磁共振成像在脑实质结核患者诊断及预后判断的临床应用

Clinical Application of MRI in Diagnosis and Prognosis of Cerebral Parenchymatous Tuberculosis Patients

目的 评价磁共振成像在脑实质结核患者诊断及预后判断的临床应用。方法 选取我院收治83例单纯脑实质结核为研究对象,所有患者均在治疗前和治疗后随第2个月和第6个月时进行磁共振扫描,比较颅内病灶特征,并分析病变的MRI演变规律。结果 共发现944个病灶,其中≤0.3cm、0.3~1.0cm和≥1cm的病灶数分别为459个（48.62%）、345个（36.55%）和140个（14.83%）。均匀强化结节病灶、环状强化伴实性中心结节病灶及环状强化伴液性中心结节病灶的例数分别为299个（31.67%）、600个（63.56%）和45个（4.77%）,其相应的ADC值分别为（0.91±0.11）×10-3 mm2/s、（0.96±0.12）×10-3 mm2/s和（2.04±0.39）×10-3 mm2/s,均显著高于正常脑实质的ADC值（P〈0.001）。随访显示,在第2个月时≤0.3cm的病灶中分别有3个（1.52%）、5个（2.53%）、96个（48.48%）和94个（47.47%）病灶预后表现为增大、不变、缩小和消失,而0.3~1.0cm和≥1cm的病灶的预后表现为增大、不变、缩小和消失所占的比例分别为3.37%、4.49%、47.75%和44.38%与13.21%、16.98%、66.04%和3.77%。第6个月时3组患者病灶消失的比例分别为77.78%、69.66%和35.85%。结论 磁共振成像不仅可以发现脑实质结核较小的病灶,还可以动态观察脑实质结核病灶的动态变化,是判断脑实质结核预后的重要指标之一。

Objective To evaluate the clinical application of MRI in diagnosis and prognosis of cerebral parenchymatous tu‐berculosis patients.Methods 83 patients with simple cerebral parenchymatous tuberculosis treated in my hospital from January 2010 to December 2014 were selected as the research subjects ,Every case was imaged by MRI when before and after treatment followed up the second months ,and sixth months ,compared with the features of intracranial lesions ,and analysed the MRI evolvement rule of the lesions.Results 994 lesions were found in all of the research subjects.Among them ,the number of le‐sions less than or equal to 0.3 cm ,0.3~1.0 cm and greater than or equal to 1cm were 459（48.62% ） ,345（36.55% ）and 140 （14.83% ） ,respectively.The number of evenly enhancement nodular lesions ,ring‐like contrast enhancement with solid center le‐sions and ring‐like contrast enhancement with liquid center lesions were 299（31.67% ） ,600（63.56% ） and 45（4.77% ） ,respec‐tively ,the ADC values of them w ere （0.91 ± 0.11 ） × 10-3 mm2/s ,（0.96 ± 0.12 ） × 10-3 mm2/s and （2.04 ± 0.39 ） × 10-3 mm2/s ,respectively ,which were significantly higher than those of in normal cerebral parenchyma（P〈 0.001）.The follow‐up results show that in the second months ,the lesions less than or equal to 0.3 cm were 3 （1.52% ） ,5（2.53% ） ,96（48.48% ） and 94（47.47% ） ,respectively ,prognosis manifestation were increase ,constant ,shrink and disappear ,and 0.3~1.0cm and greater than or equal to 1 cm ,prognosis manifestation were increase ,constant ,shrink and disappear ,accounted for 3.37% ,4.49% , 47.75% ,44.38% and 13.21% ,16.98% ,66.04% ,3.77% ,respectively.The proportion of the lesions disappeared in the three groups were 77.78% ,69.66% and 35.85% in the sixth months ,respectively.Conclusion MRI can not only find the smaller le‐sions of cerebral parenchymatous tuberculosis ,it can also dynamically observe the dynamic changes of the lesions in the cerebral parenchymatous tuberculosis ,is one of the important indicators for estimating the prognosis of cerebral parenchymatous tuber‐culosis.