真菌性脑膜炎与颅内真菌性肉芽肿的CT和MR表现特点分析  

Analysis on the characteristics of CT and MR about fungal meningitis and intracranial fungal granuloma

作　　者：向成燕 梁志鹏 张俊 胡家海 XIANG Cheng-yan;LIANG Zhi-peng;ZHANG Jun(Department of Medical Imaging,Sir Run Run Hospital,Nanjing Medical University,Nanjing211100,China.)

机构地区：[1]南京医科大学附属逸夫医院影像科,江苏南京211100

出　　处：《中国医学装备》2018年第10期51-54,共4页China Medical Equipment

摘　　要：目的:探究真菌性脑膜炎和颅内真菌性肉芽肿的影像学表现特点。方法:回顾性分析22例真菌性脑膜炎及38例颅内真菌性肉芽肿患者病例资料,所有患者均通过病原学培养证实为真菌性感染,分析患者的X射线计算机断层成像(CT)和磁共振成像(MRI)图像及其特征。结果:真菌性脑膜炎的影像学特征为炎症累及范围较广,多累及基底池及大脑凸面的脑膜;在CT上表现为累及脑池密度增高,脑沟脑回变浅,增强CT-MRI呈铸型强化。真菌性肉芽肿的影像学特征的38例患者中多发病灶32例,单发病灶仅为6例;CT上其内多呈混杂密度,肉芽肿壁欠规整、厚壁,且不连续,有"开环征"表现;MRI上T1WI多为低信号影,且信号表现不一,多呈稍短T2信号,增强扫描示肉芽肿为不规则强化,多见局部脑膜强化及类脑肉芽肿样强化。结论:真菌性脑膜炎的影像学表现不具有特征,强化时虽呈铸型强化,但仍难以与其他病菌如结核导致的脑膜炎相区分开;而颅内真菌性肉芽肿的影像学表现具有特点,通过多发病灶、肉芽肿壁的"开环征"、稍短T2信号可对其进行诊断。Objective： To explore the characteristic of imaging manifestations of fungal meningitis and intracranial fungal granuloma. Methods： The data of 22 patients with fungal meningitis and 38 patients with intracranial fungal granuloma were retrospectively analyzed. All of them were fungal infections that were verified by etiological culture. The image and image＇s characteristics of CT and MRI of patients were analyzed. Results： The imaging characteristics of fungal meningitis are as follows： it＇s involved range is wider, and most of them involved the basal cistern and the meninx of cerebral convexity. And the relative CT manifestation were the density of involved cistern increased, and cerebral anfractuosity and cerebral gyrus were shallow, and enhanced CT-MRI appeared moulded intensification. In 38 patients with intracranial fungal granuloma, 32 cases existed multiple lesions, and single lesion only was found in 6 cases. On the manifestation of CT, most of them appeared confounding density, and the walls of granuloma were not regular and were thick, and most of them had manifestation of open-ring sign. And on the manifestation of MRI, the most of T1WI were low signal shadow, and the appearances of signal were not consistency, and most of signal were short T2 signal. And the enhanced scan indicated that granulomas were irregular enhancement, and most of them were local meninx enhancement and the enhancement of similar cerebral granuloma. Conclusion： The imaging manifestation of fungal meningitis have not characteristics. Although it appears mould enhancement when it is intensified, it still is difficult to identify fungal meningitis and other meningitides that were infected by other pathogenic bacteria, for example tubercle bacillus. Besides, the imaging manifestation of intracranial fungal granuloma have characteristics. And it can be diagnosed by using multiple lesions, open-ring sign of granuloma wall and shorter T2 signal.

关 键 词：真菌性脑膜炎 颅内真菌性肉芽肿 CT 磁共振成像 

分 类 号：R814.42[医药卫生—影像医学与核医学]