颅内结核瘤的MRI诊断与治疗

Diagnosis by Using MRI and Treatment of Intracranial Tuberculomas

目的 了解磁共振检查对颅内结核瘤的诊断价值和抗结核药物治疗结果。方法 观察分析 31例经MRI检查并经抗结核治疗 6～ 8个月的脑结核瘤患者的头颅MRI表现和临床特点。结果 全部病例MRI检查均发现病灶 ,单发 2 8例 ,多发 3例 (其中粟粒性脑结核瘤 1例 ) ,大部分病灶位于大脑凸面的皮髓交界处。不同类型的结核瘤MRI表现各异。MRI显示病灶较CT更清楚 ,增强扫描发现的病灶更多 ,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 ,并具有较高的的鉴别诊断能力。目前抗结核治疗效果良好 ,一般治疗半年可获痊愈 ,极少需手术治疗。

Objective To evaluate the diagnosis vlue of MRI and the efficacy of antituberculosis short-course chemotherapy on intracranial tuberculoma patients. Methods After antituberculotic treating for 6～8 months, the MRI manifestation and the clinical characteristics of 31 intracranial tuberculoma patients were analyzed. Results 3 patients had multiple lesions (including one miliary tuberculoma). The immature tuberculomas were low intensity on T 1WI and high intensity on T 2WI. The mature tuberculomas with solid caseation appeared relatively low intensity or iso-intensity on T 1WI, and iso-intensity or low intensity on T 2WI. The mature tuberculomas with liquid center appeared centrally low intensity on T 1WI and high intensity on T 2WI with a peripheral low intensity rim on T 2WI. After contrast administration, peate shaped or ring shadows were shown surrounding the lesions of tuberculomas. MRI can detect more intracranial tuberculomas than CT and can help make differential diagnosis. Conclusions The diagnosis of typical intracranial tuberculomas can be made with MRI. With the antituberculosis short-course chemotherapy used nowdays, almost all the intracranial tuberculoma patients can be cured and only few of them need surgical operation.