脑实质多发结核瘤的MRI诊断

MR diagnosis of intracranial multituberculoma

目的 :分析脑实质多发结核瘤的MRI表现。方法 :回顾性分析 7例经脑脊液、结核菌素纯蛋白衍生物 (PPD)实验及胸水等检查、胸片及抗结核治疗随访确诊的脑实质多发结核瘤的MRI表现 ,全部病例均行SET1 WI、FSET2 WI、Gd DTPA增强T1 WI检查 ,其中 3例采用了FLAIR序列。结果 :病灶绝大部分位于灰白质交界区和基底节区 ,直径多在 5～15mm。未成熟结核结节呈长T1 、长T2 信号 ,灶周水肿明显 ,结节性强化。成熟结核结节呈典型的“靶征” ,由中心到外周分别为低信号靶心 高信号环 低信号环 ,灶周水肿较轻 ,结节状或环形强化。颅内其它结核感染征象有助于诊断。在各扫描序列中T2 WI和增强扫描对病灶的显示较佳。结论 :脑实质多发结核瘤是颅内结核的一种特殊表现 ,MRI的特征是多发病灶 。

Objective:To study the MRI features of intracranial multituberculoma.Methods:MRI features were retrospectively analyzed in 7 patients with intracranial multituberculoma confirmed by laboratory examinations (including CSF,PPD,pleural fluid test),chest film and follow up of antituberculosis therapy.All patients were imaged by MR scanner with SE T 1WI, FSE T 2WI,Gd DTPA enhanced T 1WI,and 3 of them underwent additional FLAIR.Results:The majority of the lesions located in either the boundary of gray matter and white matter or basal ganglia,and ranged in diameter from 5 mm to 15mm. Immature tuberculomas showed hypointensity signal on T 1WI and hyperintensity signal on T 2WI,and nodular enhancement after contrast injection,and were surrounded by obvious edema.Mature tuberculomas showed typical target sign on T 2WI,and the signal of the lesion from center to edge was hypointensity at the center,hyperintensity at middle and hypointensity at the outmost.They were surrounded by slight edema and showed nodular or annular enhancement.The other tubercular infective or concomitant features contributed to the diagnosis of this disease.T 2 weighted and enhanced T 1 weighted images showed the lesions more clearly than other sequences.Conclusion:The intracranial multituberculoma is a special pattern of the intracranial tuberculosis,and its MRI features are multiple foci,target sign and ring enhancement.