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CT and MRI Manifestations of Primary Central Nervous System Lymphomas

【摘要】 目的 探讨原发性中枢神经系统淋巴瘤(PCNSL)的CT及MRI表现特征,以提高术前对该病的影像诊断能力。方法 分析2008年1月—2009年8月华西医院16例经病理证实PCNSL患者的CT、MRI资料及病理资料。结果 病理检查均为B细胞来源的弥漫性大B细胞性淋巴瘤。16例PCNSL 29个病灶,单发11例(69%)，多发5例(31%)18个病灶。病灶好发部位依次是大脑半球临近蛛网膜下腔12个(41.4%)、脑室周围深部白质7个(24.1%)、胼胝体3个(10.3%)。有5例病变CT平扫表现为等或略高于脑实质密度影,无出血和钙化；MRI平扫75.9%(19/25)的病灶T1WI呈等低信号,T2WI等稍低信号,类似“脑膜瘤”样信号,均未见血管流空；增强后病灶大都均匀实质团块状或结节状强化,典型的可出现“尖角征”、“握拳征”,3例可见小囊变,呈“硬环征”。结论 CT对PCNSL的定性诊断作用有限,MRI具有一定特征性表现者,多可作出正确的诊断,但确诊有赖于病理。

Combined with diffusion tensor imaging and proton densityweighted magnetic resonance imaging on the visual pathway of central nervous system in patients with glaucoma

Objective To observe the changes of visual pathway of central nervous system in patients with glaucoma.Methods Thirty-five subjects were enrolled in this prospective study. There were seven patients of chronic primary angle closure glaucoma with bilateral visual field defects, 12 patients of primary open angle glaucoma with bilateral visual field defects, and 16 normal subjects. GE Signa HD 1.5 T magnetic resonance scanners and head eight phased array were used. The mean fractional anisotropy (FA) and the mean average diffusion coefficient (DCavg) of white matter tracts in visual pathway of bilateral optic nerve, optic chiasma, bilateral optic tract，bilateral optic radiation were measured by diffusion tensor imaging, meanwhile the white matter tracts were reconstructed by fiber tracking system. The volumes of lateral geniculate body were measured by coronal proton density weighted magnetic resonance imaging.Results The differences of FA among bilateral optic nerve, optic chiasma, bilateral optic tract，bilateral optic radiation were statistically significant (F=25.985，20.626，12.262，22.399，21.708，24.994，22.774；P＜0.05). There was no difference of DCavg among bilateral optic nerve, optic chiasma, bilateral optic tract，bilateral optic radiation（F=2.097，2.178，0.530，0.983，0.608, 0.866, 1.504；P＞0.05）. The differences of volume of lateral geniculate body among three groups were statistically significant （F=18.631，17.274；P＜0.05）. Conclusion There is degeneration in visual pathway of central nervous system in patients with glaucoma.

血清髓鞘少突胶质细胞糖蛋白抗体阳性中枢神经系统病变一例

内源性神经干细胞在中枢神经系统创伤修复中的研究进展

自上世纪60年代发现神经再生现象以来，神经科学领域专家学者做了大量关于神经再生的研究，包括体外分离培养神经干细胞并探索神经干细胞增殖、分化、迁移的规律和机制，以期最终应用于中枢神经系统疾病的治疗，如干细胞移植和神经生长因子诱导治疗等。脑脊髓损伤是死残率高、经济负担重的临床常见疾患，现撰文主要就目前神经科学领域有关调控内源性神经干细胞参与脑脊髓损伤神经再生修复的研究进展作一综述。

