艾滋病患者中枢神经系统隐球菌感染的磁共振成像特征

Magnetic resonance imaging features of Cryptococcus infection in central nervous system in patients with AIDS

目的:探讨艾滋病(acquired immune deficiency syndrome,AIDS)人群中枢神经系统隐球菌感染的磁共振成像(magnetic resonance imaging,MRI)特征。方法:回顾分析2011年7月至2017年3月期间收治的AIDS合并隐球菌性脑膜炎(cryptococcal meningitis,CM),且尚未接受抗反转录病毒治疗患者的颅脑MRI以及临床资料。明确的或者临床怀疑合并中枢神经系统其他疾病的患者未纳入分析。结果:共有39例患者纳入分析,其中位CD4细胞计数为13×106/L[(0~205)×106/L],94.9%(37/39)的患者CD4细胞计数<100×106/L。39例患者中26例患者存在颅脑异常MRI信号,可表现为多部位受累,最常累及的部位为基底节区(20/26,76.9%)。该基底节区病灶常表现为血管周围间隙(Virchow-Robin space,VRS)扩大/胶样假囊(18/20,90%),增强后未见明显强化;脑隐球菌肉芽肿的发生率为35%(7/20),增强后未见明显强化(3/5,60%)或有轻度强化(2/5,40%)。73.0%(19/26)患者存在基底节区以外的病灶,其中68.4%(13/19)的患者亦合并基底节病灶。基底节区外病灶常表现为VRS扩大/胶样假囊(12/19,63.1%),增强后未见明显强化;隐球菌肉芽肿和脑膜增厚强化的发生率分别为15.7%(3/19)和26.3%(5/19)。结论:AIDS合并中枢神经系统隐球菌感染时颅脑MRI异常发生率可能并不低,病灶多位于基底节区,常见为VRS扩大/胶样假囊,亦可表现为脑隐球菌肉芽肿。MRI增强时这些病灶往往未见强化或仅轻度强化。

Objective： To investigate the magnetic resonance imaging （MRI） features of Cryptococcus infection in central nervous system patients with acquired immune deficiency syndrome （AIDS）. Methods： The retrospective study on magnetic resonance imaging （MRI） and clinical data of cryptococcal meningitis （CM） was carried out between July 2011 and March 2017. These patients had not received anti-retroviral treatment. Patients with other specific or suspicious diseases in the central nervous system were not included in the analysis. Results： A total of 39 patients were included in the analysis, with CD4 cell counts of 13.0~106/L [（0-205）~106/L], and 94.9% （37/39） of patients with CD4 cell count 〈100xl06/L. Of the 39 patients, 26 patients showed abnormal MRI signals in the brain, which were most frequently involved in the basal ganglia （20/26, 76.9%）. The basal ganglia lesions showed dilated Virchow- Robin space （VRS）/gelatinous spseudocysts （18/20, 90%）. Postcontrast Tl-weighted MRI revealed no significant enhancement （3/5, 60%） and mild enhancement （2/5, 40%）. The incidence of cerebral cryptococcal granuloma were 35% （7/20）. Nineteen of 26 patients with lesions outside the basal ganglia, of which 13 patients also complicated with basal ganglia lesions. Postcontrast Tl-weighted MRI revealed no significant enhancement. The incidence of cryptococcal granuloma and meningeal thickening were 15.7% （3/19） and 26.3% （5/19）, respectivel）n Postcontrast T1- weighted MRI meningeal thickening revealed enhancement （5/5, 100%）. Conclusion： The incidence of brain MRI abnormality in MDS complicated with central nervous system Cryptococcus infection may not be low, and the lesions are mostly located in the basal ganglia. It most frequently displays the dilated VRS/gelatin cryptococcal granuloma. Postcontrast Tl-weighted MRI enhancement. ous spseudocysts. It can also be showed often reveals no enhancement or mild