脑内非肿瘤性占位病变的影像学诊断和鉴别诊断  

Imaging diagnosis and differential diagnosis of intracranial non-tumor space occupying lesion

作　　者：王文献[1] 刘卫金[1] 孙清荣[1] 文利[1] 梁开运[1] 夏良[1] 

机构地区：[1]第三军医大学新桥医院放射科,重庆400037

出　　处：《第三军医大学学报》2004年第15期1404-1406,共3页Journal of Third Military Medical University

摘　　要：目的　总结并分析脑内非肿瘤性占位病变的影像学表现特征。方法　收集临床确诊并有完整影像学资料的脑脓肿、脑内 脑膜结核、肺吸虫、脑囊虫和弓形体病例 49例 ,对其临床和影像学资料进行回顾性分析。结果　 2 0例脑脓肿单发病灶 11例 ,多发病灶 9例 ,平扫多呈等或稍低密度的环状影 ,增强后呈明显的环状强化 ,强化环可呈单环、多环或多环相连征 ;脑内结核性肉芽肿 19例 ,平扫结核性肉芽肿的环壁不易判断 ,增强后的强化环多呈小环征 ,脑水肿明显 ,9例脑膜结核合并有脑积水和腔隙性脑梗死 ;5例肺吸虫表现为脑实质内斑片状不规则低密度区 ,呈轻～中度强化 ,脑脊液补体结合试验阳性 ;脑实质型囊虫病 2例 ,表现为脑内多发病灶 ,平扫见点状钙化和低密度区 ,增强后呈小环状强化 ,可见“印戒征” ,另一例为脑膜型 ,增强后沿蛛网膜下腔多发的结节状和小环状强化 ;2例弓形体感染均为婴儿 ,表现为脑室扩大 ,沿侧脑室壁呈多发的斑点状钙化 ,脑实质发育差。结论　非肿瘤性肉芽肿影像学检查的全面性和准确性是非常重要的 ,同时应结合临床和流行病学资料。Objective To investigate the imaging characteristics of intracranial non tumor space occupying lesion. Methods The imaging data of 49 patients, including 20 cases of brain abscess, 19 cases of brain tuberculosis (or meningeal tuberculosis), and 10 cases of brain parasitic infestation, confirmed clinically, were analyzed retrospectively. Results The CT findings of most cases of brain abscess were in circular shape with the same density as or slightly lower density than that of the normal brain tissue on plain CT scan and with obvious annular enhancement on enhanced CT scan. For tuberculosis induced granuloma, the membrane of the local lesion was unclear on plain scan and most lesions showed small ring signs on the contrast enhanced image. Irregularly low density area was found in 5 cases with pulmonary fluke infection. Multiple lesions and some macular calcification and low density area were found in 2 cases with brain cysticercosis. On the contrast enhanced CT scan, the lesion showed signet ring signs. Conclusion General image analysis is quite important in the diagnosis of intracranial non tumor space occupying lesion. In addition, the combination of the clinical data with those of epidemiology, immunological test of cerebrospinal fluid, and other laboratory examination is necessary.

关 键 词：脑脓肿 结核性肉芽肿 肺吸虫 脑弓形体病 体层摄影术 X线计算机 

分 类 号：R445[医药卫生—影像医学与核医学] R447[医药卫生—诊断学]