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Objective To study the possibility of microvascular permeability (PS) value derived from perfusion CT (PCT) in predicting hemorrhagic transformation (HT) in acute cerebral infarction in elderly patients.Methods 52 consecutive patients with middle cerebral artery acute ischemic stroke who received thrombolytic therapy were divided into HT group and control group,and patients in HT group were further divided into hemorrhagic infarction (HI) group and parenchymal hematoma (PH) group.PCT data and Alberta stroke program early CT scores (ASPECTS) from CT angiography source images (CTA-SI) achieved within 6 hours after symptom onset of each group was retrospectively analyzed and statistically processed.Results In 52 patients,there were 22 cases developed HT,14 cases with HI,8 cases with PH.Cerebral blood flow (CBF) and cerebral blood volume (CBV) values were decreased and permeability surface area product (PS) was increased in ipsilateral in HT group and control group as compared with the contralateral (all P＜0.05).PS value in ipsilateral was significantly higher in HT group than in control group (P＜0.01),but CBF and CBV values in affected side showed no significant difference between the HT group and control group.The area under the receiver operator characteristic (ROC) curve of PS Az value was 0.968.When PS ≥5.77 ml · min-1 · 100 g-1,the sensitivity and specificity of predicting HT were 95.5％ and 86.7％ respectively.The ASPECTS was lower in HT group than in the control group (P＜0.01),and ASPECTS was higher in HI group than in PH group (P＜0.01).The differences in PCT results in affected side between the HI group and PH group was not significant.Conclusions The significantly increased PS value can be a reference in predicting HT risk and guiding thrombolytic therapy.
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ObjectiveTo evaluate the clinical effect of MSCT measurements in the pre- and postoperational osteal posterior cranial fossa for the adult patients of basilar invagination.Methods We reviewed the images of a cohort of 31 adult patients with basilar invagination,which were treated by surgical operation.According to the presence of atlantoaxial dislocation,the patients were divided into groups A and B.The basion-dens interval (BDI),atlanto-dental interval (ADI),space available of the spinal cord ( SAC),clivus-canal angle( CCA),Highly index( HI),and Chamberlian line(CBL) of the posterior cranial fossa were obtained in all the patients.Independent-sample Student's t test was used to compare the differences between groups A and groups B.Spearman correlations were analyzed between CT measurement data and effects of operations.ResultsIn Group A,the BDI,ADI,SAC,CCA,HI,CBL before and after surgery were 12.6 mm,8.3 mm,4.5 mm,3.3 mm;18.2 mm,20.8 mm,138.3°,150.4°,28.7 mm,43.4 mm,6.3 mm,3.3 mm respectively.There were significant differences ( t = 5.603,2.323,3.124,5.531,4.278 and 2.375,respectively,P ＜0.05 ).Preoperative JOA score in groups A was 10 points,and was 14 points after surgery.There was significant difference between the JOA scores before and after surgery ( t = 3.526,P ＜ 0.05 ).There were 7 effective cases and 4 stable cases after surgery in group A.Before and after surgery,JOA score and BDI,ADI,SAC,CCA,HI,CBL were significantly correlated( r = -0.667,- 0.673 ; - 0.571,- 0.619 ; 0.642,0.513 ; 0.525,0.558 ; 0.587,0.511 ; - 0.532,- 0.596,respectively,P＜0.05).The SAC,CCA,and CBL before and after surgery in group B were 18.3 mm,19.6 mm,146.8°,150.2°,2.7 mm,1.8 mm.The difference was statistically significant after operation ( t = 5.359,4.126,0.769,P ＜0.05).The BDI,ADI,and HI before and after surgery in group B were 7.2 mm,6.6 mm,2.4 mm,2.1 mm,39.3 mm,41.5 mm.And there were no significant differences (t = 1.482,2.374,0.153,P＞0.05).The preoperative JOA score in groups B was 11 points,and the postoperative score was 16 points.JOA scores before and after surgery were significantly different (t =2.874,P ＜0.05).There were 14 effective cases and 6 stable cases after operation in group B.The JOA score before and after surgery and BDI,ADI,and HI had no correlation (r =0.341,0.387;0.154,0.182; 0.192,0.167,P ＞0.05),and CBL,SAC and CCA were correlated (r = -0.756,-0.728;0.651,0.672; 0.726,0.695,P ＜0.05).ConclusionMSCT measurements for basilar invagination before and after surgery are helpful for understanding changes of osteal posterior fossa anatomy and comprehensive evaluation of surgical treatment.
