Value of MRI enhanced scan of head and cerebrospinal fluid examination in early diagnosis of intracranial tuberculosis in infants and children
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摘要:
目的探讨头颅MRI增强扫描与脑脊液检查对婴幼儿颅内结核的早期诊断价值。 方法收集2018年1~12月在我院确诊为婴幼儿颅内结核的0~3岁患儿31例,全部患儿进行MRI平扫、增强扫描及脑脊液检查,对患儿的MRI影像特征及脑脊液改变进行归纳总结,分析其诊断价值。 结果MRI结果显示脑膜结核患儿7例,脑实结核型7例,颅内结核混合型16例,单纯脑积水1例。脑膜增厚共23例(74.19%),脑膜增厚发生部位在基底池16例;软脑膜增厚14例,室管膜增厚1例。结核结节9例(29.32%);结核瘤7例(22.58%);结核性脑炎10例(32.26%);结核性脑梗塞1例;脑内软化灶5例。颅内结核患儿MRI扫描显示脑表面血管者增多者17例(54.84%)。脑脊液典型改变14例(45.16%),部分典型改变9例。 结论MRI增强扫描能早期发现病变,尤其在脑表面血管增多、增粗时,能早期提示结核菌颅内感染,结合脑脊液改变,结合密切接触史及颅外结核病史,较大提高了婴幼儿颅内结核的早期诊断。 Abstract:ObjectiveTo explore the value of MRI enhanced scan of head and cerebrospinal fluid examination in early diagnosis of intracranial tuberculosis in infants and children. MethodsThirty- one cases of the intracranial tuberculosis in infants and children were selected, which were diagnosed in clinic in the guangzhou chest hospital from January to December, 2018. All cases underwent MRI plain, enhanced scan and cerebrospinal fluid examination. The MRI imaging features and cerebrospinal fluid changes of the cases were analyzed. ResultsThe results of MRI showed 7 cases with meningeal tuberculosis, 7 cases with solid brain tuberculosis, 16 cases with mixed intracranial tuberculosis, and 1 case with simple hydrocephalus. Meningeal thickening 23 cases(74.19%), 16 cases occurred in the basal cistern, 14 cases of pial meningeal thickening, and 1 case of thickening of epedymal membrane. Nine cases with tuberculosis nodules (29.32%), 7 cases with tuberculoma (22.58%), 10 cases with tuberculous encephalitis (32.26%), 1 case of tuberculous cerebral infarction and 5 cases with softening of the brain. The MRI of intracranial tuberculosis showed hypervascularization of the brain surface in the 17 cases (54.84%). The typical change of cerebrospinal fluid Examination was found in 14 cases (45.16%), and in 9 cases of partial change of cerebrospinal fluid examination. ConclusionThe MRI enhanced scan can detect early the lesion, especially when the blood vessels on the brain surface were increased or enlarged, early signs of intracranial tuberculosis infection were significant. The changes of cerebrospinal fluid examination, the history of close contact with tuberculosis and the extracranial tuberculosis are combined. It can greatly improve the early diagnosis of intracranial tuberculosis in infants and children. -
图 1 颅内结核患儿MRI影像学表现
A, B:此例患儿MRI的T2WI、T2WI-FLAIR序列上未见明确异常信号影; C: MRI增强显示左侧额叶、双侧颞叶、左侧小脑见多个结核结节,大小均在5 mm以下,边缘清晰,呈均匀明显强化; D:此患儿T1WI显示左侧额叶、左侧半卵圆中心内侧、右侧侧脑室内、胼胝体压部前缘见结节状异常信号影,其内呈稍低信号,周围呈稍高信号,边缘尚清;右侧额叶、右侧枕叶结节影呈等信号影; E:此患儿T2WI上左侧额叶、左侧半卵圆中心内侧、右侧侧脑室内、胼胝体压部前缘结节影呈中心低周围稍高信号影, 右侧额叶、右侧枕叶结节影呈等信号影; F: MRI增强显示左侧额叶、左侧半卵圆中心内侧、胼胝体压部前缘结节影呈环形强化;右侧额叶、右侧侧脑室内、右侧枕叶结节影呈均匀强化;双侧颞叶软脑膜点状、条形增厚; G:鞍上池、环池、双侧外侧裂池、小脑幕脑膜不规则增厚,部分呈结节状增厚; H:双侧大脑表面血管影明显增多、增粗; I:双侧硬脑膜明显增厚, 以左侧为著,右侧硬膜下腔内见片状、絮状、网格状异常强化灶,左侧侧脑室明显扩张积水,左侧额叶萎缩
Figure 1. MRI image of intracranial tuberculosis in infants and children
表 1 婴幼儿颅内结核脑膜增厚分布(n)
Table 1. Distribution of intracranial tuberculosis meningeal thickening in infants and children
颅内结核MRI 脑膜型(n=7) 混合型(n=16) 百分比(%) 硬脑膜增厚 4 7 47.83 软脑膜增厚 3 11 60.87 基底池脑膜增厚 4 12 69.57 室管膜增厚 0 1 4.35 表 2 婴幼儿颅内结核脑实质病变分布(n)
Table 2. Distribution of intracranial tuberculosis brain parenchyma lesion in infants and children
颅内结核MRI 脑实质型(n=7) 混合型(n=16) 百分比(%) 结核结节 4 5 39.13 结核瘤 1 6 30.43 结核性脑炎 2 8 43.48 结核性脑梗塞 0 1 4.35 脑软化灶 1 4 21.74 表 3 脑脊液与婴幼儿颅内结核的关系(n)
Table 3. Relationship between cerebrospinal fluid and intracranial tuberculosis in infants and children
脑脊液 脑膜型(n=7) 脑实质型(n=7) 混合型(n=16) 脑积水(n=1) 总计 典型 2 4 7 1 14 部分典型 5 1 3 0 9 全不典型 0 0 1 0 1 正常 0 2 5 0 7 -
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