脑实质结核治疗后活性演变的DWI表现及DCE-MRI量化分析  

DWI and DCE-MRI Quantitative Analysis of Activity Evolution of Brain Parenchymal Tuberculosis after Treatment

作　　者：丁爽 努尔阿丽牙·艾力 贾文霄 DING Shuang;Nueraliya Aili;JIA Wen-xiao(Department of Radiology,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,P.R.C.)

机构地区：[1]新疆医科大学第一附属医院影像中心,乌鲁木齐830054

出　　处：《中国医学计算机成像杂志》2020年第4期301-305,共5页Chinese Computed Medical Imaging

基　　金：新疆维吾尔自治区自然科学基金项目No.2015211C041。

摘　　要：目的:探讨DWI及DCE-MRI量化指标在评价脑结核治疗前后病灶演变规律中的应用价值。方法:连续收集脑实质结核病患者39例,予抗结核治疗前、治疗后1个月内行DWI及DCE-MRI检查,同时在影像学检查前后3天内收集患者脑脊液行细胞因子IFN-γ含量、VEGF,MMP-9含量测定:按照颅内结核诊疗常规对本组病例进行抗结核治疗,选取39例脑结核患者中直径≥5.0mm,且在随访期间未消失的病灶进行K^trans等定量参数值的测量,动态观察各定量参数值的变化及DWI信号变化,并与相关酶联免疫检查结果进行相关性分析。结果:29例患者临床表现及影像学检查趋向好转,可测量病灶83个,10例患者临床实验室或影像学提示病情恶化,可测量病灶56个。治疗有效组中K^trans、Kep、Ve值在治疗1个月后逐渐下降,而病情恶化组中结核病灶的K^trans、Kep、Ve值较治疗前有所增高(P<0.05);K^trans、Kep、Ve值与脑脊液内细胞因子IFN-γ含量、VEGF.MMP-9水平均具有相关性(P<0.05)。治疗后结核病灶的DWI信号表现多样,缺乏特异性。结论:DCE-MRI功能成像技术中的定量指标K^trans、Kep、Ve在一定程度上有利于反映脑结核的活动性及监测抗结核药物的效果。Purpose: To explore the application value of DWI and DCE-MRI quantitative parameters in theevaluation of brain tuberculosis lesions before and after treatment. Methods: Thirty-nine patients with cerebralparenchymal tuberculosis were enrolled. DWI and DCE-MRI were performed before and Ⅰ month after antituberculosistreatment. At the same time, the level of IFN - γ, VEGF and MMP-9 in CSF were measured in threedays before and after imaging examination. The patients were treated with anti-tuberculosis methods according tothe routine diagnosis and treatment of intracranial tuberculosis. Quantitative parameters such as K^trans were measuredin 39 cases of brain tuberculosis whose diameter was ≥ 5.0mm and did not disappear during the follow-up period,and the changes of quantitative parameters and DWI signals were observed dynamically. The correlation between thequantitative parameters of DCE-MRI and the results of enzyme-linked immunosorbent assay was analyzed. Results:The clinical manifestations and imaging features of 29 patients were improved, 83 lesions could be measured. The clinical laboratory results or imaging findings of 10 patients indicated that the disease was worsened and 56 lesionscould be measured. The values of K^trans,Kep and Ve in the effective group decreased gradually after 1 month oftreatment, while the values of K^trans,Kep and Ve in the deteriorated group were higher than those before treatment (P <0.05). The values of K^trans,Kep and Ve were correlated with the level of IFN - γ, VEGF and MMP-9 in CSF (P < 0.05).The DWI signal of tuberculosis after treatment was various and lack of specificity. Conclusion: To some extent, thequantitative parameters K^trans,Kep and Ve in DCE-MRI are helpful to reflect the activity of brain tuberculosis andmonitor the effect of anti-tuberculosis drugs.

关 键 词：脑结核 DWI DCE-MRI 治疗 评价 

分 类 号：R445.2[医药卫生—影像医学与核医学]