脑脓肿的MRI诊断和立体定向手术治疗

The diagnosis value of MRI and stereotactic operation for pyogenic brain abscesses

目的探讨核磁共振(MRI)弥散加权成像(DWI)与表观弥散系数(ADC)值在脑炎病理变化全过程中的诊断价值,进一步评价立体定向脓液抽吸及引流术在脑脓肿治疗中的作用。方法利用脑炎在核磁共振DWI及ADC值上的表现,对14例23个脓肿灶的磁共振表现进行分析。共行立体定向引导脓肿穿刺及引流手术20例:脓肿穿刺14例,脓肿腔穿刺引流6例。结果脑脓肿不同期的MRIDWI表现和ADC值有明显不同。20例手术均获得成功,术后头颅CT或MRI复查显示脓肿腔消失。所有病人在随访期内(4个月至3年,平均14个月)未见脓肿复发。结论脑炎各个时期有其不同的MRI表现,DWI及ADC值已成为脑炎各期诊断的一个重要诊断依据。立体定向脑脓肿穿刺抽吸和引流手术应为脑脓肿的首选外科手段。

Objective To evaluate the diagnostic value of MRI and further evaluate the role of stereotactic aspiration and drainage in the treatment of pyogenic brain abscesses and to discuss the most effective for brain abscesses. Methods The DWI and ADC value of 14 patients with 23 lesions were analysised and measured; 20 patients were treated with stereotactic aspiration or drainage. Results Deferent period of brain abscess have deferent signal of DWI and ADC value. All the operations were carried successfully out. The clinical symptoms were disappear or improved remarkably and the CT or MRI re-examination disclosed disappear or obviously diminution of abscess at the time of discharge. No abscess recurrence occurred in the follow-up of a period from 4 months to 3 years （average 14 months） in 20 patients. Conclusion DWI and ADC value is very helpful to the diagnosis of brain abscesses and the results suggested that stereotactic operation seems to be the most appropriate surgical choice in pyogenic brain abscesses.