure cerebral blood flow in various brain regions, and may play a reference role in evaluating a patient＇s condition and judging prognosis after traumatic brain injury.

双相情感障碍患者脑结构及脑血流灌注的MRI研究进展

双相情感障碍(BD)是一类常见精神心理疾病,其高发病率、高致残率、高死亡率引起广泛关注。在临床实践中,BD的初次准确诊断率较低,容易被误诊为单相抑郁症。许多神经影像学研究表明,BD患者部分脑区的皮层厚度、灰质、白质以及功能活动发生改变,但其特异的神经影像学指标尚未明确,对于BD发病的特殊病理生理机制也尚未完全阐明。因此,本文梳理了近年来关于BD患者研究脑皮层结构及血流灌注的方法进行综述,以期望后期进行更深入的研究。

Quantitative assessment of acute kidney injury by noninvasive arterial spin labeling perfusion MRI:a pilot study

The kidneys are essential for maintaining homeostasis,are responsible for the reabsorption of water,glucose and amino acids,and filter the blood by removing waste.Acute kidney injury(AKI) is a syndrome characterized by the rapid loss of renal excretory function and the accumulation of end metabolic products of urea and creatinine.AKI is associated with the later development of chronic kidney disease and end-stage kidney disease,and may eventually be fatal.Early diagnosis of AKI and assessments of the effects of treatment,however,are challenging.The pathophysiological mechanism of AKI is thought to be the imbalance between oxygen supply and demand in the kidneys.We have assessed the ability of arterial spin labeling(ASL) perfusion magnetic resonance imaging(MRI),without the administration of contrast media,to quantify renal blood flow(RBF) non-invasively.We found that RBF was significantly lower in AKI patients than in healthy volunteers.These results suggest that ASL perfusion MRI,a noninvasive measurement of RBF,may be useful in the early diagnosis of AKI.

三维动脉自旋标记脑灌注MRI在阿尔兹海默症患者脑部血流动力学评估中的应用价值分析

目的:探讨三维动脉自旋标记脑灌注MRI(three-dimension arterial spin labeling, 3D-ASL)在阿尔兹海默症患者脑部血流动力学评估中的应用价值。方法:研究对象选取我院2014年3月~2016年9月收治的38例阿尔兹海默症患者与同期与我院行健康体检的38例老年志愿者,分别设为观察组和对照组。对所有受试者均采用三维动脉自旋标记脑灌注MRI及MMSE、MOCA量表评测,比较观察组患者脑部血流明显减低区血流灌注情况以及各血流灌注减低区血流量值与MMSE、MOCA评分相关性。结果:观察组患者双侧颞叶、双侧楔前叶、双侧扣带回、左侧枕叶血流量值明显低于对照组,差异具有统计学意义(P<0.05);且这些脑区的脑血流量与MMSE、MOCA量表均呈显著正相关(r>0.60, P<0.05)。结论:三维动脉自旋标记脑灌注MRI能反映阿尔兹海默患者脑部血流动力学的改变,且与临床神经心理学量表相关性高,因此在探究阿尔兹海默症的病理学及病理生理学原理上具有重要应用价值。

