中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2015年
11期
821-827
,共7页
贺伟%宁锋刚%周新华%吕岩%吕平欣%周震%李成海%王岳
賀偉%寧鋒剛%週新華%呂巖%呂平訢%週震%李成海%王嶽
하위%저봉강%주신화%려암%려평흔%주진%리성해%왕악
结核%脑%磁共振波谱学
結覈%腦%磁共振波譜學
결핵%뇌%자공진파보학
Tuberculosis%Brain%Magnetic resonance spectroscopy
目的 探讨脑实质结核的核磁共振(MRI)表现特点、分型及抗结核治疗中的动态变化.方法 回顾性分析2010年9月至2014年9月在我院检查并经临床确诊的脑实质结核患者134例,其中男68例,女66例,年龄14 ～ 77岁.行常规T1、T2及弥散加权成像扫描及增强扫描并分析其影像表现.脑实质结核病灶直径＜0.3 cm的结节称为粟粒结节;0.3 ～ 1.0 cm称为小结节,＞l.0cm称为大结节.根据脑实质病变大小,脑实质结核病例分为粟粒结节型、小结节型、大结节型及混合结节型;根据强化方式及信号特点,分为增生结节型、结核瘤型、脑脓肿型和混合型.76例患者抗结核治疗后行MRI动态随访.采用x2检验对不同结节的强化方式及抗结核治疗后的随访结果进行分析.对随诊结果进行logistic单因素回归分析.结果 134例脑实质结核的发生部位以大脑半球及小脑半球多见,且多发病灶多部位同时出现常见.增强扫描病变有均匀强化、环形强化和不均匀强化3种方式,72例可见2种或3种强化方式同时存在.粟粒结节(124例)、小结节(90例)及大结节(16例)中均匀强化方式及非均匀强化方式(包括环形强化和不均匀强化)分别为116和32例、34和69例及1和16例,采用x2检验分别对3种结节的不同强化方式进行比较,差异均有统计学意义(x2值分别为69.502、6.714和13.460,均p＜0.05).粟粒结节均匀强化更常见,小结节尤其是大结节环状强化更常见.根据脑实质病变大小分型,134例中粟粒结节型(68例)和混合结节型(57例)多见,小结节型(8例)和大结节型(1例)少见;根据强化方式及信号特点分型,以增生结节型(64例)和混合性脑结核(60例)多见,结核瘤型(9例)和脑脓肿型(1例)少见.结节直径＞0.5 cm的病变多数符合结核瘤的影像学表现.76例患者行MRI动态随访,最终有23例(30.3％)病变完全消失.增生结节型组病变消失率高于非增生结节型组(包括结核瘤型和混合脑结核型,分别为17/37和6/39,P=0.004).粟粒结节型脑结核的病变消失率(15/38)高于非粟粒结节型脑结核(包括结节型和混合结节型,8/38,P=0.02).Logistic单因素回归分析结果显示,随诊的结果与病变的类型有关(P＜0.05).治疗中14例出现部分病灶增大或出现新发病变,其中3例迁延不愈.结论 增强MRI脑实质结核表现为均匀强化、环形强化和不均匀强化,约1/2的患者存在2种以上强化形式,以增生结节型和混合型多见.粟粒结节均匀强化更常见,小结节尤其是大结节环状强化更常见.脑实质结核以粟粒结节型和混合结节型多见;增生结节型的治疗效果优于非增生结节型,粟粒结节型脑结核的治疗效果优于非粟粒结节型脑结核.
