AIDS相关性中枢神经系统新型隐球菌病的MRI表现  

MRI Findings in AIDS Patients with Central Nervous System Cryptococcosis

作　　者：周津如 陈秀杰 朱宇智 李华丽 李咏梅[2] 周旭峰 ZHOU Jinru;CHEN Xiujie;ZHU Yuzhi;LI Huali;LI Yongmei;ZHOU Xufeng(Department of Radiology,Luoyang Central Hospital,Zhengzhou University;Department of Radiology,The First Affiliated Hospital,Chongqing Medical University)

机构地区：[1]郑州大学附属洛阳中心医院影像科 [2]重庆医科大学附属第一医院放射科

出　　处：《中国医学计算机成像杂志》2022年第2期168-172,共5页Chinese Computed Medical Imaging

摘　　要：目的:探讨艾滋病(AIDS)患者中枢神经系统新型隐球菌病的MR特征,为早期诊断和鉴别诊断提供一定帮助。方法:回顾性分析经脑脊液培养或墨汁染色证实的且临床及影像资料完整的17例AIDS患者中枢系统新型隐球菌病的影像学特征。9例行平扫及增强检查,8例行平扫检查。结果:16例患者具有阳性发现。血管周围间隙(VRS)增宽10例,表现为穿支动脉走行区小圆形长T1长T2信号影;脑膜炎3例,MR增强后可见大脑表面脑膜增厚并轻度强化;脑膜脑炎3例,病灶形态不规则,边界不清,T1WI呈低信号,T2WI呈稍高信号,FLAIR呈高信号,DWI扩散不受限;胶样假囊5例,表现为典型的基底节区肥皂泡样改变,T1WI呈稍低信号,T2WI呈稍高信号,FLAIR呈稍高信号,DWI扩散不受限,增强后无强化;肉芽肿1例,表现为颅内多发类圆形结节,周围可见水肿,T1WI呈低信号,T2WI呈高信号,FLAIR呈等信号,DWI呈边缘高信号,增强后环形强化。4例患者合并有脑积水表现。结论:AIDS相关中枢系统隐球菌病的MR表现主要为VRS增宽、胶样假囊、脑膜炎、脑膜脑炎、肉芽肿,其中VRS增宽和胶样假囊为最常见和最典型的表现。Purpose:To investigate the MR characteristics of central nervous system infection caused by Cryptococcus neoformans in AIDS patients for better diagnosis and differentiation in early stage.Methods:The imaging features of 17 cases of AIDS associated cryptococcus neoformans central infection confirmed by CSF culture or ink staining were retrospectively analyzed.Plain scan and enhanced scan were performed in 9 cases and plain scan in 8 cases.Results:All the 16 cases were with positive results in MR imaging.The Virchow-Robin space(VRS)was dilated in 10 cases,showing a small round lesion around the perforating artery,which appeared low signal intensity on T1WI,high signal intensity on T2WI.Meningitis was found in 3 cases,which showed thickened meninges and with enhancement on the surface of the brain.There were 3 cases of meningoencephalitis with irregular shape,unclear boundary,low signal intensity on T1WI,slightly high signal intensity on T2WI,high signal intensity on FLAIR and low signal intensity on DWI.Five cases of colloid pseudocyst showed typical small soap bubble-like changes in the basal ganglia region,with slightly low signal on T1WI,slightly high signal on T2WI,slightly high signal on FLAIR,no restricted diffusion on DWI,and with no enhancement.One case of cryptoczoccomas showed multiple round nodules with edema,with low signal intensity on T1WI,high signal intensity on T2WI,equal signal intensity on FLAIR,restriced diffusion in the peripheral area on DWI,and with ring enhancement.Four cases were complicated with hydrocephalus.Conclusion:The main manifestations of AIDSrelated central cryptococcosis are VRS dilatation,colloid pseudocyst,meningitis,meningoencephalitis and cryptococcomas,among which VRS dilatation and colloid pseudocyst are the most common and typical manifestations.

关 键 词：新型隐球菌 磁共振成像 人类免疫缺陷病毒感染 胶样假囊 隐球菌瘤 

分 类 号：R445.2[医药卫生—影像医学与核医学]