脑脓肿的临床表现及MRI特征分析  

The clinical features and MRI findings of brain abscess

作　　者：黄远军[1] 曹笃[2] 段莉[1] 张鸿志[1] 周泽芳[1] Huang Yuanjun;Cao Du;Duan Li;Zharig Hongzhi;Zhou Zefang(Department of Neurology the First Branch of the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016, China;Department of Neurology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016, China)

机构地区：[1]重庆医科大学附属第一医院第一分院神经内科,重庆400016 [2]重庆医科大学附属第一医院神经内科,重庆400016

出　　处：《医药前沿》2019年第15期21-22,共2页Journal of Frontiers of Medicine

摘　　要：目的:通过分析脑脓肿的临床症状及MRI影像特点,提高临床医师对脑脓肿临床特征及MRI表现的认识.方法:纳入经手术病理证实为脑脓肿的住院患者31例,分析其主要症状及影像学特征。结果:单一病灶为28例,多发病灶3例,额叶、颞叶、顶叶、枕叶、小脑、基底节区病灶分别为12、9、7、4、2、1个。感染来源:耳源性3例,开颅术后3例,脑外伤后1例,血源性7例,隐源性17例(54.8%)。主要症状依次为头痛22例(71.0%),局灶性神经功能缺损症状17例(54.8%),颅内压升高12例(38.7%),发热10例(32.3%),意识改变6例(19.4%),癫痫5例(16.1%)。30例患者在术前完成了MRI检查,全部脓肿轮廓清晰,均有包膜形成。1例脓腔内呈气液平改变,T2WI、DWI均呈分隔样改变的高低信号,余29例T2WI呈高信号,DWI呈高信号,ADC值减低。脓肿壁在T2WI上均可见低信号暗带环及靶环征。增强后全部可见完整的强化环,脓腔无强化。脓肿周围见T1WI低信号、T2WI高信号的水肿,有明显的占位效应。结论:脑脓肿好发于额叶、颞叶、顶叶,以隐源性最为多见。头痛为脑脓肿的最常见症状,其次为局灶性症状、颅内压升高、发热。MRI检查对脑脓肿的诊断具有很高价值,T2WI序列的环形低信号,联合环形结构内的DWI高信号,对脑脓肿的敏感性为100%。Objective To investigate the clinical symptoms and MRI imaging findings in patients with brain abscess and to improve clinicians understanding about the clinical and imaging characteristics of brain abscess.Methods Retrospective analysis was made on the clniral record data of31 hospitalized patients with brain abscess confirmed by surgery and pathoIogy.The patients' main clinical symptoms and MRI characteristics were analyzed.Results 28 cases were single lesions and 3 cases were multiple lesions.The lesions' number of frontal lobe,temporal lofce,parietal lobe,ocdpital lobe,cerebellum and basal ganglia were 12,9,7,4,2,1 respectively.Sources of infection:3 cases of otogenic,3 cases of craniotomy;1 case of traumatic brain injuiy7 cases of blood-bome,and 17 cases of cryptogenic (54.8%).Of these 31 patients,22(71.0%) had headache, 17(54.8%) had focal neurological deficit, 12(38.7%) had elevated intracranial pressure, 10 (32.3%) had fevei;6(19.4%) had consciousness change and 5(16.1%) with epilepsy30 patients underwent MRI before surgeiyall abscesses were clearly defined and had envelope formation.Eexcept one case showed high&low separated signal on T2WI&DWI,the others showed high signal on T2WI&DWI and ADC value decreased.The wall of the abscess showed a ring-shaped low signal and target signal sign on T2WI.Complete ring enhancement was visible in all lesions after enhanped scan but none enhancement in the abscessAll the abscesses have different degrees of edema around with obvious occupying effectconclusion Brain abscesses often occur in the frontal lobe, temporal lobe and parietal lobe,with cryptogenicity being the most common.Headache is the most common symptom of brain abscess,fbllowed by focal symptoms, elevated intracranial pressure and fevenMRI examination has important value in diagnosis of brain abscess.Especially the ring-shaped low signal on T2W1 sequence^ombined with the DWI high signal in the ring structure, the sensitivity to brain abscess is 100%.

关 键 词：脑脓肿 临床表现 磁共振 

分 类 号：R742.7[医药卫生—神经病学与精神病学]