MRI三维动脉自旋标记法对TIA的诊断价值

目的本研究拟运用MRI三维动脉自选标记法(3D-ASL),结合DWI及时间飞跃法MRA(3DTOF-MRA),探讨3D-ASL在TIA的诊断、血流灌注评估等方面的应用价值,为临床超早期诊断、治疗提供更多的理论依据。方法发病24 h内的TIA患者13例,入院时进行常规MRI、DWI、3D-TOF-MRA及3D-ASL扫描。观察所有患者MRA图,分析颅内血管及颈内动脉有无狭窄及异常,比较DWI所示梗死面积(SDWI)和全脑血流量(CBF)图上灌注异常面积(SASL)的差异,分别计算DWI和3D-ASL对TIA患者的检出率,并结合MRA分析造成脑组织血流灌注异常的原因。对于DWI阴性但ASL灌注异常,且MRA(或CTA)显示血管狭窄的患者,计算病灶侧和对侧相应区域的CBF值的比值(rCBF),比较rCBF与入院时(发病24 h内)的NIHSS、Glasgow昏迷评分量表(GCS)、mRS及神经内科临床评分量表(ABCD2)评分、患者发病时间以及一过性脑缺血症状发作持续时间有无相关性,并且比较分析rCBF值与MRA(或CTA)所示血管直径狭窄程度的相关性。结果(1)SASL>SDWI:13例TIA患者中,11例DWI未发现病灶,即SDWI=0,而SASL>0,且显示灌注减低;2例DWI阳性,但病灶面积仍SASL>SDWI。(2)3D-ASL对TIA的检出率明显高于DWI:DWI对TIA患者病灶的检出率为15%;3D-ASL对TIA患者病灶的检出率为69%。(3)rCBF与入院时(发病24 h内)的NIHSS、GCS、mRS及ABCD2评分的分值均无相关性;rCBF与患者发病时间及一过性脑缺血症状发作持续时间无相关性;rCBF值与MRA(或CTA)所示血管直径狭窄程度呈负相关关系(rs=-0.697,P=0.011)。结论3DASL与DWI相比,对TIA的诊断敏感性较高。及早行3D-ASL检查,并与DWI、MRA等序列联合应用,能更早发现灌注异常,并初步提示责任血管狭窄程度,为临床治疗提供科学依据。

3.0T MRI三维动脉自旋标记技术诊断缺血性脑血管病的价值分析

目的:分析3.0T磁共振成像(MRI)三维动脉自旋标记(3D-ASL)技术诊断缺血性脑血管病的价值.方法:选取2019年6月至2020年7月本院收治的71例脑血管疾病患者,均行MRI检查;另选取本院健康体检行3D-ASL检查者62例,作为对照组.对比3D-ASL、MRI血管成像对缺血性脑血管病诊断的准确性、敏感度、特异度,以及不同人群中脑血管灌注情况、实验室指标水平.结果:3D-ASL对缺血性脑血管病诊断准确性为87.32%,明显高于MRI血管成像69.01%(P<0.05);3D-ASL对缺血性脑血管病诊断敏感度、特异度分别为98.33%、72.72%,而MRI血管成像分别为80.85%、54.16%,3D-ASL对缺血性脑血管病诊断敏感度、特异度均明显高于MRI血管成像检查(P<0.05);观察组灌注减低率明显高于对照组,正常灌注率、平均相对脑血流量(rCBF)值低于对照组(P<0.05);观察组溶血磷脂酸(LPA)、总磷脂(AP)、同型半胱氨酸(Hcy)、超敏C反应蛋白(HsCRP)均明显高于对照组(P<0.05).结论:3.0T MRI 3D-ASL技术对缺血性脑血管疾病诊断敏感度、特异度高,可为临床早期诊断提供参考依据.

磁共振成像联合三维动脉自旋标记灌注对脑梗死的辅助诊断价值及与血流动力学的关系研究

目的:探讨磁共振成像(MRI)联合三维动脉自旋标记(3D-ASL)灌注在脑梗死患者中的辅助诊断价值及与血流动力学的关系。方法:选择医院收治的82例疑似脑梗死患者,所有患者均行MRI和3D-ASL灌注检查,以脑梗死临床指南确诊为“金标准”,分析MRI、3D-ASL技术及二者联合在脑梗死患者中的诊断效能;测定脑部不同部位脑血流量(rCBF)水平,采用Pearson相关性分析软件对脑梗死患者检出率、脑梗死与非脑梗死患者的血流动力学指标进行比较。结果:82例疑似脑梗死患者经脑梗死临床指南最终确诊57例,MRI联合3D-ASL灌注检查灵敏度、特异度、阳性及阴性预测值高于MRI、3D-ASL灌注检查,差异有统计学意义(x^(2)=4.192,x^(2)=6.381,x^(2)=3.963,x^(2)=5.661;P<0.05);脑梗死患者脑灰质、海马及岛叶部位血流动力学水平低于非脑梗死患者,差异有统计学意义(t=12.195,t=8.467,t=9.328;P<0.05);Pearson相关性分析显示,脑梗死患者检出率与脑灰质、海马及岛叶部位血流动力学水平呈负相关性(r=0.569,r=0.631,r=0.582;P<0.05)。结论:MRI联合3D-ASL灌注检查用于脑梗死患者中,能提高辅助诊断的灵敏度和特异度,且患者检出率与血流动力学水平存在强相关性。

