磁共振成像对结核性脑膜炎伴发脑梗死的诊断价值

Diagnostic value of MRI for intracerebral infarctions accompanied by tuberculous meningitis

目的总结MRI对结核性脑膜炎伴发脑梗死的诊断价值。方法诊断为结核性脑膜炎且发生结核性脑动脉炎患者200例,行T1WI、T2WI、横断面液态衰减反转恢复序列(FLAIR)、扩散加权成像(DWI)及增强扫描,观察脑动脉血管受累情况,分析总结脑血管病变与脑梗死的关系及影像特征。结果 200例结核性脑动脉炎病变部位以大脑动脉环(Willis环)最常见,共163例,未累及Willis环的其他部位脑动脉炎37例,二者差异有统计学意义(P<0.001);200例中发生脑梗死65例,占32.5%,其中新发脑梗死15例,出血性脑梗死3例,脑梗死19例,脑软化灶28例,发生脑梗死部位以基底节区最常见,基底节及多部位并发次之。结论 MRI能很好地显示结核性脑膜炎脑血管受累情况,脑梗死的发生与结核性脑膜炎累及血管有密切关系。

Objective To investigate the MRI diagnostic value for intracerebral infarctions accompanied by tuberculous meningitis.Methods T1 weighted image,T2 weighted image,transverse fluid-attenuated inversion recovery(FLAIR),diffusion-weighted image(DWI) and contrast-enhancement were performed respectively in 200 cases tuberculous meningitis by clinical diagnosis.The involved cerebral vessels and the distributions of the intracerebral infarctions were analyzed retrospectively.Results A total of 200 cases cerebrovascular inflammation of tuberculous meningitis were observed.Of which,163 cases in the site of Willis′ circle,37 cases in other sites.There was significant difference between the sites of lesions (P<0.001).There were 65 cases cerebral infarctions in 200 cases tuberculous meningitis,among them,hemorrhagic infarctions 3 cases,acute infarctions 15 cases,common infarctions 19 cases,and encephalomalacia 28 cases.Infarct locations were mainly in basal ganglia and subcortical white matter.Conclusions MRI can show satisfactorily the distributions and image features of cerebrovascular inflammation of tuberculous meningitis,and the distributions of cerebral infarctions mainly located in basal ganglia and subcortical white matter,which have an intimate relationship with the involved vessels.