头颅CT与MRI在血行播散型肺结核并颅内结核的临床诊断价值  

Clinical diagnostic value of head CT and MRI in hematologic disseminated pulmonary tuberculosis complicated with intracranial tuberculosis

作　　者：李健康 邝红萍 赵畅 王赵杰[1] 梁瑞霞[1] LI Jian-kang;KUANG Hong-Ping;ZHAO Chang;WANG Zhao-Jie;LIANG Rui-Xia(Henan Provincial Chest Hospital,Henan Clinical Medical Research Center of Tuberculosis,Zhengzhou 450008,China)

机构地区：[1]河南省胸科医院,河南省结核病临床医学研究中心,郑州450008

出　　处：《医药论坛杂志》2023年第16期101-105,共5页Journal of Medical Forum

摘　　要：目的探讨头颅CT和MRI在血行播散型肺结核(hematologic disseminated pulmonary tuberculosis,HDPT)合并颅内结核的临床诊断价值。方法本研究以2013年01月至2022年5月河南省胸科医院收治的80例血行播散型肺结核合并颅内结核患者为试验对象,通过CT、MRI以及其他相关的实验室检查,回顾其临床表现及影像学特点,进而探讨MRI技术在颅内结核诊断中的应用价值。结果CT、MRI、增强MRI三种技术均可以准确地识别HDPT并颅内结核患者的脑部疾病,CT扫描可以达到65.0%的诊断率,而MRI平扫、MRI增强扫描可以达到80%、95.0%的诊断率,MRI增强扫描、头颅CT平扫对HDPT并发颅内结核的诊断阳性率的差异有统计学意义(χ^(2)=22.500,P<0.05),MRI平扫、头颅CT平扫对HDPT并发颅内结核诊断阳性率的差异有统计学意义(χ^(2)=4.514,P<0.05);MRI增强扫描、MRI平扫对早期HDPT并发颅内结核诊断阳性率的差异有统计学意义(χ^(2)=5.536,P<0.05);MRI平扫、CT平扫对早期HDPT并发颅内结核诊断阳性率的差异有统计学意义(χ^(2)=5.106,P<0.05)。结论对于颅内结核患者,头颅MRI平扫加增强扫描具有更高的诊断准确性,尤其在早期血行播散型肺结核合并颅内结核诊断中具有更加突出的优势,采用MRI扫描尤其是增强扫描可以作为早期颅内结核的检查方法,值得在临床实践中推广应用。Objective To evaluate the clinical diagnostic value of head CT and MRI in hematologic disseminated pulmonary tuberculosis(HDPT)complicated with intracranial tuberculosis.Methods In this study,80 patients with hematogenous disseminated pulmonary tuberculosis complicated with intracranial tuberculosis admitted from January 2013 to May 2022 were selected as test subjects.CT,MRI and other relevant laboratory examinations were performed to review their clinical manifestations and imaging characteristics,and further explore the application value of MRI technology in the diagnosis of intracranial tuberculosis.Results Studies have shown that CT,MRI and enhanced MRI can all accurately identify the brain diseases of patients with HDPT complicated with intracranial tuberculosis.CT scan can reach 65.0%diagnosis rate,while MRI plain scan and MRI enhanced scan can reach 80%and 95.0%diagnosis rate.The positive rates of HDPT complicated with intracranial tuberculosis were significantly different between enhanced MRI scan and skull CT scan(χ^(2)=22.500,P<0.05),while the positive rates of HDPT complicated with intracranial tuberculosis were significantly different between MRI scan and skull CT scan(χ^(2)=4.514,P<0.05).The positive rate of early HDPT complicated intracranial tuberculosis was significantly different between MRI enhanced scan and MRI plain scan(χ^(2)=5.536,P<0.05).The positive rate of early HDPT complicated intracranial tuberculosis was significantly different between plain MRI and CT scan(χ^(2)=5.106,P<0.05).Conclusion For patients with intracranial tuberculosis,head MRI plain scan plus enhanced scan has higher diagnostic accuracy,especially in the diagnosis of early disseminated pulmonary tuberculosis complicated with intracranial tuberculosis has more prominent advantages.MRI scan,especially enhanced scan,can be used as an examination method for early intracranial tuberculosis,and is worthy of vigorous promotion and application in clinical practice.

关 键 词：血行播散型肺结核 结核性脑膜脑炎 CT MRI 

分 类 号：R521.4[医药卫生—内科学]