276例颅内结核的临床及CT影像学特征分析

Analysis on clinical and CT imageological features in 276 cases of intracranial tuberculosis

目的探讨276例颅内结核临床及头颅CT影像学特征。方法分析276例确诊颅内结核住院患者的临床及头颅CT影像学特点。结果 276例颅内结核均合并肺结核,其中血液传播型肺结核占49.6%;中青年患者(72.5%)居多;发热(70.0%)和头痛(66.2%)居多;夏秋季发病率高,有167例(80.7%)。头颅CT平扫检查阳性率63.4%,增强扫描阳性率98.6%。其中结核性脑膜炎236例(85.5%);结核性脑炎158例(57.2%);结核瘤144例(52.2%);结核性血管炎133例(48.2%)。结论颅内结核临床表现不典型,头颅CT平扫检查多有异常,增强扫描阳性率明显增加,脑膜、脑血管、脑实质病变常常相伴而行。诊断依据要结合临床、实验室检查及头颅CT,尤其要重视头颅增强CT扫描的临床应用。

Objective To investigate the clinical and head CT imageological features features in 276 cases of intracranial tubercu‐losis .Methods The clinical and CT features in 276 inpatients with confirmed intracranial tuberculosis were analyzed .Results These 276 cases of intracranial tuberculosis all were complicated by pulmonary tuberculosis ,among them blood‐borne type accoun‐ted for 49 .6% ; young and middle‐aged cases were predominant （72 .5% ） ; the majority manifested by the symptoms of fever （70 .0% ） and headache（66 .2% ） ;the summer and autumn had the higher incidence rate ,which were 167 cases（80 .7% ） .The posi‐tive detection rate of head CT plain scanning was 63 .4% ,which of enhanced scanning was 98 .6% .Among them ,236（85 .5% ） cases were tuberculous meningitis lesions ,158 cases（57 .2% ） were tuberculous encephalitis ,144 cases （52 .2% ） were tuberculoma and 133 cases （48 .2% ） were tuberculous vasculitis .Conclusion The clinical menifestations of intracranial tuberculosis are atypical ,but the head CT plain scannig displays multiple abnormalities .Moreover ,the enhanced scanning increases the positive detection rate . The lesions of meninges ,brain vessels and brain parenchyma often occur together .Therefore ,the diagnosis basis should be combined with clinic ,laboratory tests and head CT ,especially the clinical application of head CT enhanced scanning should be paid attention to .