血管周围间隙的MRI表现.ppt

皮质脊髓束Waller变性 周林江 杨艳梅 中央前回中、上部和中央旁小叶前部以及其他一些皮质区域锥体细胞的轴突集合组成皮质脊髓束，经内囊后肢下行，至中脑的大脑脚底，占其中间3／5的外侧部；然后至脑桥基底部，分散成大小不等的纤维束下行；至延髓锥体，纤维又集拢形成一束。 皮质脊髓束Waller变性是由于它的上运动神经元或轴突的损伤而引起其远端的轴突和髓鞘顺行性变性。 引起皮质脊髓束Wallerian变性的原因，最常见者为脑卒中（包括脑梗死和脑出血），较少见者还有脑外伤、脑肿瘤和脱髓鞘性病变等。 特点 特点 Location Lesion Time Symptom MR signal DTI/DWI BOLD 早期检测 FA：定量分析 预测预后 50y,M,infarctiong in left fronto-perieto-temporal region 6w 10w 24w 卒中后皮质脊髓束Waller变性。。。。 国际脑血管病杂志2009，17（3）：205-210 Acta radiol 2007(6) 24-day-old cerebral infarct in the left MCA The myelin-stained section corresponding to the postmortem T2WI of the midbrain Moderate pallor in the left cerebral peduncle Reveal vacuolation of myelin, mild loss of axons and scattered axonal swellings 早期髓鞘空泡化，亚急性和慢性期髓鞘和轴索的丢失和巨噬细胞浸润 T2高信号在不同时期具有不同的病理特征 Location Lesion Time Symptom MR signal DTI/DWI BOLD Location Lesion Time Symptom MR signal DTI/DWI BOLD 脑梗死后3个月。组织学检查示同侧皮质脊髓束轴索空泡形成，轴索和髓鞘缺失，巨噬细胞浸润 脑梗死后2年。组织学检查示同侧皮质脊髓束大量轴索和髓鞘缺失，少量巨噬细胞浸润，组织疏松。 Stage 1: first 4 weeks; axonal degradation with little biochemical change in myelin; MRI(-) Stage 2: 4-14 weeks; myelin protein breakdown but myelin lipids remain intact and tissue become hydrophobic;high lipid-to-protein ratio results in T2 hypointensity Stage 3: 14 weeks; myelin lipid breakdown,gliosis,and changes in water content and structure, and tissues become hydrophilin, resulting in high T2 signal Stage 4: several years later, and is characterized by atrophy and the persistence of high T2 signal. Four stages of WD in the CNS Location Lesion Time Symptom MR signal DTI/DWI BOLD J. Neurol. Neurosurg. Psychiatry 2007;78:587-592. Length of DCST affected predicts outcome. Involvement of peduncle middle third may correlate with outcome,involvement of lateral or median peduncle was not correlated to outcome. Decending corticospinal tracts (DCST) refers to caudally directed motor fiber tracts definable at levels of the posterior limb of the internal capsule,cerebral peduncle, basis pontis, and medullary pyr