原发性玻璃体视网膜淋巴瘤一例

癫痫的一级预防：一项来自国际抗癫痫联盟预防工作组的报告

目前导致癫痫的病因中，有些是可以预防的。该综述总结了由此类可预防病因所造成的癫痫的公共卫生负担，并提出了癫痫一级预防的重要性。系统性回顾针对癫痫的 4 种可预防病因的流行病学研究，这些可预防病因分别是围产期损伤、脑外伤、中枢神经系统感染和卒中。通过使用统一的标准，对每项研究进行质量评估，并从满足质量评级标准的研究中提取了相关风险度量的数据，并将这些结果以中位数和四分位数的方式汇总。高质量的基于人群的研究结果显示，在中低收入国家中，所有年龄段的癫痫患病率约为 1.11%，而在高收入国家中约为 0.7%。围产期脑损伤是儿童癫痫中最常见的可预防病因，在中低收入国家中占 17%，在高收入国家中占 15%。在中低收入和高收入国家中，卒中均是老年癫痫患者中最常见的可预防病因，占所有新发癫痫病例的半数及以上，在高收入和中低收入国家中约 5%癫痫是由卒中造成的。在中低收入国家，中枢神经系统感染是较常见的癫痫病因，约占所有癫痫病例的 5%。在一些低收入农村地区和中等收入国家社区中，地方性神经囊虫病所致癫痫占所有癫痫病例的 34%。可预防的病因所致癫痫占癫痫的总体公共卫生负担的很大一部分。在中低收入和高收入国家中，围产期损伤、感染、脑外伤和卒中所致癫痫占所有癫痫的 25%。母婴保健、免疫接种、公共卫生、预防脑损伤和卒中这些公共卫生干预措施有可能会显著减少癫痫负担。

OLFACTORY ENSHEATHING CELLS TRANSPLANTATION FOR CENTRAL NERVOUS SYSTEM DISEASES IN 1 255 PATIENTS

Objective To analyze the therapeutic effect of olfactory ensheathing cells (OECs) transplantation for central nervous system diseases. Methods Between November 2001 and January 2008, 1 255 participants with central nervous system diseases were enrolled in this cl inical study for fetal OECs transplantation. There were 928 males and 327 femalesaged 1.2-87 (mean 40) years. The course of disease was (4.52 ± 4.67) years. Among them, 656 participants suffered from chronic spinal cord injury (SCI), 457 amyotrophic lateral sclerosis (ALS), 68 cerebral palsy (CP), 20 multiple sclerosis (MS), 11 the sequelae of stoke, 10 ataxia, and 33 residual diseases. The participants came from 71 countries or regions. Accidentally abortional fetal olfactory bulbs were donated voluntarily and were cultured for 2 weeks, then were transplanted. Results One thousand one hundred and twenty-eight cases were followed up for 2-8 weeks (mean 4 weeks) to obtain integrated data. Among them, the neurological functional amel ioration was noticed in 994 participants with the overall short-term improvement rate of 88.12%. Seventy-six patients experienced the various perioperative compl ications with the incidence rate of 6.74%. One hundred and twenty patients with SCI received over 1 year follow-up. And according to ASIA assessment, motor scores increased from (39.82 ± 20.25) to (44.55 ± 18.99) points, l ight touch scores from (51.56 ± 25.89) to (59.81 ± 27.72) points, pain scores from (50.36 ± 27.44) to (57.09 ± 28.51) points for foreign patients (P lt; 0.05); motor scores increased from (40.52 ± 20.80) to (46.45 ± 20.35) points, l ight touch scores from (55.64 ± 26.32) to (68.64 ± 25.89) points, pain scores from (57.05 ± 26.00) to (66.13 ± 24.29) points for good rehabil itation Chinese patients (overall P lt; 0.05); motor scores from (37.03 ± 18.52) to (38.03 ± 18.50 points (P lt;0.05), l ight touch scores from (45.88 ± 22.56) to (46.63 ± 23.09) points (P gt; 0.05), pain scores from (45.25 ± 23.68) to (45.28 ± 23.63) points (P gt; 0.05) for poor rehabil itation Chinese patients. Compared foreign patients and good rehabil itation Chinese patients with poor rehabil itation Chinese patients, difference in score change was remarkable (P lt; 0.05). One hundred and six cases of ALS, 32 CP, 8 MS, 7 ataxia, and 2 stroke sequelae were followed up for 3-48, 3-36, 2-20, 7-17, 6 and 24 months, One hundred and six cases of respectively. Majority of them (113/155, 72.9%）were benefited from OECs transplantation. Conclusion OECs transplantation into brain and spinal cord is feasible and safe . The therapeutic strategy is valuable treatment for such central nervous system diseases such as chronic SCI, ALS, CP and stroke sequelae and can improve the patients’ neurological functions and/or decrease the progressive deterioration.

