Cohn M C, Hudgins P A, Sheppard S K, Starr P A, Bakay R A
Department of Radiology, Emory University, Atlanta, GA, USA.
AJNR Am J Neuroradiol. 1998 Jun-Jul;19(6):1075-80.
Stereotactic pallidotomy, which has evolved as a result of technological advances in high-resolution MR imaging and microelectrode electrophysiological recording, is becoming a major form of treatment for patients with Parkinson disease in whom medical therapy has failed. We describe the location and appearance of the pallidotomy lesion on high-resolution MR images.
MR images in 83 patients (60 men and 23 women) who underwent stereotactic pallidotomy were reviewed retrospectively. The prepallidotomy screening study included standard spin-echo and gradient-echo sequences. After placement of a stereotactic headframe, volume-acquisition T1-weighted spoiled gradient-echo images were acquired for target localization in the posteroventral internal globus pallidus. One to three days after the pallidotomy, volume-acquisition T1-weighted and standard spin-echo sequences were obtained. In 16 patients, turbo spin-echo inversion recovery images also were obtained before and after surgery. The diameter, signal intensity, and location of the lesions relative to the midcommissural point and the intercommissural line were noted.
The average lesion volume was 118 mm3 while that of the lesion-edema complex was 420 mm3. The midportion of the lesion was located on average 3.5 mm anterior to the midcommissural point, 21 mm lateral to the middle of the third ventricle, and 1.2 mm inferior to the intercommissural line. Signal intensity of the lesions varied, but all had a rim of edema. Forty-two patients had edema extending into the optic tract, four had increased signal in the ipsilateral basal ganglia on T2-weighted images, and seven had hemorrhage involving the ipsilateral caudate, internal capsule, and putamen. All patients experienced some improvement in contralateral bradykinesia, rigidity, and dystonia.
The acute pallidotomy lesion is invariably located within the posteroventral internal globus pallidus, is usually hyperintense centrally on T1-weighted and turbo spin-echo inversion recovery MR images, and has a thin rim of edema. Edema extending into the ipsilateral optic tract was a common finding, but this series of patients evinced no visual changes.
立体定向苍白球切开术因高分辨率磁共振成像和微电极电生理记录技术的进步而发展起来，正成为药物治疗无效的帕金森病患者的一种主要治疗方式。我们描述了高分辨率磁共振图像上苍白球切开术病灶的位置和表现。
回顾性分析了83例行立体定向苍白球切开术患者（60例男性和23例女性）的磁共振图像。苍白球切开术前的筛查研究包括标准自旋回波和梯度回波序列。放置立体定向头架后，采集容积式T1加权扰相梯度回波图像用于定位苍白球腹后内侧核靶点。苍白球切开术后1至3天，采集容积式T1加权和标准自旋回波序列图像。16例患者在手术前后还采集了快速自旋回波反转恢复图像。记录病灶的直径、信号强度以及相对于连合中点和连合间线的位置。
病灶平均体积为118立方毫米，病灶 - 水肿复合体平均体积为420立方毫米。病灶中部平均位于连合中点前方3.5毫米、第三脑室中部外侧21毫米、连合间线下方1.2毫米处。病灶信号强度各异，但均有水肿边缘。42例患者的水肿延伸至视束，4例在T2加权图像上同侧基底节信号增强，7例有同侧尾状核、内囊和壳核出血。所有患者对侧运动迟缓、强直和肌张力障碍均有一定改善。
急性苍白球切开术病灶始终位于苍白球腹后内侧核内，在T1加权和快速自旋回波反转恢复磁共振图像上通常中心呈高信号，并有薄的水肿边缘。水肿延伸至同侧视束是常见表现，但该系列患者未出现视力改变。
