目的 分析脑膜结核的磁共振(MR)影像特点,提高诊断准确率.方法 回顾性分析我院2009年10月至2014年10月住院治疗的147例临床确诊的脑膜结核病例的磁共振成像(MRI)图像数据,男77例,女70例,年龄14～70岁,平均(32±13)岁,全部病例均行MRI平扫及增强扫描,26例行3D TOF序列扫描并MR血管成像(MRA),分析脑膜病变的形态和信号特点及颅内继发改变的特征.收集同期56例肺癌脑膜转移患者,男29例,女27例,年龄36～ 78岁,平均(58±11)岁,将其MRI表现与脑膜结核进行对比.计数资料采用x2检验,logistic多因素回归分析,计量资料采用t检验,P＜0.05为差异有统计学意义.结果 147例脑膜结核病例中146例累及软脑膜(99％),位于基底池及外侧裂池脑膜病变分别为104例及108例,其余为大脑纵裂池(46例)、大脑凸面(35例)及小脑背面(17例).MRI平扫阴性11例;阳性136例,阳性表现为病变脑膜不同程度增厚,相应脑池、室、沟狭窄,T2加权像(T2WI)可见不规则或结节状稍低信号77例;增强扫描病变全部强化,均匀和(或)不均匀强化,其中85例在脑膜增厚基础上,合并结节1 105个,结节呈散在分布23例,簇状分布62例,结节均匀强化452个,环状强化653个,簇状分布的结节多以环状强化或融合成团的分隔状强化为主.颅内继发改变:脑积水94例,大脑前动脉受累17例,大脑中动脉受累58例,大脑后动脉受累9例,脑梗死42例,视神经受累49例.脑膜结核与肺癌脑膜转移的MRI对比,脑膜受累类型、病灶分布部位、边缘是否光整、病变与脑膜的相对位置及脑膜结节的分布比较,除蛛网膜病变外(P=0.066),其余两组比较差异有统计学意义(P =0.000).结论 脑膜结核的MRI影像表现为大脑基底池脑膜增厚为主,合并簇状分布的脑膜结节,结节在T2WI上出现低信号,增强扫描结节呈环形及分隔状强化等征象以及继发性脑积水、脑内前循环血管炎、脑梗死等继发改变对脑膜结核的诊断均具有一定价值,增强扫描对脑膜结核的诊断具有重要意义.
目的 分析腦膜結覈的磁共振(MR)影像特點,提高診斷準確率.方法 迴顧性分析我院2009年10月至2014年10月住院治療的147例臨床確診的腦膜結覈病例的磁共振成像(MRI)圖像數據,男77例,女70例,年齡14～70歲,平均(32±13)歲,全部病例均行MRI平掃及增彊掃描,26例行3D TOF序列掃描併MR血管成像(MRA),分析腦膜病變的形態和信號特點及顱內繼髮改變的特徵.收集同期56例肺癌腦膜轉移患者,男29例,女27例,年齡36～ 78歲,平均(58±11)歲,將其MRI錶現與腦膜結覈進行對比.計數資料採用x2檢驗,logistic多因素迴歸分析,計量資料採用t檢驗,P＜0.05為差異有統計學意義.結果 147例腦膜結覈病例中146例纍及軟腦膜(99％),位于基底池及外側裂池腦膜病變分彆為104例及108例,其餘為大腦縱裂池(46例)、大腦凸麵(35例)及小腦揹麵(17例).MRI平掃陰性11例;暘性136例,暘性錶現為病變腦膜不同程度增厚,相應腦池、室、溝狹窄,T2加權像(T2WI)可見不規則或結節狀稍低信號77例;增彊掃描病變全部彊化,均勻和(或)不均勻彊化,其中85例在腦膜增厚基礎上,閤併結節1 105箇,結節呈散在分佈23例,簇狀分佈62例,結節均勻彊化452箇,環狀彊化653箇,簇狀分佈的結節多以環狀彊化或融閤成糰的分隔狀彊化為主.顱內繼髮改變:腦積水94例,大腦前動脈受纍17例,大腦中動脈受纍58例,大腦後動脈受纍9例,腦梗死42例,視神經受纍49例.腦膜結覈與肺癌腦膜轉移的MRI對比,腦膜受纍類型、病竈分佈部位、邊緣是否光整、病變與腦膜的相對位置及腦膜結節的分佈比較,除蛛網膜病變外(P=0.066),其餘兩組比較差異有統計學意義(P =0.000).結論 腦膜結覈的MRI影像錶現為大腦基底池腦膜增厚為主,閤併簇狀分佈的腦膜結節,結節在T2WI上齣現低信號,增彊掃描結節呈環形及分隔狀彊化等徵象以及繼髮性腦積水、腦內前循環血管炎、腦梗死等繼髮改變對腦膜結覈的診斷均具有一定價值,增彊掃描對腦膜結覈的診斷具有重要意義.
