中枢神经系统结核感染的CT与MRI表现(附49例分析)  

CT and MRI Manifestatios of Tuberculosis in the Central Nervous System (Analyses of 49 cases).

作　　者：樊长姝[1] 李菁[2] 

机构地区：[1]北京铁路总医院放射诊断中心,北京市100038 [2]北京铁路总医院脑系科,北京市100038

出　　处：《实用医学影像杂志》1997年第3期4-7,共4页Journal of Practical Medical Imaging

摘　　要：目的:评价和比较CT与MRI 在中枢神经系统结核诊断中的作用。材料与方法:49例中枢神经系统结核患者,男25例、女24例,年龄为12～78岁,平均36.6岁。依据其临床表现,实验室检查,以及影像特征而确诊和分型。全部病例皆行CT检查,其中18例进行MRI检查。结果:所有病例依其病变侵及部位分为3型:脑膜炎型23例,脑膜脑炎型25例,以及脊髓型1例。23例脑膜炎型患者的CT检查,其中14例有脑积水、基底池及小脑幕密度增高等改变。但未发现脑实质的病变,其中2例又经MRI检查,结果相同。25例脑膜脑炎型患者的CT检查,其中18例除有上述脑膜炎型改变外,还可看到脑实质的损害。MRI检查了15例(CT检查阴性者7例、阳性者8例)均可看到脑膜增厚,脑内干酪样病灶,结核性炎症,粟粒结节及结核瘤等改变。1例脊髓型患者CT检查为阴性,然而经MRI检查却发现其脊髓增粗,蛛网膜下腔变窄,蛛网膜增厚。结论:中枢神经系统结核感染,利用CT与MRI皆可发现异常改变。MRI在显示脑脊髓实质性病变上优于CT,然而,CT在显示脑膜增厚及钙化方面却又好于MRI。Purpose: To evaluate and compare the usefulness of CT and MRI in the diagnosis of patients with tuberculous infection in the central nervous system. Materials and Methods: Fourty - nine patients with tuberculous infection in the central nervous system, in which include 25 male and 24 female with age of 12 - 78 old years (mean , 36. 6 years) all initially underwent CT examination and 18 patients of them also underwent MRI examination, and then obtained the accurate diagnosis and the classification from their clinical manifestations and imaging findings. Results: Based on the invasive location of the lesion, 49 Patients were divided into following three types: meningitic type(23 cases), meningio - encephalitic type (25 cases), and spinal type(1 case) . For the case of CT examination, 14 of 23 meningitic type were found the hydrocephalus, high density of basal cisterns and /or cerebellar tentorium, but no abnormalities were found in brain parenchyma, in addition, 2 cases in them who underwent MRI examination were also the same findings. 18 of 25 meningio - encephalitic type were not only found the lesion mentioned above but were found the lesion in brain parenchyma. For the case of MRI examination. 15 patients who include 7 cases of CT nigative and 8 cases of CT positive were found the thickening of brain meninges, caseous foci in brain, tuberculous inflammation or nodules, and tuberculoma et c. One patient with spinal type when it was examined by CT was the negative result but MRI examination found the enlargement of spinal cord , narrowing of subarachnoid space, and thickening of arachnoid membrane. Conclusion: When there are tuberculous infections in central nervous system, CT and /or MRI technique all can find the anomalous changes, relatively speaking, the display of MRI for the lesion in brain - spinal parenchyma is superior to CT, however, the display of CT for the thickening of meninges and the calcification is better than that of MRI.

关 键 词：结核病 CNS CT MRI 

分 类 号：R8[医药卫生—临床医学] R4