不同分型脑囊尾蚴病患者影像学特征

Imaging characteristics of different types of cerebral cysticercosis

目的探讨不同分型脑囊尾蚴病的影像学特征。方法对166例经临床确诊的脑囊尾蚴病患者的CT及MRI表现进行回顾性分析。结果 166例脑囊尾蚴病患者中,脑实质型108例,脑室型15例,脑膜型3例,混合型40例。各型脑囊尾蚴病CT、MRI特点:1脑实质型脑囊尾蚴病可分为急性期型(囊泡型、脑炎型、多发环形或结节状强化型)和慢性钙化型。囊泡型:CT表现为单发或多发囊状影,边界清楚,囊内可见高密度头节;MRI表现为类圆形长T1、长T2信号,囊内可见偏心附壁的点状影,囊壁及头节为等信号,增强后无明显强化;脑炎型:CT呈散在低密度灶,MRI表现为斑片状稍长T1、长T2信号,多数无明显强化或不规则强化;结节状或多发环形强化型:CT平扫为多发结节状低密度灶,增强扫描呈多发结节或环形强化;慢性钙化型:CT表现为单发或多发的圆点状高密度影,MRI上表现为等或长T1、短T2信号。2脑室型:常发生于第三、四脑室,可并发阻塞性脑积水。3脑膜型:脑脊液间隙局限性扩大且不对称,可出现交通性脑积水,增强扫描后可出现软脑膜强化。4混合型:表现为上述2种或以上类型并存,急、慢性期影像混合存在。结论不同分型脑囊尾蚴病影像学表现各不相同,分析这些独特的影像学特征对脑囊尾蚴病患者的临床诊治及预后评判具有重要意义。

Objective To study the imaging characteristics of different types of cerebral cysticercosis. Methods The CT and MRI findings of 166 patients with clinical diagnostic cerebral cysticercosis were reviewed retrospectively. Results Among the 166 cerebral cysticercosis patients, there were 108 cerebral parenchyma type cases, 15 ventricles type cases, 3 meningeal type cases, and 40 mixed type cases according to the cysticerci being in the parts of the brain. The CT and MRI imaging characteristics of various types were as the following. 1 Brain parenchyma type included the cystoid subtype, encephalitis subtype,nodular or multiple ring enhancement subtype, and chronic calcification subtype. The cystoid subtype： CT showed single or multiple cystic shadow（s） with clear boundary, and the sac with a high density of scolex; MRI showed round long T1 and long T2 signals, eccentric punctate shadows inside the sac, cystic wall and scolex signals, but no significant enhancement. The encephalitis subtype： CT showed scattered low density lesions and MRI showed patchy slightly long T1 and long T2 signals, but no enhancement or irregular enhancement in the majority. The nodular or multiple ring enhancement subtype： CT scan showed low density lesions in multiple nodules, or CT enhancement scan showed multiple nodules or ring enhancement. The chronic calcification subtype： CT showed single or multiple dot-like high density single（s）, and MRI showed equal or long T1 and short T2 signals. 2Ventricular type： The lesions were often in the third and fourth ventricles complicated with obstructive hydrocephalus. 3 Meningeal type： there were expand and asymmetric cerebrospinal space limitations, communicating hydrocephalus,and the enhanced scan showed leptomeningeal enhancement. 4 Mixed type： The performance was mixed as two or more types above mentioned,and there existed mixed acute and chronic phases. Conclusions The imaging findings of the different types of cerebral cysticercosis are differ from one another. The analysis of the imaging characteristics of the different types of cerebral cysticercosis has a significance for the clinical diagnosis, treatment and prognostic judgment of cerebral cysticercosis patients.