结核性脑膜炎各期磁共振表现及剖析.docVIP

结核性脑膜炎各期磁共振表现及剖析 　　[摘要] 目的：探讨磁共振在各期结核性脑膜炎中的诊断价值。方法：回顾性分析69例临床确诊为结核性脑膜炎患者的临床资料及磁共振表现。结果：69例中，Ⅰ期15例，Ⅱ期40例，Ⅲ期14例，磁共振对各期结核性脑膜炎均能显示病变，尤其是MR增强扫描，对脑内粟粒性结节及脑膜炎性病变显示最佳，粟粒性结节常位于皮髓交界区，脑膜炎性病变则以脑底部明显。结论：磁共振平扫和增强是结核性脑膜炎首选的影像检查方法。 　　[关键词] 结核性脑膜炎；磁共振成像；增强扫描 　　[中图分类号]R445.2 [文献标识码]B [文章编号]1673-7210（2008）11（c）-073-02 　　 　　MRI findings and analysis of tuberculous meningitis in each stage 　　YUAN Ai-mei, XU Peng, YIN Jian-hua 　　(MRI Room, the Second Affiliated Hospital of Nanchang University, Nanchang 330006,China) 　　[Abstract] Objective: To evaluate the value of magnetic resonance imaging(MRI) for tuberculous meningitis in each stage. Methods: Clinical data and MRI findings of 69 cases with tuberculous meningitis clinically confirmed were analyzed retrospectively. Results: Among 69 cases, 15 cases stageⅠ, 40 cases stage Ⅱand 14 cases stage Ⅲ. MR can display abnormal signal of tuberculous meningitis in each stage, particularlyMR enhancement scan, which present obviously miliary nodus in the brain and the thickened leptomeninges. Miliary nodus of the brain was located mostly frequently at the junctional area of white and gray matter, and the thickened leptomeninges were mostly at the bottom of the brain. Conclusion: Routine and enhanced MRI scan is proved to be prior examination in the patients of tuberculous meningitis. 　　[Key words] Tuberculous meningitis; Magnetic resonance imaging; Enhancement scan 　　 　　近年来，由于大量抗生素及激素的运用、菌群变异、免疫低下或免疫缺陷人群增加等因素，结核病呈上升趋势，结核性脑膜炎(tuberculous meningitis，TBM)的发病率也有所增高。结核性脑膜炎主要是由身体其他部位如肺、肠、骨、肾、淋巴等的结核感染，经血液循环播散进入颅内而引起。文献报道[1]结核性脑膜炎的病死率达15.7%，其预后与早期诊断和合理治疗密切相关。但抗生素及激素的滥用可导致结脑的早期症状、体征不典型，缺乏有效的诊断方法，常被误诊和漏诊。结合国内外文献，TBM的临床误诊率达31.6%。有报道[2]认为MR成像是TBM有效检查方法之一。本文通过回顾性分析69例TBM患者MR平扫和增强扫描表现，目的在于重视MR影像学对TBM的早期诊断，减少误诊、漏诊，改善预后。 　　1 资料与方法 　　1.1 一般资料 　　69例经临床确诊为结核性脑膜炎患者，男39例，女30例，年龄最大81岁，最小9个月，平均31.5岁。临床诊断符合《现代结核病学》结核性脑膜炎的诊断标准：①结核中毒症状伴有颅内压增高现象，脑膜刺激征阳性。②有脑外活动性结核或结核病史。③脑脊液性质为浆液性改变，白细胞数增加，在1×107~1×109/L，细胞分类以单核细胞为主；蛋白质含量升高，葡萄糖、氯化钠含量降低；抗酸杆菌、结核抗体、腺苷脱氨酸、PCR等可以出现阳性。④