结核性脑膜炎MRI脑膜病变形态和信号特点及颅内继发性改变特征分析

Analysis of morphological, signal features of MRI meningeal lesions and secondary intracranial changes in tuberculous meningitis

目的分析结核性脑膜炎(TBM)磁共振成像(MRI)脑膜病变形态、信号的特点及颅内继发性改变的发生情况。方法将本院126例TBM作为研究对象,均进行MRI平扫与增强扫描检查,并且其MRI影像表现与42例肺癌脑膜转移患者进行比较。结果 126例TBM患者中,MRI平扫阳性115例(91.27%),包括脑膜中重度增厚91例,轻度增厚24例;阴性11例(8.73%),脑沟、脑池及脑室未见狭窄,并无明显异常信号,MRI增强扫描出现病变处脑沟、脑池内面线状强化高信号。MRI增强扫描均为阳性。脑血管受累54例(42.86%),脑积水81例(64.29%),脑神经受累33例(26.19%)。TBM与肺癌脑膜转移患者均存在脑膜增厚的表现,同时出现不均匀或均匀稍长或等T_1、T_2信号,MRI增强扫描病变脑膜出现强化,结节具有环形、均匀强化的表现。结论 TBM患者MRI影像特点多表现在大脑基底池脑膜增厚,脑膜结节在T_2加权像存在低信号;MRI增强扫描结节有分隔状与环形强化等表现,同时出现继发性改变如脑内前循环血管炎、脑积水及脑梗死等,其对TBM的诊断有着重要的意义,MRI增强扫描对TBM具有重要的诊断价值。

Objective To analyze the morphological,signal features and secondary intracranial changes of magnetic resonance imaging(MRI)meningeal lesions in tuberculous meningitis(TBM).Method 126 cases of TBM were selected in our hospital,and the MRI scanning and enhanced scanning were performed,and the MRI images were compared with 42 cases of meningeal metastasis in the same period of lung cancer.Results Among of the 126 cases of TBM,there were 115 cases(91.27%)of positive MRI scanning,including 91 cases of severe middle meningeal thickening,24 cases of mild thickening;11 cases were negative(8.73%),cerebral cisterns,sulci and ventricles showed no stenosis,without abnormal signal.The MRI scanning showed high signal lesions in brain ditch and intracisternal surface linear enhancement.MRI enhanced scanning showed positive results.There were 54 cases(42.86%)of cerebral vascular involvement,81 cases(64.29%)of hydrocephalus,33 cases(26.19%)of optic nerve involvement.Patients with meningeal thickening manifestations of TBM with LCMM,also showed uneven or even slightly long T1 and T2 signal,and the MRI enhanced scanning lesions of meningeal nodules have strengthened,annular and uniform enhancement performance.Conclusion The MRI features of patients with TBM show basal cistern meningeal thickening in brain,meningeal nodules like low signal on T2 for weighted MRI;enhanced nodules are separated and ring enhancement performance,while secondary change in anterior circulation such as cerebral vasculitis,hydrocephalus and cerebral infarction have great significance in the diagnosis of TBM,and enhanced MRI scanning has important value in the diagnosis of the disease.