颅脑术后发生颅内感染的CT和MRI改变及其诊断价值分析

Diagnostic value of changes of CT and MRI in patients with intracranial infection after craniocerebral surgery

目的探讨颅脑术后发生颅内感染的CT和MRI改变及其诊断价值,为临床诊治提供参考依据。方法选取医院神经外科2013年1月-2015年12月行颅脑术后发生颅内感染患者共67例,对患者的临床资料进行分类整理,由两位高年资主治医师对患者住院期间所做的CT及MRI检查图像进行评估和诊断,分析比较颅脑术后发生颅内感染患者的CT和MRI改变及颅内感染患者诊断的准确率。结果 CT结果显示,患者中正常结果35例(52.24%),异常结果32例(47.76%);32例CT异常图像主要表现弥漫性脑水肿、多发散在的斑块状低密度灶(金黄色葡萄球菌13例、表皮葡萄球菌7例、溶血葡萄球菌6例),18例增强后病灶及其周围呈高密度强化;MRI结果显示,患者中正常结果11例(16.42%),异常结果56例(83.58%);56例MRI异常图像主要表现为不规则多发性长T1、长T2信号病灶(金黄色葡萄球菌25例、表皮葡萄球菌18例、溶血葡萄球菌10例),22例增强后病灶及其周围呈高信号强化。MRI检查颅内感染患者阳性诊断率明显高于CT组,差异有统计学意义(P<0.01);CT组早期发生异常者26例(38.81%),后期异常者9例(13.43%);MRI组早期异常58例(86.57%),后期异常者23例(34.33%),MRI组阳性诊断率明显高于CT组(P<0.05),差异有统计学意义。结论 MRI和CT技术对颅内感染患者的诊断及治疗具有重要作用,同时MRI对颅内感染患者的确诊作用更大,提高了诊断的准确率。

OBJECTIVE To explore the diagnostic value of changes of CT and MRI in patients with intracranial infection after craniocerebral surgery so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 67 patients who underwent the craniocerebral surgery in department of neurosurgery from Jan 2013 to Dec2015and had postoperative intracranial infection were enrolled in the study,then the clinical data of the patients were classified and sorted,the CT and MRI examination images of the patients that were shot during the hospital stay were evaluated and diagnosed by two senior attending physicians,the changes of CT and MRI of the patients with postoperative intracranial infection were observed and compared,and the accuracy of diagnosis of the patients with intracranial infection was analyzed.RESULTS The CT results showed that 35（52.24%）cases were normal,and 32（47.76%）cases were abnormal.The abnormal CT images of the 32 cases mainly presented as diffuse brain edema and multi scattered patchy low-density lesions（Staphylococcus aureus in 13 cases,Staphylococcus epidermidis in 7cases,Staphylococcus haemolyticus in 6cases）,and 18 cases showed high-density enhancement of lesions and their surroundings after enhancement.The MRI results indicated that 11（16.42%）cases were normal,and 56（83.58%）were abnormal.The abnormal MRI images of the 56 cases mainly presented as irregular multiple long T1 and long T2 signal intensity（S.aureusin 25 cases,S.epidermidisin 18 cases,S.haemolyticusin 10cases）,22 cases showed high-signal enhancement of lesions and their surroundings after enhancement.The positive diagnosis rate of the patients with intracranial infection of the MRI was significantly higher than that of the CT（P〈0.01）.Totally 26（38.81%）cases showed abnormal CT images in early stage,9（13.43%）cases in late stage.Totally 58（86.57%）cases showed abnormal MRI images in early stage,23（34.33%）cases in late stage,and the positive diagnosis rate of the MRI group was significantly higher than that of the CT group.CONCLUSION Both MRI and CT play an important role in diagnosis and treatment of the patients with intracranial infection,furthermore,the MRI shows more significant effect on diagnosis of the patients with intracranial infection and raises the accuracy of diagnosis.