真菌性脑脓肿和脑肉芽肿临床和MR表现  

Clinical and MR features of fungal encephalopyosis and granuloma

作　　者：鱼潇 孙亲利[2] 荐志洁[2] 高洁[2] 鱼博浪[2] 

机构地区：[1]西安交通大学第一附属医院神经外科,陕西西安710061 [2]西安交通大学第一附属医院医学影像科,陕西西安710061

出　　处：《实用放射学杂志》2016年第12期1842-1844,共3页Journal of Practical Radiology

摘　　要：目的：探讨真菌性脑脓肿和真菌性脑肉芽肿的临床和 MR表现特点。方法回顾性分析10例经手术病理或临床血清监测证实的真菌性脑脓肿和真菌性脑肉芽肿的临床和 MR资料,分析临床情况和 MR信号、病变强化、扩散加权成像（DWI）和磁共振波谱（MRS）表现特点。结果6例真菌性脑脓肿,2例发生于鞍区手术后,脓肿位于鞍内和鞍上。2例发生在额部手术后,脓肿位于额叶,其中1例脓肿多发。2例无手术史者脓肿分别位于左侧额叶和右侧小脑。脓肿壁薄,呈环形显著强化,张力高,DWI 呈高信号。1例巨大真菌性肉芽肿位于额叶并伸入鼻窦,显著不均匀强化,胆碱（Cho）明显升高。3例隐球菌肉芽肿为多发病灶,以双侧基底节分布为主,2例合并脑膜炎。结论真菌性脑脓肿MR表现类似细菌性脑脓肿,区别困难。脑真菌性肉芽肿MRS可表现有Cho明显升高,可能与胶质增生有关。脑隐球菌性肉芽肿MR表现有一定的特点,病灶多发,以基底节区分布为主,常合并有脑膜炎。Objective To investigate the clinical and MR features of fungal encephalopyosis and fungal granuloma.Methods The clinical and MR data of 10 cases with fungal encephalopyosis and fungal granuloma confirmed by surgical pathology or clinical serum were analyzed retrospectively.Then we analyzed the clinical conditions,MR signals,lesion enhancement,DWI and MRS performance characteristics of the 10 cases.Results Six cases were fungal encephalopyosis,among which 2 cases occurred in the sella turcica after surgery which located in and above the sella turcica.2 cases occurred in the frontal lobe after frontal surgery and 1 case of them was multiple encephalopyosis.2 cases of encephalopyosis without operation history were located in the left frontal lobe and right cerebellum respectively.The abscess walls of these cases were thin and showed high tension.Furthermore,it had annular significant signal enhancement and high signal in DWI scan.One case of huge fungal granuloma located in the frontal lobe and into the sinuses which showed uneven signal enhancement. The Cho level was significantly increased.Three cases of cryptococcal granuloma showed multiple lesions located in the bilateral basal ganglia region and 2 out of them accompanied with cephalomeningitis.Conclusion The MR performance of fungal encephalopyosis was quite similar with bacterial brain abscesses,which makes the differential diagnosis difficult.The brain fungal granuloma MRS may display a significant increase of Cho level which might be related with gliosis.It shows certain characteristics of brain MR performance of cryptococcal granuloma which are multiple lesions,preferential distribution of basal ganglia region and accompanying cephalomeningitis.

关 键 词：真菌感染 脑脓肿 肉芽肿 磁共振成像 

分 类 号：R742[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]