血行播散性肺结核与继发性肺结核并发颅内结核的MRI特征分析

Analysis of MRI features of hematogenous disseminated pulmonary tuberculosis and secondary pulmonary tuberculosis combined with intracranial tuberculosis

目的探讨血行播散性肺结核与继发性肺结核并发颅内结核的MRI特征,以期提高两者的诊断水平。方法回顾性分析广州市胸科医院2021年1月—2022年12月经临床诊断的符合纳排标准的血行播散性肺结核并发颅内结核患者87例(A组)与继发性肺结核并发颅内结核患者102例(B组),通过对两组患者MRI扫描征象的对比,分析两者的MRI特征。结果A组混合型颅内结核共56例,占64.37%。A组病变分布>5个脑叶、粟粒结节、小结节检出率高于B组(P<0.05)。B组脑实质型颅内结核为54例,占52.94%。B组病变分布≤5个脑叶、大结节的检出率高于A组(P<0.05)。增强MRI表现中,A组结节全瘤强化检出率高于B组(P<0.05),B组环形强化检出率高于A组(P<0.05)。结论血行播散性肺结核并发颅内结核以混合型多见,病变分布范围广,更易检出粟粒结节和小结节,增强MRI扫描以结节全瘤强化多见,继发性肺结核并发颅内结核以脑实质型多见,病变范围局限,更易检出大结节,增强MRI扫描以环形强化多见。两者有各自的MRI表现特征,可为临床早期诊断与治疗提供帮助。

Objective Exploring the MRI characteristics of hematogenous disseminated pulmonary tuberculosis and secondary pulmonary tuberculosis complicated with intracranial tuberculosis,in order to improve the diagnostic level of both.Methods A retro-spective analysis of 87 patients(Group A)with hematogenous disseminated pulmonary tuberculosis complicated with intracranial tuberculosis and 102 patients(Group B)with secondary pulmonary tuberculosis complicated with intracranial tuberculosis diagnosed clinically in Guangzhou Chest Hospital from January 2021 to December 2022,who met the inclusion criteria,through the comparison of the MRI scanning signs of two groups of patients,objective to analyze the MRI features of both.Results A total of 56 cases of mixed intracranial tuberculosis in Group A,accounting for 64.37%,the detection rates of lesions with a distribution of>5 lobes,miliary nodules,and small nodulesin Group A were higher than that in Group B(P<0.05).There were 54 cases of brain parenchymal intracranial tuberculosis in Group B,accounting for 52.94%,the detection rates of lesions with a distribution of≤5 lobes and large nodules in Group B were higher than that in Group A(P<0.05).In enhanced MRI manifestations,the detection rate of total nodule enhancement in Group A which was higher than that in Group B(P<0.05).The detection rate of circular enhancement in Group B was higher than in Group A(P<0.05).Conclusion Hematogenous disseminated pulmonary tuberculosis complicated by intracranial tuberculosis is more common in mixed type,It has lesion distribution is wide and more easier to detect miliary nodules and small nodules,it is more commonly seen nodular whole tumor enhancement in enhanced MRI scan.Secondary pulmonary tuberculosis complicated by intracranial tuberculosis is more common in brain parenchymal type,It has limited lesion size and is more easier to detect large nodules,it is more commonly seen circular enhancement in enhanced MRI scan.They both have their own MRI manifestations,which can provide assistance for early clinical diagnosis and treatment.