儿童神经系统影像诊疗讲义.ppt

* 8 Good moring everyone. today it is my honor to share with you the topic of 多数手足口病患儿症状轻微，有自限性， 这是另一个病例，T2显示左侧桥脑后部点状稍高信号，但是病灶比较小，很容易漏诊，DWI可以清楚的显示病灶呈显著高信号，边界比较清楚，FLAIR和T1则很难辨认出病灶 T1和FLAIR都没有发现病灶， T2显示双侧桥脑后部对称性小片状稍高信号，但很难勾画出边界， DWI可以清楚的显示病灶呈显著高信号，边界清楚，相应ADC值减低 SWI 深静脉和静脉窦扩张 HIE -SWI */20 女，13岁 左侧肢体不由自主运动20余天 走路时左下肢足内翻，步态不稳，症状不能控制，紧张性加重 体查：左侧病理征阳性 生化检查：血清铜、铜蓝蛋白、尿铜、血清铁、铁蛋白、风湿、类风湿指标、甲功水平、脑脊液生化检查、常规未见异常 结 果 典型“虎眼征” T2WI HSD */20 结 果 SWI幅度图 苍白球极低信号 SWI相位图 苍白球相位值降低 */20 讨 论 NBIA——Hallervorden-Spatz disease（HSD） ICD编码G23.0 泛酸盐激酶2(PANK2)基因突变 泛酸盐激酶相关神经变性(Pantothenate Kinase-Associated Neruodegeneration，PKAN) Zhou B, et al. A novel pantothenate kinase gene (PANK2) is defective in Hallervorden-Spatz syndrome. Nat Genet 2001;28:345-349 */20 虎眼征 铁盐沉积于神经元细胞及周围间隙 苍白球低信号 铁盐沉着 低信号内部斑点状高信号 所谓的“疏松组织区” 细胞死亡、胶质细胞增生、水含量增加及空泡形成区域 T2WI Delgado RF , et al. J Magn Reson Imaging.2011 如何开单？ 颅脑平扫+增强+SWI 小结 DWI：看脑水肿最敏感，检查时间不到1分钟 MRS观察代谢，用于科研，临床价值有待观察 WI：看微出血、静脉扩张，检查时间3分钟 */20 * 1 Hippocampal body 2 Hippocampal head: digitationes hippocampi 3 Hippocampal tail 4 Fimbria 5 Crus of the fornix 6 Splenium of the corpus callosum 7 Calcar avis in the occipital horn 8 Collateral trigone 9 Collateral eminence 10 Uncal recess of the temporal horn (the amygdala overlying the hippocampal head has been removed) 11 Uncal part of the hippocampus 12 Parahippocampal gyrus (sublculum) 13 Hippocampal sulcus 1 Section of the hippocampus 2 Temporal horn of the lateral ventricle 3 Parahippocampal gyrus 4 Fusiform gyrus 5 Inferior temporal gyrus 6 Middle temporal gyrus 7 Superior temporal sulcus 8 Superior temporal gyrus 9 Lateral fissure 10 Insula 11 Postcentral gyrus 12 Central sulcus 13 Precentral gyrus 14 Precentral sulcus 15 Superior frontal gyrus 16 Cingulate sulcus 17 Cingulate gyrus 18 Corpus callosum 19 Fornix 20 Lateral ventricle 21 Caudate nucleus 22 Internal capsule, posterior limb 23 Claustrum 24 Putamen 25 Lateral pallidum 26 Ventral lateral thalamic nucleus 27 Dorsomedial thalamic nucle