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Objective To assess the clinical value of MSCT in diagnosing the overcrowding of osteal posterior cranial fossa (PCF) in adults.Methods MSCT images of a cohort of 52 adult patients with foramen magnum osteal malformation confirmed by surgery (diseased group), and 100 healthy adults (control group) were retrospectively reviewed.Images post-processing techniques included multi-planer reformation (MPR) and volume rendering (VR).The posterior cranial fossa volume (PCFV), posterior cranial fossa height (PCFH), clivus length (CL), clivus gradient (CG), supraocciput length (SL), and anteroposterior diameter of the foramen magnum (FMD) were measured on sagittal images in 52 patients and 100 normal adults.Independent-sample student's t test was used to compare the differences between patients and normal adults.Results The results of PCFV, PCFH, CL, SL,FMD and CG, male of control group were (168.2 ±12.3) cm~3, (38.2 ±1.2), (47.1 ±2.8), (41.1 ±1.8), (36.6 ±4.9) mm, (51.5±3.6)°, female of control group were (157.5 ±10.2) cm~3, (36.5 ±1.4), (46.2 ±2.2), (39.7 ±1.3), (35.2 ±3.8), (49.6±3.1)° ;diseased group were (128.7 ±11.7) cm~3, (30.6 ±1.9), (36.2 ±1.4), (37.3 ±0.9), (33.9 ±3.5)mm, (44.5 ±2.8)° .There was significant sex difference in PCFV, PCFH, CL, SL and CG in control group (t =4.70, 6.44, 4.84, 4.43 and 2.81 respectively, P<0.01), but FMD was not significant(t=1.97,P>0.05); the results of PCFV, PCFH, CL, CG and SL were significant different between diseased group and male of control group (t=16.62, 24.04, 25.01, 14.17 and 10.99 respectively,P<0.01) ; the results of PCFV, PCFH, CL, CG and SL were significant different between diseased group and female of control group (t=13.23, 17.80, 27.50, 11.67 and 8.73 respectively,P<0.01) ;but there were no significant differences of FMD between diseased group and control group, both male and female (t=2.96,2.07, P> 0.05).Conclusions The overcrowding of PCF can be accurately measured by MCST.As a routine preoperative examination, MSCT is helpful in the therapeutic selection and the anatomic and pathologic study of PCF.
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Purpose:To discuss the MRI features and differential diagnosis of hemangioblastomas in the central nervous system.Materials and Methods: The MRI features of 22 patients with hemangioblastomas confirmed histopathologically were analyzed retrospectively.Results: In this group there were 50 lesions in 22 patients.Multiple lesions were revealed in 5 cases.The lesions located in the cerebellar hemisphere and vermis ( n = 40),medulla oblongata and spinal cord ( n.= 9 ),cerebral hemisphere ( n = 1).Among the 50 lesions,12 appeared as a large cyst with mural nodule,36 as a solid mass,2 as a simple cyst.Of large cyst with mural nodule lesions,the content of the cyst was hy-pointense signal on T1WI,and hyperintense signal on T2WI.The mural nodules were slightly hypointense signal or isointense signal on Tl WI,and hyperintense signal on T2WI.The solid masses were isointense signal on Tl WI,slightly hyperintense signal and hyperintense signal on T2WI.On contrast enhanced scans,all mural nodules and solid tumors were showed marked homogeneous enhancement.On PWI the mural nodules and solid tumors were demonstrated marked hyperperfusion.Conclusion:Hemangioblastomas have distinctive manifestation,MRI enhanced scans and PWI play an important role in the diagnosis and differential diagnosis of hemangioblastomas.
