颅内结核瘤的MRI诊断

MRimaging of intracranial tuberculomas

目的 通过分析３２ 例脑结核瘤的ＭＲＩ表现，讨论了脑结核瘤的鉴别诊断。方法 回顾性分析了３２ 例经手术、病理或临床随访证实为脑结核瘤患者的ＭＲＩ表现。全部病例均获取自旋回波Ｔ１ＷＩ、自旋回波或快速自旋回波Ｔ２ＷＩ及钆喷替酸葡甲胺（ＧｄＤＴＰＡ） 增强Ｔ１ＷＩ。结果 全部病例ＭＲＩ平扫均发现病灶，单发２５ 例（包括脑膜结核瘤１ 例） ，多发７ 例（ 其中粟粒性脑结核瘤１ 例），除１ 例粟粒性外，３１ 例患者共发现４６ 个病灶。不同类型的结核瘤ＭＲＩ表现各异，ＭＲＩ显示病灶较ＣＴ更清楚，增强扫描发现病灶更多，不同类型的结核瘤对抗结核药物治疗反应不同。结论 ＭＲＩ可以明确诊断典型脑结核瘤，并具有较高的鉴别诊断能力。

Objective To analyse the MRIfeatures of intracranial tuberculomas and to discuss the differential diagnosis- Methods 32 patients(16 malesand16females,4- 46 yearsofage,mean22 years) with clinically and pathologicalprovedintracranialtuberculomas werestudiedretrospectively- MRIstudies wereobtained on Siemens1-0TMRScanner- Spin echosequence T1 weightedimages,spin echoandfastspin echosequence T2weightedimages wereacquiredin allpatients- Axial ,sagitaland coronal T1 weighted imagas were obtained after IVadminitration of Gd DTPAin all patients- Results 7 patients had multiple lesions (including 1 miliary tuberculoma)- Theimmaturetuberculomas werehypointenserelativetobraingrey matteron T1 weightedimagesand hyperintense on T2 weighted images; after contrast administration the lesions showed homogeneous nodular enhancement- The mature tuberculomas with solid caseation appeared relatively hypointense orisointense on T1weightedimagesandisointenseto hypointenseon T2 weightedimages- The maturetuberculomas withliquid centre appeared centrally hypointense on T1 and hyperintense on T2 weightedimages with a peripheralhypointenserim on T2 weighted images- After contrast administration, the mature tuberculomas showed rim enhancement- ConclusionsThe diagnosisoftypicalintracranialtuberculomascanbe made with MRimaging- MRIcan detect more intracranialtuberculomasthan CTand can help make differentialdiagnosis-