结核性脑膜炎磁共振的诊断应用

MRI in diagnosis of tuberculous meningitis

目的评价磁共振液体衰减反转恢复(FLAIR)技术和钆喷酸葡甲胺盐(GDPA)增强MRI对结核性脑膜炎的临床诊断价值,为临床诊治提供参考。方法对90例结核性脑膜炎患者均行常规TSE序列T1WI/T2WI、FLAIR序列及MRI增强检查,对比3种成像方法对结核性脑膜炎的显示能力。结果 90例患者检查结果显示,MRI增强发现脑膜病变83例,FLAIR序列发现脑膜异常72例,TSE序列T2WI发现脑膜异常61例,3种检查方法差异有统计学意义;将3种检查方法对结核性脑膜炎显示率的两两比较发现,单纯结核性脑膜炎的MRI增强检查、FLAIR序列、T1WI/T2WI显示率分别为45.6%、37.8%、33.3%,合并脑内结核瘤分别为33.3%、28.9%、22.2%,伴有并发症分别为13.3%、13.3%、10.0%,在单纯结核性脑膜炎及合并脑内结核瘤中,经χ2检验3种检查方法差异有统计学意义(P<0.05),3种检查方法对伴有并发症的患者的显示率,经χ2检验差异无统计学意义。结论增强MRI对结核性脑膜炎具有特征性表现,结合FLAIR序列可以显著提高结核性脑膜炎的显示率,并为临床诊断结核性脑膜炎提供可靠依据。

OBJECTIVE To evaluate the value of magnetic resonance liquid attenuated inversion recovery（FLAIR） technology and GDPA enhanced MRI in diagnosis of tuberculous meningitis so as to guide the clinical treatment.METHODS A total of 90cases of tuberculous meningitis patients underwent the conventional TSE sequence T1WI/ T2WI,FLAIR sequence and enhanced MRI examination,then display capabilities of tuberculous meningitis of the three imaging methods were compared.RESULTS Of totally 90cases of patients receiving the examinations,the MRI enhancement discovered the meningeal disease in 83cases;the FLAIR sequence found meningeal abnormal in 72cases;the TSE sequence T2WI found meningeal abnormalities in 61cases,the difference between the three examination methods was statistically significant.Compared with the display rate of the tuberculous meningitis between each pair,the display rates of the simple tuberculous meningitis was 45.6% by the MRI enhancement,37.8% by FLAIR sequence,33.3% by T1WI/T2WI;the display rate of the merged intracranial tuberculous tumor was 33.3% by the MRI enhancement,28.9% by FLAIR sequence,22.2% by T1WI/T2WI;the display rate of the complications was 13.3% by the MRI enhancement,13.3% by FLAIR sequence,10.0% by T1WI/ T2WI;the chi-square test indicated that the difference in the display of the simple tuberculous meningitis or the merged intracranial tuberculous tumor between the three examination methods was statistically significant（P 0.05）and that the difference in the display rate of the complication was not statistically significant.CONCLUSION The enhanced MRI has a characteristic performance of tuberculous meningitis,the enhanced MRI combined with FLAIR sequence can significantly improve the display rate of tuberculous meningitis so as to provide a reliable basis for the clinical diagnosis of tuberculous meningitis.