磁共振多延迟三维动脉自旋标记和一站式CTA-CTP对急性缺血性脑血管病变患者诊断价值比较

目的分析磁共振多延迟三维动脉自旋标记(3D-ASL)和一站式CT血管成像(CTA)-CT灌注成像(CTP)对急性缺血性脑血管病变(AICVD)患者诊断价值。方法选取2020年6月~2021年6月在本院就诊的128例疑似AICVD患者,均进行多延迟3D-ASL和一站式CTA-CTP检查,以数字减影血管造影(DSA)作为金标准,比较多延迟3D-ASL和一站式CTA-CTP诊断结果与金标准的kappa一致性,比较两种方法的诊断价值。结果经DSA诊断确诊为AICVD患者114例,其中短暂性脑缺血(TIA)29例、小面积缺血性脑卒中(CIS)45例、大面积CIS 40例;多延迟3D-ASL共诊断出112例AICVD患者,其中TIA 30例、小面积CIS 39例、大面积CIS 43例,与金标准DSA诊断比较,kappa值为0.848;一站式CTA-CTP共诊断出111例AICVD患者,其中TIA 30例、小面积CIS 39例、大面积CIS 42例,与金标准DSA诊断比较,kappa值为0.676;多延迟3D-ASL诊断不同类型AICVD的敏感度、准确度、阳性预测值、kappa值高于CTACTP(P<0.05)。结论3D-ASL和一站式CTA-CTP对AICVD均有一定的诊断价值,但3D-ASL与金标准DSA的诊断一致性较高。

动脉自旋标记的新进展及其在缺血性脑血管病的应用

动脉自旋标记是一种利用血液中的水作为示踪剂的MR成像技术,它具有安全无创的优点,可用于灌注成像或血管成像,但其固有信噪比较低,易受多种因素干扰。近年出现多种兼具独特应用价值的改良技术,比如可以实现高选择性血管成像或灌注成像血管编码动脉自旋标记和可以对特定流速血流进行标记的流速选择动脉自旋标记。这些技术除了提高信噪比、改善影像质量外,也拓宽了动脉自旋标记技术的应用范围。就这些技术的新进展及其在缺血性脑血管病的应用现状予以综述。

动脉自旋标记脑灌注技术在快速动眼睡眠障碍研究中的应用

目的:采用磁共振动脉自旋标记技术(ASL)对快速动眼睡眠障碍(R BD)患者的脑血流灌注异常情况进行研究,探讨ASL的应用价值。方法:我们的研究包括经同步视频多导睡眠监测(PSG)证实的原发性RBD患者20例及年龄、性别与RBD患者匹配的健康志愿者15例。所有的被试均在GE Discovery MR750磁共振扫描仪上进行ASL序列和3D-BRAVO序列的扫描。ASL的数据分析采用基于体素的方法在SPM8软件上进行。RBD组和对照组被试脑皮质灌注的差异采用双样本t检验进行分析。结果:RBD患者皮质灌注增高的区域主要位于额叶、前扣带皮质、辅助运动区、壳核、海马旁回、楔前叶和脑桥等;皮质灌注降低的区域主要位于枕叶、舌叶、颞叶中部等。结论:ASL技术可以发现RBD患者的灌注异常,在神经退行性病变的研究方便有较大的应用价值。

