艾滋病颅内机遇性感染及肿瘤病变的CT诊断

CT diagnosis of intracranial infection and mass in HIV/AIDS

目的:探讨HIV/AIDS相关性颅内感染及肿瘤病变的CT表现特点,提高颅内感染性及肿瘤病变的诊断水平。方法:回顾分析在博茨瓦纳玛丽娜公主医院临床及病理检验证实的26例AIDS患者的头颅CT表现。全部病例均有完整的CT资料。结果:①AIDS合并脑弓形虫感染6例,典型表现为颅内单发或多发结节影,边缘不规则,中央见坏死灶,增强扫描病灶明显强化,4例坏死灶不均匀轻度强化,周围见明显水肿带;②脑结核3例,表现为颅内多发散在低密度区及小结节灶,增强扫描2例病灶强化,1例表现为多发散在钙化点;③病毒性脑炎4例,两侧大脑多发片状低密度区,增强CT无明显强化,1例见沿脑回线样强化,轻度脑肿胀;④结核性脑膜炎2例,增强扫描见两侧大脑外侧裂池、桥脑环池明显异常强化;⑤脑脓肿7例,表现为颅内厚壁空洞形成,增强后壁明显强化,病灶周围水肿明显;⑥淋巴瘤4例,表现为颅内团块状影,平扫呈等或稍高密度,密度较均匀,增强后中度或明显强化,周围轻中度水肿。结论:CT检查是AIDS所致颅内机遇性感染最基本的影像学检查方法,能很好地显示病变的部位、形态以及病灶周围水肿情况。但在临床定性诊断时需要结合实验室检测和组织活检。

Objective：To study the CT imaging findings of intracerebral infections and mass in patients with HIV/AIDS.Methods：The imaging data of 26 patients with AIDS which evaluated together with clinical symptoms,pathology in Princes Marina Hospital of Botswana with intracerebral opportunistic infections were analyzed retrospectively.Results：CT of 6 cases with cerebral toxoplasmosis showed intracranial single or multiple nodules with irregular margin and necrosis in the center,surrounded by apparent edema,after contrast injected,significant enhancement of nodules were seen.Cerebral tuberculosis in 3 cases showed intracranial scattered in small nodules,some enhanced after contrast injected,one case showed more divergence in the calcifications.4 cases of encephalitis,both sides of the sheet density of multiple brain areas,enhanced CT scan see no obvious enhancement,one liner meningeal enhancement.2 cases of tuberculous meningitis,enhanced scan see both sides of the Silvian fissure pool,central pontine obviously abnormal enhancement.7 cases of brain abscess,showing the formation of intracranial cavities with thick wall,after contrast injected,significant enhancement of the wall were seen,severe edema arounded.4 cases of lymphoma showed intracranial masses with isointensity or hyperdensity in plan CT and obvious enhancement after contrast injected,with mild or moderate peripheral edema.Conclusion：CT scanning is the basic examination of the intracerebral opportunistic infections in patients with AIDS,it can well show the parts,shape and edema of the lesions.