头颅MRI增强扫描与脑脊液检查对婴幼儿颅内结核的早期诊断价值

Value of MRI enhanced scan of head and cerebrospinal fluid examination in early diagnosis of intracranial tuberculosis in infants and children

目的探讨头颅MRI增强扫描与脑脊液检查对婴幼儿颅内结核的早期诊断价值。方法收集2018年1~12月在我院确诊为婴幼儿颅内结核的0~3岁患儿31例,全部患儿进行MRI平扫、增强扫描及脑脊液检查,对患儿的MRI影像特征及脑脊液改变进行归纳总结,分析其诊断价值。结果MRI结果显示脑膜结核患儿7例,脑实结核型7例,颅内结核混合型16例,单纯脑积水1例。脑膜增厚共23例(74.19%),脑膜增厚发生部位在基底池16例;软脑膜增厚14例,室管膜增厚1例。结核结节9例(29.32%);结核瘤7例(22.58%);结核性脑炎10例(32.26%);结核性脑梗塞1例;脑内软化灶5例。颅内结核患儿MRI扫描显示脑表面血管者增多者17例(54.84%)。脑脊液典型改变14例(45.16%),部分典型改变9例。结论MRI增强扫描能早期发现病变,尤其在脑表面血管增多、增粗时,能早期提示结核菌颅内感染,结合脑脊液改变,结合密切接触史及颅外结核病史,较大提高了婴幼儿颅内结核的早期诊断。

Objective To explore the value of MRI enhanced scan of head and cerebrospinal fluid examination in early diagnosis of intracranial tuberculosis in infants and children.Methods Thirty-one cases of the intracranial tuberculosis in infants and children were selected,which were diagnosed in clinic in the guangzhou chest hospital from January to December,2018.All cases underwent MRI plain,enhanced scan and cerebrospinal fluid examination.The MRI imaging features and cerebrospinal fluid changes of the cases were analyzed.Results The results of MRI showed 7 cases with meningeal tuberculosis,7 cases with solid brain tuberculosis,16 cases with mixed intracranial tuberculosis,and 1 case with simple hydrocephalus.Meningeal thickening 23 cases(74.19%),16 cases occurred in the basal cistern,14 cases of pial meningeal thickening,and 1 case of thickening of epedymal membrane.Nine cases with tuberculosis nodules(29.32%),7 cases with tuberculoma(22.58%),10 cases with tuberculous encephalitis(32.26%),1 case of tuberculous cerebral infarction and 5 cases with softening of the brain.The MRI of intracranial tuberculosis showed hypervascularization of the brain surface in the 17 cases(54.84%).The typical change of cerebrospinal fluid Examination was found in 14 cases(45.16%),and in 9 cases of partial change of cerebrospinal fluid examination.Conclusion The MRI enhanced scan can detect early the lesion,especially when the blood vessels on the brain surface were increased or enlarged,early signs of intracranial tuberculosis infection were significant.The changes of cerebrospinal fluid examination,the history of close contact with tuberculosis and the extracranial tuberculosis are combined.It can greatly improve the early diagnosis of intracranial tuberculosis in infants and children.