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Objective To evaluate the value of MR angiography in thrombolytic therapy of acute ischemic stroke. Methods According to inclusion criteria, 65 patients who also having large vessel occlusion were selected, and they were performed rt-PA treatment (38 patients) and routine treatment (27 patients) within 3-6 hours of onset of symptoms, respectively. Mann-Whitney U test and chi square test were performed to compare the clinical and MR imaging baseline index and the clinical outcome between the two groups respectively. Clinical outcome was assessed after 3 months using a dichotomized modified Rankin scale score.Data were also compared with the combined analysis of the ATLANTIS, ECASS, NINDS rt-PA trials. Resets The difference of clinical outcome in 3 months between the two groups was significant (P < 0. 05) and the median of the two group was 1 and 3, respectively. The ratio of favorable outcome (mRS 0-1) in the two groups was 52. 6% (20/38) and 33.3% (9/27), respectively. Conclusion MR angiography plays an important role in thrombolytic therapy of acute ischemic stroke and it should be used to consummate the conventional inclusion criteria, the patients with large vessel occlusion should be treated by rt-PA.
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Objective We investigated the changes of the motorial network in patients suffered from brain tumors adjacent to the central sulcus occurred with reorganization of motor function using function connectivity MRI(fcMRI)technique in order to provide the new evidence for the compensational hypothesis of the reorganization caused by focal lesions.Methods Using 1.5 T MRI unit,14 patients with brain tumors in the vicinity of the central sulcus occurred with reorganization of motor function and 6 normal volunteers were examined with fcMRI technique while the subjects performed no task.By selecting seed voxels(region of interest)in the regions showing the most activation in M1 area on the activated map and cross correlating with every voxel within the brain,the fcMRI maps based on unilateral primary motor(M1)area were calculated.The location,extent and volume of the region showing significant connectivity to the several seed voxel,such as left/right M1 area in the health group and affected/unaffected M1 area in the patient group were evaluated on the fcMRI map.Results In healthy group,the extent and volume of the region showing significant connectivity to the left M1 area[(9514.17±186.92)mm3]were almost similar to those to the right M1 area [(9364.67±382.75)mm3].There showed no significant difference in motor connectivity between the two groups(P>0.05).In the tumor group,the volume of regions showing significant connectivity to the M1 area located in the affected hemisphere [(11193.14±811.29)mm3]was obviously higher than that of regions based on the seed voxel in the unaffected side[(6549.86±400.94)mm3](t=20.383,P＜0.01).The volume was significantly different among the regions showing high connectivity to the M1 of the affected side in patient group.those showing significant connectivity to the left M1 and fight M1 in health group(P＜0.01),the former was the biggest(P＜0.01).The extent of the regions showing connectivity to the affected M1 was consistent with the reorganization area of motor function revealed by fMRI.The volume of regions showing significant connectivity to M1 area of unaffected hemisphere in patient group showed significant difference compared with those showing significant connectivity to the left M1 and right M1 in health group(P＜0.01),the former was smallest(LSD,P＜0.01).especially in the affected hemisphere.It might mean the disrupted functional connectivity between the M1 area of unaffected hemisphere in patient group and motor area located in the collateral side.Conclusion The increased connectivity between the M1 area of the affected hemisphere and the other motor cortex might indicate that the reorganization in the motor pathway and the formation of the potential compensatory network second to the impairment of the normal motor pathway resulted in the functional reorganization of the motor cortex.The fcMRI technique might be a valuable approach to reveal the pathophysiological changes of nerve network caused by brain tumor.
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The deterioration of indoor air quality (IAQ) in medical district was caused by the personnel in the area, the buildings and their surroundings, and the situations of the air conditioning system. It is necessary to control the personnel entering the medical area and to strengthen the management of the buildings and their surroundings, and the air conditioning system for maintaining high IAQ. The development of new efficient air cleaning (equipment) is of importance in the same way.
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Objective To investigate the clinical and characteristic imaging findings of intracranial gliosarcoma. Methods The imaging findings of surgery and pathology proved intracranial gliosarcoma in 15 cases were retrospectively analyzed. There were 10 males and 5 females, ranging in age from 44 to 67 years (mean age 58 years). Results All tumors were located in supratentorium, including 13 cases in the temporal or parietal lobe, 1 cases in the occipital lobe, and 1 cases in the thalamus. Tumors appeared as round or ellipse in shape. The lesions ranged in size from 3 to 9 cm (mean 4.6 cm). CT scan showed mingled hypo and isodensity in 7, hypodense in 4 with CT value from 18 to 22 HU, hyperdense in 4 with the CT value from 48 to 55 HU. Enhancement appeared as an irregular pattern. The margin was clear. Most intracranial gliosarcoma showed perifocal edema. MRI were examined in 6 cases, whichappeared as low signal on T 1WI, and as high signal on T 2WI. There was irregular enhancement of the mass. Conclusion It was difficult to make the correct preoperative diagnosis for gliosarcoma, but it was possible to make a tendency diagnosis using CT or MR combined with the history. Contrast enhanced CT and MRI should be useful in differentiating gliosarcoma from glioblastoma.