The developments and applications of functional ultrasound imaging

In recent years, due to the emergence of ultrafast ultrasound imaging technology, the sensitivity of detecting slow and micro blood flow with ultrasound has been dramatically improved, and functional ultrasound imaging (fUSI) has been developed. fUSI is a novel technology for neurological imaging that utilizes neurovascular coupling to detect the functional activity of the central nervous system (CNS) with high spatiotemporal resolution and high sensitivity, which is dynamic, non-invasive or minimally invasive. fUSI fills the gap between functional magnetic resonance imaging (fMRI) and optical imaging with its high accessibility and portability. Moreover, it is compatible with electrophysiological recording and optogenetics. In this paper, we review the developments of fUSI and its applications in neuroimaging. To date, fUSI has been used in various animals ranging from mice to non-human primates, as well as in clinical surgeries and bedside functional brain imaging of neonates. In conclusion, fUSI has great potential in neuroscience research and is expected to become an important tool for neuroscientists, pathologists and pharmacologists.

抗髓磷脂少突胶质细胞糖蛋白抗体阳性脑炎一例并文献复习

Central nervous system complications in patients with carotid artery stenosis undergoing off-pump coronary artery bypass grafting: A retrospective cohort study

ObjectiveTo analyze the effect of carotid artery stenosis degree and intervention for carotid artery stenosis on the incidence of central nervous system complications after off-pump coronary artery bypass grafting (OPCABG) and explore the influencing factors. MethodsA total of 1 150 patients undergoing OPCABG in our hospital from June 2018 to June 2021 were selected and divided into two groups according to whether there were central nervous system complications, including a central nervous system complication group [n=61, 43 males and 18 females with a median age of 68.0 (63.0, 74.0) years] and a non-central nervous system complication group [n=1 089, 796 males and 293 females with a median age of 65.5 (59.0, 70.0) years]. The risk factors for central nervous system complications after OPCABG were analyzed. ResultsUnivariate analysis showed that age, smoking, hyperlipidemia, preoperative left ventricular ejection fraction, intra-aortic ballon pump (IABP), postoperative arrhythmia, postoperative thoracotomy and blood transfusion volume were associated with central nervous system complications. The incidence of central nervous system complications in patients with severe carotid artery stenosis or occlusion (11.63%) was higher than that in the non-stenosis and mild stenosis patients (4.80%) and moderate stenosis patients (4.76%) with a statistical difference (P=0.038). The intervention for carotid artery stenosis before or during the operation did not reduce the incidence of central nervous system complications after the operation (42.11% vs. 2.99%, P<0.001). Age, postoperative arrhythmia, severe unilateral or bilateral carotid artery stenosis and occlusion were independent risk factors for postoperative central nervous system complications (P<0.05). Conclusion The age, smoking, hyperlipidemia, preoperative left ventricular ejection fraction, intraoperative use of IABP, postoperative arrhythmia, secondary thoracotomy after surgery, blood transfusion volume and OPCABG are associated with the incidence of postoperative central nervous system complications in patients. Age, postoperative arrhythmia, severe unilateral or bilateral carotid artery stenosis and occlusion are independent risk factors for postoperative central nervous system complications. In patients with severe carotid artery stenosis, preoperative treatment of the carotid artery will not reduce the incidence of central nervous system complications.