婴幼儿颅内感染与磁共振脑膜强化模式的初步研究

A preliminary study of MRI meningeal enhancement patterns in infantile intracranial infection

目的：探讨婴幼儿颅内感染磁共振增强脑膜强化方式。方法：回顾性分析95例临床怀疑颅内感染患儿的临床资料和磁共振增强影像表现，其中男45例，女50例，年龄1天-2岁。95例患儿均行磁共振常规平扫及T1WI增强扫描，脑膜强化分为4级，确诊标准为脑脊液化验和临床诊断。结果：经临床确诊病毒性脑炎33例，脑膜强化分级0级14例，Ⅰ级0例。Ⅱ级12例，Ⅲ级7例。化脓性脑膜炎17例，O级0例，Ⅰ级15例，Ⅱ级0例，Ⅲ级2例。结核性脑膜炎25例，0级7例，Ⅰ级0例，Ⅱ级2例，Ⅲ级16例。临床排除感染20例。结论：婴幼儿软脑膜表面毛细血管丰富，因此仅凭软脑膜轻中度的强化，不能作为颅内感染的可靠征象，婴幼儿颅内感染早期病理改变轻微，影像表现也可以正常．需结合临床确诊。

Objective： To explore MRI meningeal enhancement patterns in infants with intracranial infection. Methods： Ninety-five cases（45 males and 50 female） were included in our study. Meningeal enhancement patterns were divided into four grades. The final diagnosis was based on evidence from cerebrospinal fluid biochemical examinations and clinical manifesta- tions. Results： For meningeal enhancement patterns in 33 cases of viral encephalitis, there were 14 cases of grade 0, 0 case of grade Ⅰ, 12 cases of grade Ⅱ, and 7 cases of grade Ⅲ. For meningeal enhancement patterns in 17 cases of purulent meningitis, thele were 0 case of grade 0, 15 cases of grade Ⅰ, 0 case of grade Ⅱ, and 2 cases of grade Ⅲ. In 25 cases of tuberculous meningitis, meningeal enhancement patterns included 7 cases of grade 0, 0 case of grade Ⅰ, 2 cases of grade Ⅱ, and 16 cases of grade Ⅲ. There were 20 patients without infection. Conclusion： It is not a reliable sign to diagnose in- fantile intracranial infection only by mild to moderate enhancement of the pia mater which is rich in capillaries, with slight changes in pathology, imaging findings can be normal in early stage of infantile intracranial infection and final diagnosis de- pends on clinical findings and follow-up.