磁共振弥散加权成像及灌注加权成像在颅内结核与病毒性脑炎鉴别诊断中的应用  

Application of diffusion weighted imaging and perfusion weighted imaging in the differentiation of intracranial tuberculosis and viral encephalitis

作　　者：邢小微[1] 张家堂[1] 娄昕[2] 王玉林[2] 李金锋[2] 田成林[1] 黄旭升[1] 郎森阳[1] 马林[2] 于生元[1] XING Xiao-wei;ZHANG Jia-tang;LOU Xin;WANG Yu-lin;LI Jin-feng;TIAN Cheng-lin;HUANG Xu-sheng;LANG Sen-yang;MA Lin;YU Sheng-yuan(Department of Neurology;Department of Radiology, Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院神经内科,北京100853 [2]解放军总医院放射科,北京100853

出　　处：《解放军医学杂志》2018年第6期494-498,共5页Medical Journal of Chinese People's Liberation Army

基　　金：全军医学科技"十二五"科研项目(CWS11J064);三亚市医疗卫生科技创新项目(YW1308)~~

摘　　要：目的评价磁共振(MRI)弥散加权成像(DWI)和灌注加权成像(PWI)在颅内结核、病毒性脑炎鉴别诊断中的价值和作用。方法对19例颅内结核患者和23例病毒性脑炎患者在急性或亚急性阶段进行MRI常规扫描、DWI和PWI检查。测量并计算两组病例的相对表观弥散系数(rADC)、相对脑血流量(rCBF)和相对脑血容量(rCBV)值,并比较数值的差异。结果 DWI结果显示病毒性脑炎病灶区平均ADC值低于对侧正常脑白质区,颅内结核病灶区的平均ADC值高于对侧正常脑白质区,而病毒性脑炎组的rADC值小于颅内结核组(P<0.05),差异有统计学意义;PWI结果显示,颅内结核组rCBV、rCBF值小于病毒性脑炎组(P<0.05),差异有统计学意义。结论 rADC、rCBV、rCBF能为鉴别颅内结核、病毒性脑炎提供依据,即病毒性脑炎病灶区rADC低于颅内结核。颅内结核病灶区的灌注(CBF、CBV)较对侧正常脑组织灌注减低,而病毒性脑炎病灶区灌注较对侧正常脑组织升高。Objective To evaluate the value and effects of diffusion weighted imaging（DWI） and perfusion weighted imaging（PWI） of magnetic resonance imaging（MRI） in differential diagnosis of intracranial tuberculosis and viral encephalitis.Methods The conventional MRI, DWI and PWI were performed in 19 patients with intracranial tuberculosis and 23 patients with viral encephalitis during their acute or subacute phase. The values of relative apparent diffusion coefficient（rADC）, relative cerebral blood volumes（rCBV） and relative cerebral blood flow（rCBF） in the two groups were detected and calculated, and then statistical analyses were performed. Results DWI results revealed that the average value of ADC was lower in the focal area of viral encephalitis than in the contralateral normal white matter area, but was higher in the focal area of intracranial tuberculosis than in the contralateral normal white matter area, and the rADC value in patients with viral encephalitis was lower than in patients with intracranial tuberculosis（P〈0.05）. The PWI results revealed that the values of rCBV and rCBF were lower in patients with intracranial tuberculosis than in patients with viral encephalitis（P〈0.05）. Conclusion The values of ADC, rADC, rCBV and rCBF are helpful in differential diagnosis of intracranial tuberculosis and viral encephalitis.

关 键 词：颅内结核 病毒性脑炎 弥散加权成像 灌注加权成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R512.3[医药卫生—诊断学]