头颅磁共振成像在中枢神经系统白色念珠菌病诊治中的应用价值

Clinical value of cranial MRI in the diagnosis and treatment of central nervous system candidiasis

目的中枢神经系统白色念珠菌病（CNSC）缺乏特异性临床表现，目前尚无快速、特异性诊断手段。该研究旨在探讨头颅磁共振成像（MRI）在CNSC诊疗中的应用价值。方法回顾性分析2009～2013年10例CNSC患儿的临床资料。结果10例患儿中9例在入院后8d内进行了头颅MRI检查，其中5例同时行增强MRI。9例患儿中，8例呈脑膜脑炎改变，6例伴程度不等的脑萎缩改变，其中1例出现脑积水伴脑脓肿改变，1例伴有脑白质病变。6例患儿在人院后MRI初查时发现感染后脑血管炎表现，包括脑梗死（2例）、静脉窦栓塞（3例）及MoyaMoya样改变（1例）。3例患儿经增强MRI扫描证实存在感染性肉芽肿病变。结合临床，8例患儿在MRI检查后疑诊CNSC。7例患儿在病原学检查结果回报前加用抗真菌治疗。6例患儿抗真菌治疗3～4周后上述MRI病变好转。后经脑脊液培养10例患儿均确诊为CNSC。结论头颅MRI检查，尤其增强头颅MRI，对CNSC的诊断和治疗有重要意义，值得进一步开展病例对照研究。

Objective To study the clinical value of cranial magnetic resonance imaging （MRI） in the diagnosis and treatment of central nervous system candidiasis （CNSC）, which has no specific clinical manifestations and has no rapid and specific diagnostic tools. Methods A retrospective analysis was performed on the clinical data of 10 children who were diagnosed with CNSC in Beijing Children＇s Hospital Affiliated to Capital Medical University between 2009 and 2013. Results Nine of the 10 children underwent cranial MRI within 8 days after admission, and 5 of the 9 children underwent contrast-enhanced MRI at the same time. Eight of the 9 children showed the features of meningoencephalitis, and 6 cases were accompanied by varying degrees of brain atrophy; one case showed hydrocephalus and cerebral abscess, and another case showed leukoencephalopathy. Six cases were found to have the features of cerebral vasculitis after infection in the first MRI after admission, including cerebral infarction （2 cases）, venous sinus thrombosis （3 cases）, and Moyamoya disease （1 case）. Infectious granulomatous lesions were confirmed by contrast-enhanced MRI in 3 cases. Given the clinical manifestations, 8 of the 9 cases were diagnosed as suspected CNSC after MRI, and 7 of these cases received antifungal therapy before the pathogen test results were returned. The lesions on MRI were improved in 6 cases after 3-4 weeks of antifungal treatment. All the 10 children were diagnosed with CNSC by positive cerebrospinal fluid culture results. Conclusions Cranial MRI, especially contrast-enhanced MRI, is of great significance for the diagnosis and treatment of CNSC. To confirm the guidance of MRI in the diagnosis and treatment of CNSC, further case-controlstudies are needed.