功能磁共振成像对颅内结核的诊断价值评价  

Value of Functional Magnetic Resonance Imaging for the Detection of Intracranial Tuberculosis

作　　者：罗竹人[1] 蔡琳婷 岳岑 郭春英 汪艳[1] LUO Zhuren;CAI Linting;YUE Cen;GUO Chunying;WANG Yan(Department of Radiology,The First Affiliated Hospital of XiamenUniversity,Xiamen Fujian 361003,China;Department of Neurology,The First Affiliated Hospital of XiamenUniversity,Xiamen Fujian 361003,China)

机构地区：[1]厦门大学附属第一医院放射科,福建厦门361003 [2]厦门大学附属第一医院神经内科,福建厦门361003

出　　处：《中国卫生标准管理》2019年第6期94-97,共4页China Health Standard Management

基　　金：国家自然科学基金青年科学基金项目(81401459)

摘　　要：目的探讨弥散加权成像(DWI)、灌注加权成像(PWI)及磁共振波谱成像(MRS)定量指标在颅内结核诊断中的价值。方法收集本院2017年7月—2018年7月临床确诊为颅内结核的36例患者(其中脑膜结核11例,脑实质结核8例,混合型颅内结核17例)和8例低级别胶质瘤患者为研究对象,在治疗前或术前进行头颅MRI常规及功能影像学检查,分析其影像学表现,测量并计算脑实质结核和低级别胶质瘤病灶的DWI相对表观弥散系数(rADC)、PWI相对脑血流量(rCBF)、相对脑血容量(rCBV)及MRS的Cho/Cr、Cho/NAA,并分析其差异性。结果 (1)颅内结核MRI表现具有一定特征性,MRI能清晰显示病变及其周围情况;(2)DWI:脑实质结核rADC值(1.305±0.114)小于低级别胶质瘤(1.447±0.051);(3)PWI:脑实质结核rCBF(0.580±0.038)及rCBV(0.497±0.019)分别小于低级别胶质瘤(1.745±0.040)及(1.856±0.073);(4)MRS:脑实质结核Cho/Cr(1.793±0.038)及Cho/NAA(1.417±0.080)分别小于低级别胶质瘤(2.339±0.076)及(2.193±0.048);以上结果比较差异均具有统计学意义,P <0.05。结论功能磁共振成像诊断颅内结核具有一定临床价值:DWI的r ADC、PWI的r CBF和r CBV及MRS的Cho/Cr和Cho/NAA能够为鉴别脑实质结核和低级别胶质瘤提供依据。Objective To investigate the value of quantitative diffusion weighted imaging(DWI),perfusion weighted imaging(PWI)and magnetic resonance spectroscopy(MRS)in the diagnosis of intracranial tuberculosis.Methods From July 2017 to July 2018,36 patients with intracranial tuberculosis(including 11 cases of meningeal tuberculosis,8 cases of brain parenchymal tuberculosis and 17 cases of mixed intracranial tuberculosis)and 8 cases of low grade gliomas were collected.The conventional and functional MR imaging in our hospital were performed in all cases before treatments or operations.Morphological characteristics of lesions were observed.Furthermore,the relative apparent diffusion coefficient(rADC)values,relative cerebral blood flow(rCBF),relative cerebral blood volumes(rCBV),and the ratios of Cho/Cr and Cho/NAA of the lesions in brain parenchymal tuberculosis and low grade gliomas were measured and their variances were analyzed.Results(1)MRI manifestations of intracranial tuberculosis had certain characteristics.The lesions and surrounding conditions were clearly shown on MRI;(2)DWI:The rADC value of brain parenchymal tuberculosis was(1.305±0.114),which was lower than(1.447±0.051)of low grade gliomas;(3)PWI:The rCBF and rCBV value of brain parenchymal tuberculosis was(0.580±0.038)and(0.497±0.019),which was lower than(1.745±0.040)and(1.856±0.073)of low grade gliomas,respectively;(4)MRS:The ratios of Cho/Cr and Cho/NAA in the mass of brain parenchymal tuberculosis was(1.793±0.038)and(1.417±0.080),which was lower than(2.339±0.076)and(2.193±0.048)of low grade gliomas,respectively.The above results showed statistical difference(P<0.05).Conclusion Functional magnetic resonance imaging was valuable for diagnosis of intracranial tuberculosis:The rADC value of DWI,the rCBF and rCBV value of PWI,and the ratios of Cho/Cr and Cho/NAA in MRS can provide evidence for differentiating diagnosis between intracranial tuberculosis and low grade gliomas.

关 键 词：颅内结核 脑实质结核 低级别胶质瘤 功能磁共振成像 弥散加权成像 灌注加权成像 磁共振波谱成像 

分 类 号：R445[医药卫生—影像医学与核医学]