MRI在颅内结核及其并发症诊断中的优越性

The superiority of MRI diagnosis in intracranial tuberculosis and its complications

目的探讨颅内结核及其并发症的磁共振成像(MRI)表现在影像学诊断中的优越性。方法回顾性分析39例经临床及实验室检查或手术病理明确诊断的颅内结核患者的临床及MRI资料,其中30例经临床及实验室脑脊液检查确诊,9例为术后病理检查确诊。结果单纯结核性脑膜炎18例,单纯结核瘤11例,结核性脑膜炎并结核瘤6例,粟粒性颅内结核4例。39例中,24例结核性脑膜炎并发脑梗死12例、并发脑积水9例、并发脑梗死和脑积水3例。结核性脑膜炎的MRI主要表现为脑膜及脑基底池的异常增强,并可伴发脑梗死、脑积水;结核瘤表现为1个或多个散在分布的结节伴水肿,并有异常环形、结节状强化表现;粟粒性脑结核MRI表现为软脑膜、脑实质区弥漫分布大小基本均匀的结节影伴周围明显水肿带。结论 MRI在诊断颅内结核及其并发症方面较CT更具有优越性,在显示病变的部位、范围、分型及制定治疗方案等均具有重要价值。

Objective To evaluate the diagnostic value of magnetic resonance imaging （MRI） for intracranial tuberculosis and its complications. Methods The clinical and MRI data from 39 patients with intracranial tuberculosis proved by postoperative pathology （9 cases） or clinical examination and laboratory examination of cerebrospinal fluid （30 cases） were retrospectively analyzed. Results Of 39 cases, 18 were tuberculous meningitis, 11 were tuberculoma, 6 were tuberculous meningitis combined tubereuloma,4 were miliary tuberculosis. Of 24 patients with tuberculous meningitis out of 39 cases, 12 were complicated with cerebral infarction,9 with hydrocephalus ,3 with cerebral infarction and hydrocephalus. The MRI main features of tuberculous meningitis were as follows： abnormal enhancement of meninges and basal cistern, and concomitant cerebral infarction or hydrocephalus. The characteristics of tuberculoma were one or a few scattered nodules accompanying the manifestation of edema, abnormal ring and nodular enhancement. The miliary cerebral tuberculosis showed diffuse and mainly homogeneous nodular shadows which accompanying peripheral edema zone in the cerebral pia mater and cerebral parenchyma. Conclusions MRI possesses more superiority over CT in the diagnosis of intracranial tuberculosis and its complications, and has an important role in showing location,range, classification of foci and making therapy scheme.