脑囊虫病MRI诊断及病理分析.docVIP

脑囊虫病MRI诊断及病理分析 　 作者：郭会利 张敏 程敬亮 孙骏谟 【摘要】 目的 分析脑囊虫病的病理演变特点，探讨脑囊虫病的MRI特征及诊断价值。方法 分析36例脑囊虫病的MRI表现特点，并结合12例手术后病理材料进行比较。结果 脑实质型18例，脑室型4例，脑膜型3例，混合型11例，主要MRI特点：(1)囊虫存活期，病灶呈圆型，多发常见，附壁囊虫头节呈偏心型小点状影，T1WI呈略高信号，T2WI呈中低信号；囊液T1WI呈低信号，T2WI呈高信号；在FLAIR上脑脊液呈低信号，而囊液呈相对高信号；周围水肿不明显。(2)囊虫退变坏死期，头节消失，囊腔扩大，周围水肿明显。(3)病灶钙化后，T1WI及T2WI均呈低信号，周围水肿消失。(4)增强扫描表现为：囊壁环状增强(24/36)，或不增强(12/36)；囊内小点状影增强(22/36)，或不增强(14/36)。(5)脑室型：常发生于第三、四脑室，其中第三脑室1例(1/36)，第四脑室3例(3/36)，均引起阻塞性脑积水。(6)脑膜型：因蛛网膜粘连，而引起脑积水(2/36)。结论 脑囊虫病在病理演变过程中，具有特征性的MRI表现；MRI对确定脑囊虫病的数目、大小、部位等发病特点及病理演变过程具有很高的诊断价值。 【关键词】 脑囊虫病 磁共振成像 诊断价值 病理分析 【Abstract】 Objective To analyze the pathological and developmental characteristics of cerebral cysticercosis (CC) and explore the MRI characteristics of CC and its diagnostic value.Methods The MRI findings of 36 CC cases were analyzed and compared with the postoperative pathological materials of 12 cases.Results The thirty-six cases included 18 of cerebral-parenchymal type，4 of cerebral-ventricular type，3 of meningeal type，and 11 of mixed type.The CC MRI findings are characterized mainly by：(1)frequently-encountered multiple circular foci during the cysticercus survival：small excentric spotty images of the mural cysticercus scolex ：slightly high signs on T1WI and middle-lower signs on T2WI；lower signs on T1WI and high signs on T2WI of the capsular liquid；lower signs of the cerebrospinal fluid but relatively high signs of the capsular liquid on FLAIR；and unremarkable peripheral edema；(2)scolex disappearance，enlarged capsular cavity and remarkable peripheral edema during cysticercus degeneration and necrosis；(3)lower signs on T1WI and T2WI and peripheral edema disappearance after the focal calcification；(4)findings shown by the enhanced scanning：strengthened (24/36) or non-strengthened (12/36) cyst-wall circular images；strengthened (22/36) or non-strengthened (14/36) small intracapsular spotty images；(5)cerebral-ventricular type often occurring in the third and fourth ventricles：one case in the third ventricle