动脉自旋标记技术对系统性红斑狼疮患者脑血流量的初步研究

目的神经精神性狼疮是系统性红斑狼疮(systemic lupus erythematosus,SLE)最常见的并发症,其发病机制尚不明确,目前"脑血管病学说"占据主导地位,因此早期评估SLE患者脑血流改变具有重要价值。文中采用动脉自旋标记(arterial spin labeling,ASL)技术研究无明显神经精神症状的SLE患者脑血流情况。方法纳入2014年6月至2015年9月于南京军区南京总医院就诊的28例无明显神经精神症状的SLE患者(SLE组)和30例性别和年龄匹配的健康志愿者(对照组)行常规MRI和ASL数据采集及精神心理学量表检查,包括数字连接试验-A(number connection test-A,NCT-A)、数字符号试验(digital symbol test,DST)、焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表(self-rating depression scale,SDS)对2组受试者脑灰质、白质及全脑平均脑血流量(cerebral blood flow,CBF)值进行比较;运用SPM8软件对受试者CBF图进行基于体素的统计学分析,观察SLE患者脑血流变化的主要脑区,将差异脑区的CBF值与患者的临床资料行相关分析。结果与对照组相比,SLE组的灰质(40.5±3.7 vs 37.3±6.5,P=0.028)、全脑(38.0±3.5 vs 35.1±6.1,P=0.032)平均CBF值降低,其中显著降低的区域主要位于辅助运动区及邻近的扣带回中部、前扣带回、左侧额内侧回、左侧额下回及左侧岛叶(P<0.05,FWE校正)。相关分析显示,患者组NCT-A值与左侧额内侧回CBF值(r=-0.402,P=0.032)及左侧额下回CBF值(r=-0.382,P=0.045)呈负相关。结论利用ASL-MR灌注成像技术显示无明显神经精神症状的SLE患者存在CBF降低,且与患者的认知功能改变有关。

三维动脉自旋标记技术在短暂性脑缺血发作中的应用

目的探讨三维动脉自旋标记（3D—ASL）技术在短暂性脑缺发作（TIA）中的应用价值。方法选择2014年8月～2015年9月于江苏省扬州市第一人民医院就诊的TIA患者27例．于末次发作24h内行头颅CT、常规磁共振序列、DWI、MRA及3D—ASL检查，其中5例行DSC—PWI检查者。所获得的灌注伪彩图由2名观察者独自观察，手工绘制感兴趣区（ROI）及镜像区，并定量分析相对脑血流量（rCBF）。结果头颅CT皆未显示异常。定性分析显示，27例TIA患者3D—ASL出现局灶性低灌注者23例（85．19％）；定量分析显示，ROIrCBF为（28．98±8．12）mL／（100g·min），镜像区rCBF为（40．58±9．15）mL／（100g·min），两者间差异有统计学意义（t=9．590，P〈0．05）。MRA阳性为14例（51．85％），3D-ASL皆为阳性（100．00％）；MRA阴性为13例，3D—ASL阳性为9例（69．23％）。DWI阳性为10例（37．04％），3D—ASL阳性为9例（90．00％）；DWI阴性为17例，3D—ASL阳性为14例（82．35％）。3例患者经治疗后复查局灶性低灌注见恢复。定性分析两种灌注成像技术检查结果显示，5例（100．00％）患者对低灌注的显示一致；定量分析显示，两种灌注成像技术的ROI与镜像区之间rCBF比值ASL为（0．52±0．17），DSC为（0．56±0．19），两者间差异无统计学意义（t=0．388，P〉0．05）。结论与传统的MRA及DWI阳性率相比，3D—ASL技术对TIA局灶性低灌注的显示更敏感，而且与DSC—PWI对低灌注的显示一致，对TIA患者的诊断、疗效评估及随访具有重要价值。

Current and future applications of magnetic resonance imaging and spectroscopy of the brain in hepatic encepha-lopathy

Hepatic encephalopathy （HE） is a common neuropsychiatric abnormality, which complicates the course of patients with liver disease and results from hepatocellular failure and/or portosystemic shunting. The manifestations of HE are widely variable and involve a spectrum from mild subclinical disturbance to deep coma. Research interest has focused on the role of circulating gut-derived toxins, particularly ammonia, the development of brain swelling and changes in cerebral neurotransmitter systems that lead to global CNS depression and disordered function. Until recently the direct investigation of cerebral function has been difficult in man. However, new magnetic resonance imaging （MRI） techniques provide a non-invasive means of assessment of changes in brain volume （coregistered MRI） and impaired brain function （fMRI）, while proton magnetic resonance spectroscopy （^1H MRS） detects changes in brain biochemistry, including direct measurement of cerebral osmolytes, such as myoinositol, glutamate and glutamine which govern processes intrinsic to cellular homeostasis, including the accumulation of intracellular water. The concentrations of these intracellular osmolytes alter with hyperammonaemia. MRS-detected metabolite abnormalities correlate with the severity of neuropsychiatric impairment and since MR spectra return towards normal after treatment, the technique may be of use in objective patient monitoring and in assessing the effectiveness of various treatment regimens.

