多层螺旋CT延迟扫描对颅内结核病灶的显示优势探讨

Advantage of dual-phase contrast-enhanced multi-slice computed tomography in intracranial tuberculosis

目的探讨多层螺旋CT延迟扫描是否对颅内结核病灶的观察更具优势。方法选择山东省胸科医院自2003年1月至2011年11月经临床资料证实的30例颅内结核患者，采用16层螺旋CT先常规平扫后行双期扫描：动脉期注入对比剂后25s行螺旋扫描，延迟期于5min后行常规扫描。根据病灶侵犯颅内部位及形态的不同将其分为3种不同类型：脑膜增厚、脑膜结核瘤（包括脑膜结节）以及脑实质结核瘤（包括结核结节），并从动脉期及延迟期增强图像中各类型病灶大小、病灶边缘清晰度、病灶与周围血管关系的情况等方面进行量化计分，比较该2期病灶图像质量的差异。结果从30例颅内结核患者中共发现符合纳入标准的病灶526个，包括脑膜增厚22个，脑膜结核瘤、结核结节235个，脑实质结核瘤、结核结节269个。延迟期所示脑膜增厚、脑膜结核瘤、脑实质结核瘤的病灶大小计分（1．64±0．58；1．64±0．58；1．59±0．60）、病灶边缘清晰度计分（2．00；1．73±0．49；1．88±0．34）及其与血管断面的区分能力计分（1．82±0．39；2．00±0．06；2．00±0．06）与动脉期（0．36±0．49，0．36±0．52，0．41±0．53；0．00，0．27±0．45，0．12±0．32；1．09±0．68，1．22±0．74，1．27±0．75）比较明显具有优势，差异均有统计学意义（P〈0．05）。论多层螺旋CT双期扫描尤其是延迟期扫描在对颅内结核病灶的显示上具有明显优势。

Objective To explore the superiority of dual-phase contrast-enhancement multi-slice computed tomography （MSCT） in observing intracranial tuberculosis. Methods Thirty patients with intracranial tuberculosis, admitted to our hospital from January 2003 to November 2011, were chosen in our study; regular 16-slice spiral CT scan was performed, and then, dual-phase MSCT was performed as follows： contrast-enhanced scan was performed 25 seconds after arrival of contrast material on vascular phase, and 5 minutes after that （lag phase）, conventional scanning was performed. According to the different lesions and morphologies of the tuberculosis, they were divided into three types： meningeal thickening, meningeal tuberculoma and parenchymal tuberculoma; the lesion sizes and edge definition and the relationship of the lesions with the surrounding vascular lesions in these three types were scored and calculated, and the differences of the image quality were compared at the vascular phase and lag phase. Results A total of 526 lesions in 30 patients were found, including 22 with meningeal thickening, 235 with meningeal tuberculomas/tubercles, and 269 with parenchymal tuberculomas/tubercles. As compared with these three types at the vascular phase （0.36±0.49, 0.36±0.52 and 0.41±0.53; 0.00, 0.27±0.45 and 0.12±0.32; 1.09±0.68, 1.22±0.74 and 1.27±0.75）, these three types at the lag phase had siguifieant differences in the scores of lesion sizes （1.64±0.58, 1.64±0.58 and 1.59± 0.60） and lesion edge definition （2.00, 1.73±0.49 and 1.88±0.34） and the relationship of the lesions with the surrounding vascular lesions （1.82±0.39, 2.00±0.06 and 2.00±0.06, P〈0.05）. Conclusion Imagesin the lag phase have advantages on diagnosis of intracranial tuberculosis.