先天性心脏病并发脑脓肿影像学诊断.docVIP

先天性心脏病并发脑脓肿影像学诊断 　 作者：孙志强，罗莉漫，黄文才，曾晓华，陈信坚 【摘要】 　　目的 探讨影像学对先天性心脏病合并脑脓肿的诊断价值。方法 回顾性分析l2例先天性心脏病合并脑脓肿患者的临床资料和影像学表现，其中男8例，女4例。最小年龄15个月，最大年龄26岁，平均10岁7个月。12例均行CT检查，3例行MRI检查。结果12例患者中法洛四联症9例，肺动脉狭窄合并卵圆孔未闭1例，室间隔缺损1例，大血管转位1例。发生部位有顶叶、枕叶、顶枕叶及额顶叶。CT平扫脓肿的中心为低密度，周围可见完整或不完整的等密度环，增强扫描环壁呈明显强化。MR表现为混杂的长T1长T2信号，增强后可见厚薄较均匀一致的环形强化壁，多有分房状强化。结论 先天性心脏病尤其是发绀型先心病，极易并发脑脓肿，CT及MR能够对本病作出早期诊断，有利于及时治疗，减少死亡率。 【关键词】 先天性心脏病；脑脓肿；X线计算机体层摄影术；磁共振成像 　　Abstract： Objective To evaluate the imaging diagnosis of congenital heart disease combined with brain abscess. Methods The clinical data and the imaging manifestationswere retrospectively analyzed in 12 patients (8 male and 4 female, average age 10 years and 7 months). All the patients were scanned by CT, and three ones were examined by MRI.Results The 12 cases included tetralogy of Fallot in 9, pulmonary artery stenosis combined with patent foramen ovale in one, ventricular septal defect in one, and transposition of great vessels in one case. Brain abscess occurred in parietal lobe, occipital lobe, parieto-occipital lobe and frontoparietal lobe. CTplain scan showed low density core of the brain abscess with a circumference of integrated or halfbaked equaldensity circle, and enhanced scan showed apparent reinforcement of the circle. The image of MR showed mixedlong T1 and long T2 signals, and circular reinforcement of even thickness could be found after enhancement, mostly with chambered reinforcement. Conclusion Congenital heart diseases, especially those with cyanosis, are prone to combining brain abscess, which can be diagnosed by CT and MRI examination at early stage. 　　Key words： congenital heart disease; brain abscess; computerized tomography; magnetic resonance imaging 　　先天性心脏病（先心病）并发脑脓肿，因其早期症状不典型以及原发疾病的掩盖，发现一般较晚。近年来随着CT及磁共振技术的广泛应用，使该病的早期诊断率及病死率明显下降。本文回顾性分析我院2001年以来收治的12例患者的临床资料及影像表现，探讨影像学对先心病合并脑脓肿的诊断价值。 　　1 资料与方法 　　1.1 一般资料 　　12例先心病合并脑脓肿病例中男8例，女4例。最小年龄15个月，最大年龄26岁，平均10岁7个月。其中法洛四联症9例，肺动脉狭窄合并卵圆孔未闭1例，室间隔缺损1例，大血管转位1例。 　　1.2 成像方法 　　CT机采用美国GE公司Hispeed Adva