脑结核瘤磁共振成像的特殊征象及探讨  

Special Features of Magnetic Resonance Imaging in Cerebral Tuberculoma

作　　者：姚春慧 李波 张沁 谭娟 李文彬[2] 

机构地区：[1]喀什地区第二人民医院影像中心,新疆喀什844000 [2]上海交通大学附属第六人民医院放射科,上海200233

出　　处：《现代医用影像学》2015年第6期940-943,共4页Modern Medical Imageology

摘　　要：目的:分析总结颅内结核瘤的磁共振表现的一些特殊征象,结合临床实验室检查,探讨非手术准确诊断脑结核瘤的方法。材料与方法:回顾性分析我院有完整资料的29结果例经临床确诊的脑结核病例,对其MR的影像学表现及GD-DTPA增强扫描的特点进行分析和探讨。结果:15例43个成熟结核瘤由环壁和坏死的核心两部分组成,呈单环或花簇状环状强化,10例未成熟结核瘤呈等T1、等T2信号,片絮状均匀强化,4例粟粒性脑结核呈脑内散在的多发等或长T1、长T2信号,结节样均匀强化或小环状强化,29例中21例合并有脑膜增厚,呈线样、条状强化,脑结核瘤以多发为主22/29例(75.8%),结论:典型的结核瘤有特征性影像学表现,非典型的需要与脑脓肿、胶质瘤和脑转移瘤鉴别,诊断颅脑结核,颅内多发结节状或环形强化病灶,合并脑室积水,增强扫描多合并脑膜强化等磁共振特殊表现,结合临床实验室检查和病史,可提高诊断符合率,减少误诊,强化抗结核治疗后短期复查磁共振也可帮助鉴别诊断。Purpose： The aim of this study was to outline some special MRI findings features of cerebral tuberculoma, and highlight the importance of radiological diagnosis. Materials and Methods： We conducted retrospective analysis of 29 cerebral tuberculoma cases of patients with clinical diagnosis in Kashgar Prefecture Second People＇ s Hospital, the imaging features of MR and GD -DTPA enhanced scan were analyzed and discussed. Results： 15 cases of 43 mature tuberculoma were made up of two parts of the core ring wall and necrosis, and with a single ring or clustered ring enhancement. There were 10 cases of immature tuberculoma showed T1 isointensity signal and T2 isointensity signal, and with aflocculent homogeneous enhancement. 4 cases of cerebral miliary tuberculoma were scattered in multiple, with isointensity signal or T1 hypointensity signal and T2 hyperintensity signal, contrast enhanced MRI scan indicated nodular enhancement or small annular enhance- ment. In 21 cases of 29 cases were complicated with the thickening of the dura, and contrast enhancement showed in line or in the strip enhancement. There were mainly cerebral tuberculoma cases with multiple primary, accounting for 75.8% （22/29） Conclusion： Typical cerebral tubereuloma has characteristic MR imaging features. The need to identify atypical cerebral tu- bereuloma with brain abscess, glioma and brain metastasis. Intraeranial multiple nodules or circular enhancement lesions, combined with hydrocephalus, dural enhancement of enhanced scanning were conducive to the diagnosis of cerebral tubereulo- ma. Combined with clinical laboratory examination and medical history, it can improve the diagnostic accuracy, reduce misdiagnosis, after antituberculosis treatment in shortterm follow - up MR imaging can also help to identify the diagnosis.

关 键 词：脑结核病 特殊征象 磁共振 

分 类 号：R529.3[医药卫生—内科学] R445.2[医药卫生—临床医学]