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Objective To analyse imaging features of atypical meningioma.Methods There were 17 cases with atypical meningiomas proved by pathology,7 cases were male,10 cases were female,ranged in age from 34～69 years.17 cases all examined with CT,and 10 cases with CT enhanced scanning;12 cases examined with MRI and 8 cases with MR enhanced scanning,5 cases examined with DSA.Results The major imaging features of atypical meningioma included:the borders of tumors were mostly irregular,nonhomogeneous density or signal on plain CT and MRI,nonhomogeneous enhancement on enhanced CT and MRI.Cystic and necrotic changing and the invasion of cranial bone and adjacent structure could be seen.5 cases with dural tail sign on MRI,3 of them,this sign was short,thick and irregular.Heavy staining was showed on DSA.Conclusion Atypical meningiomas are of some clinical and imaging features.
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Objective To examine the feasibility by applying the CT density-difference postprocessing in early diagnosis of middle cerebral artery (MCA) occlusion. Methods The possible MCA occlusion patients were scanned with CT in early stage (within 3 hours) and divided into two groups randomly.Each group included 50 samples and one was processed technologically by CT density-difference and the other one was not.The two groups were scanned once more in 24 hours later and the data being processed by statistical method. Results The results showed that the accurate diagnosis rates were 14.3% within 60 minutes,93.3% from 60 to 119 minutes and 100% from 120 to 180 minutes .In comparing these two groups,there appeared no significant differences in the situation within 60 minutes and there was found significant difference in the other two situations. Conclusion Applying the technology of CT density-difference postprocessing,the middle cerebral artery (MCA) occlusion in early stage might be diagnosed.
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Objective To study the correlation among pathological,clinical and the imaging features(CT and MRI) of the Rathke cleft cysts.Methods CT,MRI and clinical findings of Rathke cleft cysts in 43 patients confirmed by operation and pathology were retrospectively studied.Results 27 cysts located at intrasella and suprasella and 16 cysts entirely located at intrasella.Cysts were round or oval in shape with definite borders.The size of 30 cysts exceed 10mm in diameter.On CT scans reviewed,the cysts were low density in 9 cases,hyper-density in 9 cases and isodensity or mixed density in 8 cases.The cyst's wall with calcification was seen in one.On postcontrast CT scans,6 cases showed circular and peripheral cyst's wall enhancement and others were no enhancement.On MR imaging,the lesions were low or isodense on T1WI and hyper-intensity on T2WI in 18 cases,both were high signal intensity on T1WI and T2WI in 6 cases,high signal intensity on T1WI and mixed signal intensity on T2WI in 4 cases.An intracystic nodule having high signal intensity on T1WI,and low or mixed signal intensity on T2WI was observed in 4 cases.On contrast-enhanced MR imaging,enhancement of the cyst's wall was shown in 9 cases.During surgery,the lesions were noted to have a cyst of semisolid consistency,and cystic contents were described from CSF-like clear fluid in 10 cases,jellied-like brown mucoid fluid in 15 cases,caseous-like mucoid fluid in 12 cases,machine oil-like mucoid fluid in 6 cases.At histopathology,a part of cystic fluid included cholesterol crystal and necrotic debris.Cholesterol clefts and hemosiderin pigment,and granuloma were shown by staining with HE in 11 cases.The PAS staining was positive in 16 cases,cystic fluid contained partial mucopolysaccharides and protein.Conclusion Typical Rathke cysts can be dignosised in the preoperative,the findings of CT and MRI are not specific in atypical cysts.The imaging features were different with the fluid component of Rathke cleft cysts..