目的 探討腦實質結覈的覈磁共振(MRI)錶現特點、分型及抗結覈治療中的動態變化.方法 迴顧性分析2010年9月至2014年9月在我院檢查併經臨床確診的腦實質結覈患者134例,其中男68例,女66例,年齡14 ～ 77歲.行常規T1、T2及瀰散加權成像掃描及增彊掃描併分析其影像錶現.腦實質結覈病竈直徑＜0.3 cm的結節稱為粟粒結節;0.3 ～ 1.0 cm稱為小結節,＞l.0cm稱為大結節.根據腦實質病變大小,腦實質結覈病例分為粟粒結節型、小結節型、大結節型及混閤結節型;根據彊化方式及信號特點,分為增生結節型、結覈瘤型、腦膿腫型和混閤型.76例患者抗結覈治療後行MRI動態隨訪.採用x2檢驗對不同結節的彊化方式及抗結覈治療後的隨訪結果進行分析.對隨診結果進行logistic單因素迴歸分析.結果 134例腦實質結覈的髮生部位以大腦半毬及小腦半毬多見,且多髮病竈多部位同時齣現常見.增彊掃描病變有均勻彊化、環形彊化和不均勻彊化3種方式,72例可見2種或3種彊化方式同時存在.粟粒結節(124例)、小結節(90例)及大結節(16例)中均勻彊化方式及非均勻彊化方式(包括環形彊化和不均勻彊化)分彆為116和32例、34和69例及1和16例,採用x2檢驗分彆對3種結節的不同彊化方式進行比較,差異均有統計學意義(x2值分彆為69.502、6.714和13.460,均p＜0.05).粟粒結節均勻彊化更常見,小結節尤其是大結節環狀彊化更常見.根據腦實質病變大小分型,134例中粟粒結節型(68例)和混閤結節型(57例)多見,小結節型(8例)和大結節型(1例)少見;根據彊化方式及信號特點分型,以增生結節型(64例)和混閤性腦結覈(60例)多見,結覈瘤型(9例)和腦膿腫型(1例)少見.結節直徑＞0.5 cm的病變多數符閤結覈瘤的影像學錶現.76例患者行MRI動態隨訪,最終有23例(30.3％)病變完全消失.增生結節型組病變消失率高于非增生結節型組(包括結覈瘤型和混閤腦結覈型,分彆為17/37和6/39,P=0.004).粟粒結節型腦結覈的病變消失率(15/38)高于非粟粒結節型腦結覈(包括結節型和混閤結節型,8/38,P=0.02).Logistic單因素迴歸分析結果顯示,隨診的結果與病變的類型有關(P＜0.05).治療中14例齣現部分病竈增大或齣現新髮病變,其中3例遷延不愈.結論 增彊MRI腦實質結覈錶現為均勻彊化、環形彊化和不均勻彊化,約1/2的患者存在2種以上彊化形式,以增生結節型和混閤型多見.粟粒結節均勻彊化更常見,小結節尤其是大結節環狀彊化更常見.腦實質結覈以粟粒結節型和混閤結節型多見;增生結節型的治療效果優于非增生結節型,粟粒結節型腦結覈的治療效果優于非粟粒結節型腦結覈.
목적 탐토뇌실질결핵적핵자공진(MRI)표현특점、분형급항결핵치료중적동태변화.방법 회고성분석2010년9월지2014년9월재아원검사병경림상학진적뇌실질결핵환자134례,기중남68례,녀66례,년령14 ～ 77세.행상규T1、T2급미산가권성상소묘급증강소묘병분석기영상표현.뇌실질결핵병조직경＜0.3 cm적결절칭위속립결절;0.3 ～ 1.0 cm칭위소결절,＞l.0cm칭위대결절.근거뇌실질병변대소,뇌실질결핵병례분위속립결절형、소결절형、대결절형급혼합결절형;근거강화방식급신호특점,분위증생결절형、결핵류형、뇌농종형화혼합형.76례환자항결핵치료후행MRI동태수방.채용x2검험대불동결절적강화방식급항결핵치료후적수방결과진행분석.대수진결과진행logistic단인소회귀분석.결과 134례뇌실질결핵적발생부위이대뇌반구급소뇌반구다견,차다발병조다부위동시출현상견.증강소묘병변유균균강화、배형강화화불균균강화3충방식,72례가견2충혹3충강화방식동시존재.속립결절(124례)、소결절(90례)급대결절(16례)중균균강화방식급비균균강화방식(포괄배형강화화불균균강화)분별위116화32례、34화69례급1화16례,채용x2검험분별대3충결절적불동강화방식진행비교,차이균유통계학의의(x2치분별위69.502、6.714화13.460,균p＜0.05).속립결절균균강화경상견,소결절우기시대결절배상강화경상견.근거뇌실질병변대소분형,134례중속립결절형(68례)화혼합결절형(57례)다견,소결절형(8례)화대결절형(1례)소견;근거강화방식급신호특점분형,이증생결절형(64례)화혼합성뇌결핵(60례)다견,결핵류형(9례)화뇌농종형(1례)소견.결절직경＞0.5 cm적병변다수부합결핵류적영상학표현.76례환자행MRI동태수방,최종유23례(30.3％)병변완전소실.증생결절형조병변소실솔고우비증생결절형조(포괄결핵류형화혼합뇌결핵형,분별위17/37화6/39,P=0.004).속립결절형뇌결핵적병변소실솔(15/38)고우비속립결절형뇌결핵(포괄결절형화혼합결절형,8/38,P=0.02).Logistic단인소회귀분석결과현시,수진적결과여병변적류형유관(P＜0.05).치료중14례출현부분병조증대혹출현신발병변,기중3례천연불유.결론 증강MRI뇌실질결핵표현위균균강화、배형강화화불균균강화,약1/2적환자존재2충이상강화형식,이증생결절형화혼합형다견.속립결절균균강화경상견,소결절우기시대결절배상강화경상견.뇌실질결핵이속립결절형화혼합결절형다견;증생결절형적치료효과우우비증생결절형,속립결절형뇌결핵적치료효과우우비속립결절형뇌결핵.
