MRI、脑脊液检查对颅内结核患者抗结核治疗效果的评估价值研究  

Value of MRI and cerebrospinal fluid examination in evaluating the curative effect of anti-tuberculosis treatment on patients with intracranial tuberculosis

作　　者：纪俊雨[1] 袁帅[1] 申静[1] 赵宇明[1] JI Junyu;YUAN Shuai;SHEN Jing;ZHAO Yuming(Department of Radiology,Hebei Chest Hospital,Shijiazhuang 050041,China)

机构地区：[1]河北省胸科医院放射科,石家庄050041

出　　处：《磁共振成像》2021年第5期65-68,共4页Chinese Journal of Magnetic Resonance Imaging

基　　金：河北省医学科学研究重点课题计划(编号:20170430)。

摘　　要：目的探究MRI、脑脊液检查对颅内结核患者抗结核治疗效果的评估价值。材料与方法选取2012年5月至2017年5月接受MRI检查的颅内结核患者400例,根据颅内结核类型分为单纯脑实质结核、结核性脑膜炎和混合型颅内结核,分析不同类型颅内结核的MRI特征、抗结核治疗过程中的动态MRI变化;收集患者脑脊液标本,行脑脊液生化、细胞学检查,分析抗结核治疗过程中脑脊液指标的变化情况,总结MRI、脑脊液检查对颅内结核患者抗结核治疗效果的评估价值。结果400例颅内结核患者检出单纯脑实质结核179例(44.75%)、结核性脑膜炎71例(17.75%)和混合型颅内结核150例(37.50%)。单纯脑实质结核患者共检出病灶425个病灶,其中粟粒型196个,结节型167个,结核瘤62个;MRI信号特点表现为:信号均匀,呈稍长或等T1信号、长或稍长T2信号;信号不均匀,中心呈长或等T1信号、长T2信号,边缘呈稍长或等T1、T2信号。增强扫描表现为:均匀强化、环形强化和实性强化;治疗后1个月、3个月和6个月粟粒型病灶消失率均高于结节型和结核瘤的病灶消失率。结核性脑膜炎患者MRI表现为脑回样T2WI高信号,T1WI等或低信号,增强后可见脑膜呈放射状强化,以鞍上池脑膜强化、环池脑膜强化和四叠体池脑膜强化为主;治疗后,脑膜强化程度及增厚减轻,脑膜病变均进一步好转。混合型颅内结核患者MRI表现同时具有单纯脑实质结核和结核性脑膜炎的MRI征象;治疗后,脑膜病变好转,部分出现脑膜结节增大或增多。治疗后1个月、3个月和6个月,颅内结核患者的蛋白、白细胞、中性粒细胞和淋巴细胞水平均较治疗前下降,氯化物和葡萄糖水平较治疗前升高(P<0.05)。结论不同类型的颅内结核存在明显MRI特征,明确颅内结核患者抗结核治疗期间的MRI动态及脑脊液生化、细胞学水平变化,有助于临床抗结核治疗疗效的评估及预测。Objective:To investigate the value of MRI and cerebrospinal fluid examination in evaluating the curative effect of anti-tuberculosis treatment on patients with intracranial tuberculosis.Materials and Methods:A total of 400 patients with intracranial tuberculosis who received MRI in the radiology department of the hospital from May 2012 to May 2017 were enrolled in the study.According to the type of intracranial tuberculosis,they were divided into simple brain parenchymal tuberculosis,tuberculous meningitis and mixed intracranial tuberculosis.The MRI characteristics of different types of intracranial tuberculosis and the dynamic MRI changes during anti-tuberculosis treatment were analyzed.Patients’cerebrospinal fluid samples were collected for biochemical and cytological examinations.Changes in cerebrospinal fluid indicators during anti-tuberculosis treatment were analyzed,and the value of MRI and cerebrospinal fluid examination in evaluating the curative effect of anti-tuberculosis treatment was summarized.Results:In 400 cases with intracranial tuberculosis,there were 179 cases(44.75%)with simple brain parenchymal tuberculosis,71 cases(17.75%)with tuberculous meningitis and 150 cases(37.50%)with mixed intracranial tuberculosis.A total of 425 lesions were detected in patients with simple brain parenchymal tuberculosis,including 196 of miliary type,167 of nodular type,and 62 tuberculomas.MRI findings were as follows:even signals,slightly longer or equal T1 signals,long or slightly longer T2 signals;uneven signals,long or equal T1 signals and long T2 signals in the center,slightly longer or equal T1 and T2 signals at the edge.Enhanced scan showed homogenous enhancement,circular enhancement and solid enhancement.The disappearance rate of miliary lesions was higher than that of nodular ones and tuberculoma at 1 month,3 months and 6 months after treatment.MRI of patients with tuberculous meningitis showed gyrus-like high signal on T2WI,equal or low signal on T1WI.After enhanced scan,the meninges showed radial enhance

关 键 词：颅内结核 脑实质结核 结核性脑膜炎 磁共振成像 脑脊液 细胞学技术 

分 类 号：R445.2[医药卫生—影像医学与核医学] R529.3[医药卫生—诊断学]