磁共振mTI-ASL与DCE技术对胶质瘤分级诊断的研究

胶质瘤是指起源于神经上皮胶质细胞的肿瘤,是最常见的颅内原发性肿瘤,具有强侵袭性、浸润性,病死率高的特点。根据世界卫生组织(world health organization WHO)2007年的分类标准,胶质瘤级别从低到高分为Ⅰ到Ⅳ级,其中Ⅰ、Ⅱ是低级别胶质瘤,Ⅲ、Ⅳ是高级别;级别高低的临床病程和预后差异很大;神经影像学不断发展,脑肿瘤成像及其临床应用愈加成熟,脑肿瘤的神经成像从最初简单的描述病灶的解剖学位置,形态学改变,到现在多种成像方式的观察病灶,为脑肿瘤的诊断及治疗提供了更加多元化的帮助;核磁共振灌注成像可以评价肿瘤血管的异常增生程度,评估胶质瘤的血流灌注、微血管生成及血管通透性等信息,对胶质瘤的诊断分级提供更多的依据,本文拟对核磁共振灌注成像的动态对比增强磁共振DCE及多期态动脉自旋标记成像multitiASL在胶质瘤的诊断、临床治疗、病情跟踪方面的优势及不足进行讨论。

术前MRI 3D CUBE薄层扫描及ASL扫描对儿童局灶性皮质发育不良Ⅱ型的诊断价值

目的分析局灶性皮质发育不良(FCD)Ⅱ型患儿MRI 3D CUBE薄层扫描及动脉自旋标记(ASL)扫描影像图,探讨其对FCD的诊断价值。方法2017年5月—2021年7月郑州大学第三附属医院诊治FCDⅡ型患儿11例,均行手术治疗,术前行头颅MRI平扫、增强扫描、3D CUBE薄层扫描、ASL扫描,观察病灶部位、有无皮质增厚及皮质下高信号等,判断FCD影像学分型;ASL图像经后处理获得病变区脑血流量(CBF)值及同水平对侧正常区CBF值,并进行比较。以术后组织病理检查结果为金标准,计算MRI平扫及MRI平扫联合增强扫描、3D CUBE薄层扫描或ASL扫描诊断FCD的准确率。结果11例患儿FCD病理分型为FCDⅡa型9例,FCDⅡb型2例。影像学分型为放射带型4例,高信号型6例,轻微型1例。病灶部位为额叶3例,额顶叶2例,颞叶2例,顶叶1例,颞枕叶1例,颞顶叶2例。11例行MRI平扫,其中9例显示皮质增厚及皮质下高信号,2例显示脑沟变浅,脑皮质略增厚。9例行增强扫描,均显示病灶无强化。9例行3D CUBE薄层扫描,均显示皮质增厚及皮质下不均匀异常高信号(4例皮质下高信号指向侧脑室)。9例行ASL扫描,其中2例病灶呈高灌注,7例病灶呈低灌注。MRI平扫诊断FCD 9例,准确率为81.8%;MRI平扫联合增强扫描诊断FCD 9例,准确率为81.8%;MRI平扫联合3D CUBE薄层扫描诊断FCD 10例,准确率为90.9%;MRI平扫联合ASL诊断FCD 10例,准确率为90.9%;MRI平扫、3D CUBE薄层扫描联合ASL扫描诊断FCD 11例,准确率为100.0%。9例行ASL患儿病灶区CBF值[(50.9±12.0)mL/(100 g·min)]低于对侧正常区CBF值[(70.3±4.2)mL/(100 g·min)](t=-1.939,P<0.001)。结论MRI平扫联合3D CUBE薄层扫描、ASL扫描可提高儿童FCDⅡ型诊断准确率,为术中精确定位及切除病变提供依据。

