Clinical value of MRI combined with CSF detection in the diagnosis and differential diagnosis of central nervous system infection
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摘要:
目的探讨MRI联合脑脊液（CSF）检查在诊断和鉴别中枢神经感染中的临床价值。 方法选取2019年1月~2020年5月在我院治疗的中枢神经系统感染性疾病患者151例，其中病毒性脑膜炎84例，化脓性脑膜炎35例，结核性脑膜炎32例，均给予MRI检查，检查CSF中的乳酸脱氢酶（LDH）、蛋白、乳酸和白细胞计数（WBC）。 结果结核性脑膜炎MRI异常检出率高于病毒性脑膜炎和化脓性脑膜炎（P < 0.05）；病毒性脑膜炎和化脓性脑膜炎MRI异常检出率比较差异无统计学意义（P > 0.05）；病毒性脑膜炎病灶区域脑膜强化检出率高于化脓性脑膜炎和结核性脑膜炎（P < 0.05）；化脓性脑膜炎病灶呈环形强化检出率高于病毒性脑膜炎（P < 0.05）；结核性脑膜炎颅底脑膜强化检出率高于病毒性脑膜炎和化脓性脑膜炎（P < 0.05）；病毒性脑膜炎CSF中LDH、蛋白、乳酸和WBC明显低于化脓性脑膜炎和结核性脑膜炎（P < 0.05）；结核性脑膜炎CSF中LDH高于化脓性脑膜炎（P < 0.05），而蛋白和WBC低于化脓性脑膜炎（P < 0.05）；筛选出LDH（X1）、蛋白（X2）和WBC（X3）3个指标建立判别函数，即：Y病脑=-0.056X1- 0.065X2-0.062X3+1.168，Y化脑=-0.041X1+0.102X2+0.089X3-1.102，Y结脑=0.112X1-0.057X2-0.078+1.032；MRI联合CSF参数函数诊断病毒性脑膜炎的敏感度、特异性和准确率分别为79.76%、74.63%和77.48%，诊断化脓性脑膜炎的敏感度、特异性和准确率分别为80.00%、81.03%和80.79%，诊断结核性脑膜炎的敏感度、特异性和准确率分别为78.13%、84.87%和83.44%。 结论MRI联合CSF检测在诊断和鉴别中枢神经感染中有较高应用价值，值得临床使用。 Abstract:ObjectiveTo investigate the clinical value of MRI combined with cerebrospinal fluid (CSF) in the diagnosis and differential diagnosis of central nervous system infection. MethodsOne hundred and fifty-one patients with central nervous system infectious diseases treated in our hospital from January 2019 to may 2020 were selected, including 84 cases of viral meningitis, 35 cases of purulent meningitis and 32 cases of tuberculous meningitis. All patients were examined by MRI. The lactate dehydrogenase (LDH), protein, lactic acid (LA) and white blood cell count (WBC) in CSF were examined. ResultsThe abnormal detection rate of MRI in tuberculous meningitis was significantly higher than that in viral meningitis and purulent meningitis (P < 0.05). There was no significant difference in abnormal detection rate of MRI between viral meningitis and purulent meningitis (P > 0.05). The detection rate of meningeal enhancement in viral meningitis was significantly higher than that in purulent meningitis and tuberculous meningitis (P < 0.05). The detection rate of ring enhancement in purulent meningitis was significantly higher than that of viral meningitis (P < 0.05). The detection rate of meningeal enhancement in tuberculous meningitis was significantly higher than that in viral meningitis and purulent meningitis (P < 0.05). The LDH, protein, LA and WBC in CSF of viral meningitis were significantly lower than those in purulent meningitis and tuberculous meningitis (P < 0.05). The LDH in CSF of tuberculous meningitis was significantly higher than that in purulent meningitis (P < 0.05), while the protein and WBC were significantly lower than those in purulent