造血干细胞移植后中枢神经系统真菌感染的影像学分析  

Image Analysis of Invasive Fungal Disease in Central Nervous System After Hematopoietic Stem Cell Transplantation

作　　者：程敏[1] 洪楠[1] CHENG Min;HONG Nan(Department of Radiology,Peking University People's Hospital,Beijing 100044,P.R.China)

机构地区：[1]北京大学人民医院放射科

出　　处：《临床放射学杂志》2019年第12期2232-2237,共6页Journal of Clinical Radiology

摘　　要：目的探讨造血干细胞移植(HSCT)后中枢神经系统真菌感染(CNS-IFD)的影像学特点及影像与预后的关系。方法回顾性分析20例异基因造血干细胞移植(allo-HSCT)后诊断为CNS-IFD患者的CT、MR影像学资料。分析影像学特点,并根据MR影像学表现分组,比较死亡率与随访时间,并用Kaplan Meier生存函数描绘生存曲线。结果首次CT阳性率为61.5%(8/13),阳性者均表现为片状低密度影;随访中83.3%(5/6)出现环形或点片状高密度。MR(18例)表现为环形、团块状、结节状、脑回状或片状病灶,其中8例环形、3例团块状病灶均在T2WI、扩散加权成像(DWI)出现低信号,T1WI出现高信号者分别有7例(87.5%)和2例(66.7%)。其余形态病灶未出现特征信号。环形病灶与其他病灶比较,患者死亡率相对较低(62.5%、100%,P=0.034),随访时间较长(P=0.018)。生存曲线显示环形病灶预后最佳,片状病灶其次,余均较差。结论HSCT后CNS-IFD的影像学表现多样,环形病灶、团块状病灶在T2WI、DWI会出现特征性的低信号,脑脓肿的预后可能较好。Objective To analyze the imaging characteristics of invasive fungal disease(IFD)in the central nervous system(CNS)after hematopoietic stem cell transplantation(HSCT),and the relationship with the prognosis.Methods CT and MR images of twenty patients,who underwent HSCT and were diagnosed as CNS-IFD,were retrospectively ana-lyzed.Imaging characteristics were recorded.According to MR imaging findings,mortality and follow-up time were com-pared,and the survival curve was plotted with Kaplan Meier survival function.Results The positive rate of initial CT was 61.5%(8/13).All positive cases showed low density shadows.Follow-up CT showed high density with ring,spot or patch shapes in 83.3%(5/6)cases.MR images(18 cases)showed lesions with ring,mass,nodule,gyrus or patch shapes.All lesions with ring(8 cases)and mass(3 cases)shapes showed low intensity on T2WI and DWI.High intensities on T1WI were displayed in 7 ring-like(87.5%)and 2 mass-shape(66.7%)lesions.Lesions with other shapes showed no characteristic appearance on MRI.Patients with ring-like lesions had a lower mortality(62.5%vs 100%,P=0.034)and a longer follow-up period(P=0.018).Conclusion Image appearances of CNS-IFD after HSCT are varied.Ring-like or mass lesions showed characteristic low intensities on T2WI and DWI.Abscesses may have a better prognosis.

关 键 词：中枢神经系统真菌感染 造血干细胞移植 体层摄影术 X线计算机 磁共振成像 

分 类 号：R457.7[医药卫生—治疗学] R742.9[医药卫生—临床医学] R445.2