MR三维动脉自旋标记灌注成像联合ABCD2评分在TIA发作早期发生脑梗死预测的价值

目的:分析MR三维动脉自旋标记(3D ASL)灌注成像联合短暂性脑缺血发作(TIA)早期卒中风险预测ABCD2评分对TIA发病早期发生脑梗死的预测价值。方法:选取医院收治的45例临床确诊TIA住院患者,分别进行3D ASL灌注成像和ABCD2评分。根据ABCD2评分将45例患者分为低危组(11例)、中危组(13例)和高危组(21例);根据3D ASL有无低灌注病灶分ASL低灌注组(23例)及ASL正常灌注组(22例);按TIA患者7 d内是否进展判断为梗死及非梗死。分析3D ASL灌注检查结果、ABCD2评分及二者联合应用与TIA后7 d内发生脑梗死的关系。结果:在45例TIA患者中末次发病后7 d内发生脑梗死10例(占22.2%)。ABCD2评分低危组11例,7 d内无脑梗死发生;中危组13例,2例发生脑梗死(占15.4%);高危组21例,8例发生脑梗死(占34.8%);ABCD2评分与TIA后7 d内发生脑梗死呈正相关(r=0.46,P<0.05)。3D ASL脑灌注成像中,正常灌注组22例,其中1例7 d内发生了脑梗死(占4.5%),低灌注组23例中9例发生了脑梗死(占39.1%),正常灌注组脑梗死发生率明显低于低灌注组,差异有统计学意义(χ^2=7.782,P<0.05)。ABCD2评分低危+低灌注及正常灌注共11例,无脑梗死发生,ABCD2评分中高危+低灌注21例,9例发生脑梗死(占42.9%),ABCD2评分中高危+正常灌注13例,1例发生脑梗死(占7.7%)。ABCD2评分高危+低灌注16例,8例发生梗死(占50.0%),高危+正常灌注5例,0例梗死,两者比较差异有统计学意义(χ^2=11.084,P<0.05)。结论:3D ASL灌注成像联合ABCD2评分在预测TIA后早期发生脑梗死风险方面具有重要的临床价值。

Computer-aided differential diagnosis system for Alzheimer’s disease based on machine learning with functional and morphological image features in magnetic resonance imaging

Alzheimer’s disease (AD) is a dementing disorder and one of the major public health problems in countries with greater longevity. The cerebral cortical thickness and cerebral blood flow (CBF), which are considered as morphological and functional image features, respectively, could be decreased in specific cerebral regions of patients with dementia of Alzheimer type. Therefore, the aim of this study was to develop a computer-aided classification system for AD patients based on machine learning with the morphological and functional image features derived from a magnetic resonance (MR) imaging system. The cortical thicknesses in ten cerebral regions were derived as morphological features by using gradient vector trajectories in fuzzy membership images. Functional CBF maps were measured with an arterial spin labeling technique, and ten regional CBF values were obtained by registration between the CBF map and Talairach atlas using an affine transformation and a free form deformation. We applied two systems based on an arterial neural network (ANN) and a support vector machine (SVM), which were trained with 4 morphological and 6 functional image features, to 15 AD patients and 15 clinically normal (CN) subjects for classification of AD. The area under the receiver operating characteristic curve (AUC) values for the two systems based on the ANN and SVM with both image?features were 0.901 and 0.915, respectively. The AUC values for the ANN-and SVM-based systems with the morphological features were 0.710 and 0.660, respectively, and those with the functional features were 0.878 and 0.903, respectively. Our preliminary results suggest that the proposed method may have potential for assisting radiologists in the differential diagnosis of AD patients by using morphological and functional image features.

以突发记忆力下降为首发症状的桥本脑病一例

桥本脑病又称甲状腺毒性脑病、自身免疫性甲状腺炎相关的激素反应性脑病,是与桥本甲状腺炎相关的以神经系统功能紊乱为主的自身免疫性疾病,易被误诊。该文报道1例28岁女性患者,其以突发记忆力下降为首发症状,伴有桥本甲状腺炎及血液免疫学指标异常,头颅MRI显示双侧海马呈对称性损害,动脉自旋标记MRI呈局部异常高灌注,脑脊液细胞学检查可见免疫活性细胞。予大剂量甲泼尼龙冲击治疗后患者病情明显好转。2周后出院。出院后继续口服甲泼尼龙,随访2个月,患者有关生活细节的记忆力基本正常,但对数字的记忆及运用能力较发病前降低,工作能力下降。