磁共振脑膜强化模式在婴幼儿颅内感染诊断中的应用价值研究

Value of magnetic resonance meningeal enhancement patterns in diagnosis of intracranial infection in infants and young children

目的探讨磁共振脑膜强化模式在婴幼儿颅内感染诊断中的应用价值,为临床诊治提供参考依据。方法选取2013年7月-2014年6月医院收治的76例经脑脊液检查确诊的颅内感染婴幼儿,所有患儿均经T1WI增强扫描以及磁共振常规平扫,脑膜强化共有4级,观察分析所有婴幼儿磁共振脑膜强化的影像学表现。结果磁共振检查中,12例(15.79%)化脓性脑膜炎有10例(83.33%)表现为全脑膜强化;28例(36.84%)例病毒性脑膜炎中有8例(28.57%)表现为软脑膜可疑过度强化,9例(32.14%)表现为蛛网膜-软脑膜强化,5例(17.86%)表现为全脑膜强化级;21例(27.63%)结核性脑膜炎有13例(61.90%)表现为脑基底池异常强化;15例(19.74%)其他感染中4例(26.67%)表现为脑基底池异常强化,1例(6.67%)表现为软脑膜可疑过度强化,2例(13.33%)表现为蛛网膜-软脑膜强化;增强后12例化脓性脑膜炎,10例(83.33%)为Ⅰ级,2例(16.67%)为Ⅲ级;28例病毒性脑膜炎中14例(50.00%)为0级,9例(32.14%)Ⅱ级,5例(17.86%)Ⅲ级;21例结核性脑膜炎中7例(33.33%)为0级,1例(4.76%)Ⅱ级,13例(61.90%)Ⅲ级;15例其他感染中8例(53.33%)0级,1例(6.67%)Ⅰ级,6例(40.00%)为Ⅱ级。结论婴幼儿具有较为丰富的软脑膜表面毛细血管,仅仅依靠软脑膜轻中度强化,难以作为颅内感染的可靠征象,再加之婴幼儿颅内感染早期病理变化较为轻微,因此在确诊中需要和临床诊断相互结合。

OBJECTIVE To explore the value of magnetic resonance meningeal enhancement modes in diagnosis of intracranial infection in infants and young children so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 76 infants and young children who were diagnosed with intracranial infection by cerebrospinal fluid examination and were treated in the hospital from Jul 2013 to Jun 2014 were enrolled in the study,all of the children received T1 WI enhanced scan and magnetic resonance plain scan,and there were 4 levels of meningeal enhancement.The imaging manifestations of magnetic resonance meningeal enhancement of all the infants and young children were observed.RESULTS Of 12 （15.79%） cases of purulent meningitis who received MRI examination,10 （83.33 %） showed full meningeal enhancement.Of 28 （36.84 %） cases of viral meningitis,8 （28.57 %）showed leptomeningeal suspected and excessive enhancement,9 （32.14 %） showed arachnoid-leptomeningeal enhancement,and 5 （17.86%） showed whole meningeal enhancement grade.Of 21 （27.63%） cases of tubercular meningitis,13 （61.90%） showed abnormal enhancement of brain basal pool.4 （26.67%） of 15 （19.74%） cases of other infections showed abnormal enhancement of brain basal pool,1 （6.67 %） showed leptomeningeal suspected and excessive enhancement,2 （13.33%） showed arachnoid-leptomeningeal enhancement.Among the 12 cases of purulent meningitis who received magnetic resonance meningeal enhancement,no case showed grade 0,10 （83.33%） showed grade Ⅰ,0 （0.00%） showed grade Ⅱ,and 2 （16.67%） showed grade Ⅲ.Of the 28 cases of viral meningitis,14 （50.00%） showed grade 0,0 showed grade 1,9 （32.14%） showed grade Ⅱ,and 5 （17.86%） showed grade Ⅲ.Of the 21 cases of tubercular meningitis,7 （33.33%） showed grade 0,0 （0.00%）showed grade Ⅰ,1 （4.76%） showed grade Ⅱ,and 13 （61.90%） showed grade Ⅲ.Of 15 cases of other infections,8 （53.33%） showed grade 0,1 （6.67%） showed grade Ⅰ,6 （40.00%） showed grade Ⅱ,and 0 （0.00%）showed grade Ⅲ.CONCLUSION Infants have abundant pial surface capillaries,only the mild to moderate leptomeningeal enhancement can not be served as a reliable sign for the intracranial infection,in addition,the pathological change of the intracranial infection is slight in early stage,thus,it is necessary to combine with clinical diagnosis to make a definite diagnosis.