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Objective To explore the technique and the clinical value of Neuroform stents in combination with Guglielmi detachable coil(GDC) to treat wide-necked basilar artery aneurysms.Methods 30 cases with wide-necked basilar artery aneurysms were treated with Neuroform stent combined with GDC.Of 30 wide-necked basilar artery aneurysms,the location of lesions was at basilar tip in 16,basilar trunk in 9 and the beginning of the basilar in 5.Results In 30 cases,total occlusion was achieved in 25 and partial occlusion in 5 patients.The thrombosis within stent occurred in 2 patinets,and remainder of patients recovered well.There were no thromboembolic events in 20 cases followed up for 3~6 months.Twenty-two patients were angiographically followed up for 3 months after the procedure,among them,the aneurysms visualized and the arteriae burdened aneurysms were passed free in densely packed and 3 aneurysms with neck remnant.Conclusion The Neuroform stent is a easy and safe intracranial stent for embo1ization of wide-necked intracranial aneurysms,especially suitable for wide-necked basilar artery aneurysms with severely tortuous intracranial artery.
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Objective To study CT and MRI features of intracranial chondrosarcomas. Methods CT and MRI of 3 cases with intracranial chondros arcomas proved by pathology were retrospectively analyzed.Results CT scans showed the tumors were lobular mass, per itumoral edema were not serious, intratumorous calcification and bone invasion w ere seen in 2 cases.MRI showed that tumor had low to intermediate signal intensi ty or hypointensity on T 1WI, high signal intensity on T 2WI. On contrast enha nced MRI,the center of lesions which was low signal intensity on T 2WI was no e nhancement, but there was observable enhancement at periphery of tumors.Conclusion Intracranical chondrosarcomas are often orgina ted from synchondrosis of the skull base,the lesions are often associated with c alcification, and bone invasion, the accurate dignosis should depend on microsco pic examination and immunohistochemical staining.
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Objective:To analyse the imaging featrues of intractranial tuberculoma and improve the diagnostic accuracy.Methods:31 patients with clinical characteritics and pathological proved intracranial tuberculomas were studied retrospectively.Results:"egg-shell"calcification were the feature of giant calcified and ossified tuberculoma.CT scaning were single and multiple nodular lesion.In the contrast enhancing CT scaning,plate shaped or ring form shadows were shown.MRI were provided hypointense on T1WI and hyperintense on T2WI.The rim homogeneous enhancement were showd in the Gd-DTPA.Conclusion:The diagnosis of typical intracranial tuberculomas can be made.After antituberculosis chemotherapy,CT and MRI can help made differsntial diagnosis.Operative indications should be select strictly.
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Objective To investigate the characteristic clinical, imaging, and pathologic findings of intracranial neuronal and mixed neuronal-glial tumours. Methods The imaging findings of surgery and pathobiology proved intracranial neuronal and mixed neuronal-glial tumours in 14 cases (7 male and 7 female, ranging in age from 6-56 years; mean age 33.8 years) were retrospectively analyzed. Results Eight gangliogliomas were located in the frontal lobe (4 cases), temporal lobe (1 case),fronto- temporal lobe(2 cases), and pons (1 case). They appeared as iso-or low density on CT, iso-or low signal intensity on T 1WI, and high signal intensity on T 2WI on MR imaging. Two central neurocytomas were located in the supratentorial ventricles. Four desmoplastic gangliogliomas were seen as cystic masses, appearing as low signal intensity on T 1WI and high signal intensity on T 2WI Conclusion Intracranial neuronal and mixed neuronal-glial tumours had imaging characteristics. Combined with clinical history, it was possible to make a tendency preoperative diagnosis using CT or MR.
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Objective To study the clinical law and imaging characteristics of intracranial primary malignant lymphoma.Methods The clinical law and imaging finding in 27 cases of intracranial primary malignant lymphoma confirmed by pathology were analysed CT scan was performed in all cases.MRI examination were carried out in 20 cases simultaneously.Results The first symptom in most cases was headache,and other symptoms were epileopsy,dizziness,hemiplegia,etc.This lesion was mostly seen in male around 40 years old.The lesions were mostly equal or high density on CT,equal or low signal intensity on T 1WI and closed to grey matter signal intensity on T 2WI.Tumors were enhanced obviously on contrast-enhanced scans,necrosis of center of focus was seen in 1/3 cases.The lesions were single or multiple.Conclusion The accuray diagnosis of intracranial primary malignant lymphoma can be done by combined clinical data with imaging features.