meningitis (P < 0.05). Three indicators, LDH (X1), protein (X2) and WBC (X3), were screened out to establish discriminant functions, namely: Yviral meningitis=-0.056X1-0.065X2-0.062X3+ 1.168, Ypurulent meningitis=-0.041X1 + 0.102X2 + 0.089X3-1.102, Ytuberculous meningitis =0.112X1-0.057X2-0.078 + 1.032. The sensitivity, specificity and accuracy of MRI combined with CSF parameter function in the diagnosis of viral meningitis were 79.76%, 74.63% and 77.48%, the sensitivity, specificity and accuracy of diagnosing purulent meningitis were 80.00%, 81.03% and 80.79%, the sensitivity, specificity and accuracy rate of diagnosing tuberculous meningitis were 78.13%, 84.87% and 83.44%. ConclusionMRI combined with CSF detection has high application value in the diagnosis and differential diagnosis of central nervous system infection. -
表 1 不同疾病类型患者一般资料比较
Table 1. Comparison of general data of patients with different disease types (Mean±SD)
组別 男/女 年龄(岁） BM(kg/m2) 病毒性脑膜炎(n=84) 51/33 32.15±7.32 22.65±2.13 化脓性脑膜炎(n=35) 22/13 34.65±8.03 22.80±3.01 结核性脑膜炎(n=32) 19/13 31.88±8.43 22.50±2.87 F/χ2 0.089 1.203 0.846 P 0.957 0.422 0.911 
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表 2 不同疾病类型MRI异常检出率比较
Table 2. Comparison of abnormal detection rate of MRI in different disease types[n (%)]
组別 异常检出率 χ2 P 病毒性脑膜炎(n=84) 33(39.29) 化脓性脑膜炎(n=35) 13(37.14) 7.477 0.024 结核性脑膜炎(n=32) 21(65.63)ab aP < 0.05 vs病毒性脑膜炎；bP < 0.05 vs化脓性脑膜炎.
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表 3 不同疾病类型MRI征象比较
Table 3. Comparison of MRI signs of different disease types[n(%)]
组別 病灶区域脑膜强化 病灶呈环形强化 颅底脑膜强化 病毒性脑膜炎(n=84) 29(34.52) 2(2.38) 2(2.38) 化脓性脑膜炎(n=35) 4(11.43)a 8(22.86)a 1(2.86) 结核性脑膜炎(n=32) 4(12.50)a 2(6.25) 15(46.88)ab χ2 10.286 14.32 47.257 aP < 0.05 vs病毒性脑膜炎；bP < 0.05 vs化脓性脑膜炎.
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表 4 不同疾病类型CSF参数比较
Table 4. Comparison of CSF parameters of different disease types (Mean±SD)
组別 LDH(U/L) 蛋白(g/L) LA(U/L) WBC(×109/L) 病毒性脑膜炎(n=84) 16.68±4.22 1.12±0.32 11.45±2.03 0.22±0.09 化脓性脑膜炎(n=35) 75.51±11.80a 3.65±1.00a 51.15±9.44a 4.49±1.10a 结核性脑膜炎(n=32) 87.62±12.26ab 3.01±0.94ab 52.21±8.94a 1.78±0.72ab F 21.106 10.541 32.211 13.544 P 0.000 0.000 0.000 0.000 aP < 0.05 vs病毒性脑膜炎；bP < 0.05 vs化脓性脑膜炎；LDH：乳酸脱氢酶；LA：乳酸；WBC：白细胞计数.
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表 5 MRI联合CSF诊断价值
Table 5. Diagnostic value of MRI combined with CSF(%)
组別 敏感度 特异性 准确率 病毒性脑膜炎 79.76(67/84) 74.63(50/67) 77.48(117/151) 化脓性脑膜炎 80.00(28/35) 81.03(94/116) 80.79(112/151) 结核性脑膜炎 78.13(25/32) 84.87(101/119) 83.44(126/151) χ2 0.046 2.941 3.932 P 0.977 0.230 0.140 注：联合方法采用并联方式.
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