Objective To investigate the MRI features,classification and the evolution of cerebral parenchymal tuberculosis(TB) during anti-tuberculosis treatment.Methods A total of 134 patients with cerebral parenchymal TB registered in our hospital from Sep.2010 to Aug.2010 were studied retrospectively.There were 68 males and 66 females,aged 14 to 77 years.The MRI characteristics of these patients were analyzed after T1 WI,T2WI,DWI and enhanced scan.The millet,small and large nodules were named by the lesion diameter of less than 0.3 cm,0.3 to 1.0 cm and lager than 1.0 cm in brain parenchymal TB,respectively,and accordingly the cerebral parenchymal TB cases were divided into millet nodule type,small nodule type,large nodule type and mixed nodule type with at least 2 of 3 nodule sizes.According to the enhanced scanning patterns and signal characteristics,the cases were divided into hyperplastic nodule,tuberculoma type,abscess type and mixed type.Serial follow-up MRI scans were performed in 76 patients during their anti-tuberculosis treatment.Data on lesions of different size were analyzed by Chi-square test and the follow-up results were analyzed by single-factor logistic regression.Results Of all the 134 patients,the lesions were commonly found in the cerebral hemisphere and cerebellar hemisphere,often multiple in different locations.Three patterns of homogeneous enhancement,ring enhancement,and variegated enhancement were found in the 134-patients after the enhanced scan,of which 2 or more patterns co-existed in 72 cases.There were 124 cases with millet nodules,of which 116 were homogeneous enhancement and 32 were heterogeneous enhancement (including ring enhancement and variegated enhancement).Ninety cases were found to have small nodules,of which 34 were homogeneous enhancement and 69 were heterogeneous enhancement.Sixty cases were found to have large nodules,of which 1 was of homogeneous enhancement and 16 were of heterogeneous enhancement.The case number of the homogeneous enhancement and heterogeneous enhancement was significantly different for the 3 different sized nodules,respectively (P ＜ 0.05).Homogeneous enhancement was seen commonly in millet nodules,while heterogeneous enhancement in small nodules especially large nodules.In contrast to small nodule type (8 cases) and large nodule type (l case),millet nodule type (68 cases) and mixed nodule type (57 cases) were predominant.The hyperplastic nodule type (64 cases) and mixed cerebral tuberculosis (60 cases) were predominant in contrast to tuberculoma type (9 cases) and abscess type (1 case) in the 134 patients.The cases with lesion diameter more than 0.5 cm mostly showed tuberculoma.The disappearance rates were 23 (30.3％) among 76 patients with serial MRI follow-up scans.The disappearance rate of hyperplastic nodule type (17/37) was significantly higher than that of the non-hyperplastic nodule type (including tuberculoma and mixed type) (6/39) (P =0.004).The disappearance rate of millet nodule type (15/38) was significantly higher than that of the non-millet nodule type (8/38) (P =0.02).Single-factor logistic regression analysis showed that,the results of the follow-up only related to 2 classifications (P ＜ 0.05).Fourteen patients were found to have enlarged lesions or newly appeared lesion during anti-tuberculosis treatment,of which 3 were refractory.Conclusions Cerebral parenchymal TB showed certain MRI characteristics.Homogeneous enhancement,ring enhancement,and variegated enhancement.About half of the patients had more than 2 enhancement patterns.Homogeneous enhancement and heterogeneous enhancement were commonly seen in millet nodules and small nodules especially large nodules,respectively.According to the classification of lesion size,millet nodule type and mixed nodule type were predominant.According to the characteristics of the lesion enhancement pattern and signal characteristics,hyperplastic nodule type and mixed type were predominant.This classification would help to guide the treatment of cerebral parenchymal TB.The treatment effect of hyperplastic nodule type was better than non-hyperplastic nodule type,and millet nodule type was better than non-millet nodule types.
