艾滋病相关性颅内隐球菌感染的MRI表现分析  

Analysis of MRI findings of AIDS related cryptococcal meningitis

作　　者：李超[1] 杜超[1] 许传军[1] 

机构地区：[1]江苏省南京市第二医院放射科,江苏南京210003

出　　处：《医学影像学杂志》2017年第10期1858-1862,共5页Journal of Medical Imaging

基　　金：2014年南京医学科技发展项目(编号:ZKX14029)

摘　　要：目的总结AIDS(acquired immunodeficiency syndrome,AIDS)合并颅内隐球菌感染患者的MRI特征,提高本病的早期诊断符合率,从而改善预后及疗效评估。方法回顾41例通过脑脊液检测确诊隐脑并且排除其他感染的AIDS患者的颅脑MRI图像。由两名神经影像专家对MR图像进行判读,对MR特征(边缘,数目,位置,信号特点)进行统计分析,总结其特征表现。结果 41例确诊为隐脑的AIDS患者中MR表现阳性患者19例。阳性组与阴性组之间两组间年龄、性别没有显著差异(P>0.05),MR表现阳性组中发病部位多位于基底节及侧脑室周围(78.9%)。MR常见征象是基底节区VR间隙(Virchow-Robin spaces)扩大(42.1%);弥散受限的胶样假性囊肿(21.1%);脑室扩张或脑积水(15.8%)。隐球菌脑膜炎(21.1%)多发生在额、顶、颞叶的脑膜增厚强化,邻近脑组织水肿。发生于脑内的隐球菌肉芽肿形成(21.1%)多为T_1低信号T_2高信号,增强后不均匀轻度强化。隐球菌室管膜炎(5.3%),表现为两侧脑室周围对称性晕状T_1低信号T_2高信号。结论隐脑在MR表现为基底节区VR间隙扩大,也可表现为基底节区异常信号,粟粒状强化,周围水肿。其中弥散受限的胶样假性囊肿与脑室扩张或脑积水具有一定特征。隐球菌脑膜炎时多为额、顶、颞叶软脑膜增厚强化,邻近脑组织水肿。隐球菌室管膜炎,表现为两侧脑室周围对称性晕状异常信号。Objective To summarize the MRI feature of AIDS with intracranial cryptococcal meningitis patients,in order to improve the early diagnosis of this disease,and improve the diagnostic accuracy,evaluation the prognosis and curative effect.Methods Retrospective analysis of brain MRI images of 41 cases diagnosed cryptococcal meningitis by cerebrospinal fluid detection and exclusion of other brain infection in patients with AIDS. The MR image interpretation by two neuroimaging experts on the characteristics of MR（ edge number,location,signal characteristics）. Thenr statistical analysis to summarizes its characteristics.Results Of 41 cases were diagnosed as cryptococcal meningitis in AIDS patients,19 patients had positive MR findings in. MR（ positive group）. There is no significant differences between the positive group and negative group in age and gender（ P〉0. 05）,Abnormal lesions of MR positive group mostly located around the basal ganglia and the lateral ventricle（ 78. 9%）. The common MR manifestation is dilated Virchow-Robin spaces（ 42. 1%）; ventricular dilatation（ 15. 8%）; Restricted diffusion of gelatinous pseudocysts（ 21. 1%）. Cryptococcal meningitis（ 21. 1%） occurred in the frontal or temporal lobe,and meningeal thickening and enhancement. Cryptococcal granuloma occurs in the brain（ 21. 1%）,it manifest T1 low signal T2 high signal and inhomogeneous enhancement. Cryptococcal ependymitis（ 5. 3%） showed bilateral symmetrical per-ventricular halo T1 low signal T2 high signal. Conclusion The MRI manifestations of Cryptococcal meningitis is mostly dilated VR spaces in basal ganglia,and further development showed abnormal signal in basal ganglia with miliary enhancement and peripheral edema. Gelatinous pseudocysts and ventricular expansion has certain characteristics. Cryptococcal meningitis manifested leptomeningeal thickening and enhancement and adjacent brain tissue edema. Cryptococcal ependymitis showed bilateral symmetrical per-ventricular halo abnormal signal.

关 键 词：艾滋病 隐球菌脑炎 脑膜炎 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R512.91[医药卫生—诊断学]