목적 분석뇌막결핵적자공진(MR)영상특점,제고진단준학솔.방법 회고성분석아원2009년10월지2014년10월주원치료적147례림상학진적뇌막결핵병례적자공진성상(MRI)도상수거,남77례,녀70례,년령14～70세,평균(32±13)세,전부병례균행MRI평소급증강소묘,26례행3D TOF서렬소묘병MR혈관성상(MRA),분석뇌막병변적형태화신호특점급로내계발개변적특정.수집동기56례폐암뇌막전이환자,남29례,녀27례,년령36～ 78세,평균(58±11)세,장기MRI표현여뇌막결핵진행대비.계수자료채용x2검험,logistic다인소회귀분석,계량자료채용t검험,P＜0.05위차이유통계학의의.결과 147례뇌막결핵병례중146례루급연뇌막(99％),위우기저지급외측렬지뇌막병변분별위104례급108례,기여위대뇌종렬지(46례)、대뇌철면(35례)급소뇌배면(17례).MRI평소음성11례;양성136례,양성표현위병변뇌막불동정도증후,상응뇌지、실、구협착,T2가권상(T2WI)가견불규칙혹결절상초저신호77례;증강소묘병변전부강화,균균화(혹)불균균강화,기중85례재뇌막증후기출상,합병결절1 105개,결절정산재분포23례,족상분포62례,결절균균강화452개,배상강화653개,족상분포적결절다이배상강화혹융합성단적분격상강화위주.로내계발개변:뇌적수94례,대뇌전동맥수루17례,대뇌중동맥수루58례,대뇌후동맥수루9례,뇌경사42례,시신경수루49례.뇌막결핵여폐암뇌막전이적MRI대비,뇌막수루류형、병조분포부위、변연시부광정、병변여뇌막적상대위치급뇌막결절적분포비교,제주망막병변외(P=0.066),기여량조비교차이유통계학의의(P =0.000).결론 뇌막결핵적MRI영상표현위대뇌기저지뇌막증후위주,합병족상분포적뇌막결절,결절재T2WI상출현저신호,증강소묘결절정배형급분격상강화등정상이급계발성뇌적수、뇌내전순배혈관염、뇌경사등계발개변대뇌막결핵적진단균구유일정개치,증강소묘대뇌막결핵적진단구유중요의의.
Objective To investigate the MRI features of meningeal tuberculosis.Methods The MR images of meningeal tuberculosis were retrospectively analyzed in 147 patients who were clinically diagnosed from 2009 to 2014 years in our hospital,including 77 males,and 70 females.Their age ranged from 14 to 70 years,and the average age was(32 ± 13)years.All cases underwent MR plain scan and enhancement scan,and 26 cases underwent 3D TOF sequence and MRA vascular reconstruction.The characteristics of the morphological change,MR signal of meningeal lesions and the secondary changes were investigated for 56 cases of meningeal carcinomatosis due to lung cancer,including 29 males and 27 females.Their age ranged from 36 to 78 years old,and the average age was (58 ± 11) years.The MR imaging characteristics of meningeal lesions were compared with those of meningeal tuberculosis.Chi-square test and logistic regression analysis were used for count data analysis,and t-test was used for measurement data.P ＜ 0.05 was regarded as statistically significant.Results Among 147 cases of meningeal tuberculosis,146 (99.32％) had involvement of the cerebral pia mater,104 of the basal cistern,and 108 of the cistern of lateral fissure pools.Lesions located in fissura longitudinalis cerebri pool,convexity of brain and cerebellar back were found in 46,35 and 17 cases,respectively.MRI findings in plain scan were normal in 11 patients,and abnormal in 136 cases.Thickening meningeal lesions with different degrees were shown in the abnormal cases,with irregular or nodular slightly low signal intensity in T2 WI in 77 cases.The meningeal lesions of all cases had homogeneous or inhomogeneous enhancement in enhanced scanning.There were 85 cases with meningeal nodules,including nodules with scattered distribution in 23 cases,and cluster distribution in 62 cases.The number of nodules was up to 1 105,including 452 nodules with homogeneous enhancement,and 653 nodules with ring enhancement.Most nodules of cluster distribution showed ring enhancement or separate enhancement.Secondary changes included hydrocephalus in 94 cases,anterior cerebral artery involvement in 17 cases,middle cerebral artery involvement in 58 cases,posterior cerebral artery involvement in 9 cases,42 cases complicated with cerebral infarction and optic nerve involvement in 49 cases.Comparison of MR manifestations of meningeal tuberculosis and meningeal metastasis showed that,the location,type of meningeal involvement,edge of lesions,relative position of lesions and meninges,distribution of nodules were significantly different (P ＜ 0.05),except arachnoid lesions (P =0.066).Conclusion The MRI characteristics of meningeal tuberculosis were thickening of cerebral basilar cistern meninges.These signs were valuable for MRI diagnosis of meningeal tuberculosis,including cases complicated with meningeal nodules of cluster distribution.The nodules were of low signal on T2WI,with ring enhancement or separate enhancement,with secondary hydrocephalus,cerebral vasculitis in anterior circulation,and brain infarction.The result also showed that contrast-enhanced MRI was valuable for diagnosis of meningeal tuberculosis as well.
