CAJ | 학술논문

目的：评价磁共振成像在脑实质结核患者诊断及预后判断的临床应用。方法选取我院收治83例单纯脑实质结核为研究对象，所有患者均在治疗前和治疗后随第2个月和第6个月时进行磁共振扫描，比较颅内病灶特征，并分析病变的M RI演变规律。结果共发现944个病灶，其中≤0.3 cm、0.3～1.0 cm和≥1 cm的病灶数分别为459个（48.62％）、345个（36.55％）和140个（14.83％）。均匀强化结节病灶、环状强化伴实性中心结节病灶及环状强化伴液性中心结节病灶的例数分别为299个（31.67％）、600个（63.56％）和45个（4.77％），其相应的 ADC值分别为（0.91±0.11）×10‐3 mm2／s、（0.96±0.12）×10‐3 mm2／s和（2.04±0.39）×10‐3 mm2／s ，均显著高于正常脑实质的ADC值（P＜0.001）。随访显示，在第2个月时≤0.3 cm的病灶中分别有3个（1.52％）、5个（2.53％）、96个（48.48％）和94个（47.47％）病灶预后表现为增大、不变、缩小和消失，而0.3～1.0 cm和≥1 cm的病灶的预后表现为增大、不变、缩小和消失所占的比例分别为3.37％、4.49％、47.75％和44.38％与13.21％、16.98％、66.04％和3.77％。第6个月时3组患者病灶消失的比例分别为77.78％、69.66％和35.85％。结论磁共振成像不仅可以发现脑实质结核较小的病灶，还可以动态观察脑实质结核病灶的动态变化，是判断脑实质结核预后的重要指标之一。
목적：평개자공진성상재뇌실질결핵환자진단급예후판단적림상응용。방법선취아원수치83례단순뇌실질결핵위연구대상，소유환자균재치료전화치료후수제2개월화제6개월시진행자공진소묘，비교로내병조특정，병분석병변적M RI연변규률。결과공발현944개병조，기중≤0.3 cm、0.3～1.0 cm화≥1 cm적병조수분별위459개（48.62％）、345개（36.55％）화140개（14.83％）。균균강화결절병조、배상강화반실성중심결절병조급배상강화반액성중심결절병조적례수분별위299개（31.67％）、600개（63.56％）화45개（4.77％），기상응적 ADC치분별위（0.91±0.11）×10‐3 mm2／s、（0.96±0.12）×10‐3 mm2／s화（2.04±0.39）×10‐3 mm2／s ，균현저고우정상뇌실질적ADC치（P＜0.001）。수방현시，재제2개월시≤0.3 cm적병조중분별유3개（1.52％）、5개（2.53％）、96개（48.48％）화94개（47.47％）병조예후표현위증대、불변、축소화소실，이0.3～1.0 cm화≥1 cm적병조적예후표현위증대、불변、축소화소실소점적비례분별위3.37％、4.49％、47.75％화44.38％여13.21％、16.98％、66.04％화3.77％。제6개월시3조환자병조소실적비례분별위77.78％、69.66％화35.85％。결론자공진성상불부가이발현뇌실질결핵교소적병조，환가이동태관찰뇌실질결핵병조적동태변화，시판단뇌실질결핵예후적중요지표지일。
Objective To evaluate the clinical application of MRI in diagnosis and prognosis of cerebral parenchymatous tu‐berculosis patients.Methods 83 patients with simple cerebral parenchymatous tuberculosis treated in my hospital from January 2010 to December 2014 were selected as the research subjects ,Every case was imaged by MRI when before and after treatment followed up the second months ,and sixth months ,compared with the features of intracranial lesions ,and analysed the MRI evolvement rule of the lesions.Results 994 lesions were found in all of the research subjects.Among them ,the number of le‐sions less than or equal to 0.3 cm ,0.3~1.0 cm and greater than or equal to 1cm were 459(48.62% ) ,345(36.55% )and 140 (14.83% ) ,respectively.The number of evenly enhancement nodular lesions ,ring‐like contrast enhancement with solid center le‐sions and ring‐like contrast enhancement with liquid center lesions were 299(31.67% ) ,600(63.56% ) and 45(4.77% ) ,respec‐tively ,the ADC values of them w ere (0.91 ± 0.11 ) × 10-3 mm2/s ,(0.96 ± 0.12 ) × 10-3 mm2/s and (2.04 ± 0.39 ) × 10-3 mm2/s ,respectively ,which were significantly higher than those of in normal cerebral parenchyma(P< 0.001).The follow‐up results show that in the second months ,the lesions less than or equal to 0.3 cm were 3 (1.52% ) ,5(2.53% ) ,96(48.48% ) and 94(47.47% ) ,respectively ,prognosis manifestation were increase ,constant ,shrink and disappear ,and 0.3~1.0cm and greater than or equal to 1 cm ,prognosis manifestation were increase ,constant ,shrink and disappear ,accounted for 3.37% ,4.49% , 47.75% ,44.38% and 13.21% ,16.98% ,66.04% ,3.77% ,respectively.The proportion of the lesions disappeared in the three groups were 77.78% ,69.66% and 35.85% in the sixth months ,respectively.Conclusion MRI can not only find the smaller le‐sions of cerebral parenchymatous tuberculosis ,it can also dynamically observe the dynamic changes of the lesions in the cerebral parenchymatous tuberculosis ,is one of the important indicators for estimating the prognosis of cerebral parenchymatous tuber‐culosis.