脑实质结核增强MRI细节表现研究及与脑转移瘤的对比分析  

Study on the detailed features of enhanced MRI in brain parenchymal tuberculosis and comparative analysis with brain metastases

作　　者：梁瑞云 任会丽[1] 黎惠如[1] 李城城 方伟军[1] 宋敏[1] 张晖[1] Liang Ruiyun;Ren Huili;Li Huiru;Li Chengcheng;Fang Weijun;Song Min;Zhang Hui(Department of Radiology,Guangzhou Chest Hospital,Guangzhou Key Laboratory of Tuberculosis Research,Guangdong Guangzhou 510095,China;Department of Internal Medicine,Guangzhou Chest Hospital,Guangzhou Key Laboratory of Tuberculosis Research,Guangdong Guangzhou 510095,China)

机构地区：[1]广州市胸科医院放射科,广州市结核病研究重点实验室,广东广州510095 [2]广州市胸科医院内科,广州市结核病研究重点实验室,广东广州510095

出　　处：《新发传染病电子杂志》2023年第5期29-35,共7页Electronic Journal of Emerging Infectious Diseases

基　　金：广州市卫生健康科技项目(20231A010030);广州市医学重点学科(2021-2023)结核病学;2023年度广州市科技计划项目(2023A03J0539)。

摘　　要：目的分析脑实质结核与脑转移瘤患者的增强MRI细节表现特征,探讨两者的异同。方法选取广州市胸科医院2019年1月至2020年12月经临床确诊的72例脑实质结核患者(研究组),同时收集同期符合纳入标准的脑转移瘤患者72例(对照组)进行对比分析,匹配原则为性别相同、年龄相差2岁以内。通过对比两组患者增强MRI细节征象,分析脑实质结核与转移瘤的增强MRI细节表现特征。结果①脑实质结核(研究组)多发病灶共65例(90.28%);当病灶<0.3cm时,以结节全瘤强化为主,共22例(30.56%);当病灶≥0.3cm时,以环形强化为主,共58例(80.56%)。②研究组簇状强化、病灶外周无强化低信号环、环形强化壁厚薄均匀、中心细小分隔、中心轻度强化环(环中环)检出率分别为30.56%(22/72)、44.44%(32/72)、63.89%(46/72)、38.89%(28/72)、16.67%(12/72);对照组分别为13.89%(10/72)、23.61%(17/72)、31.94%(23/72)、16.67%(12/72)、4.17%(3/72),两组比较差异均有统计学意义(均P<0.05)。对照组环形强化壁厚薄不均、内壁结节检出率分别为61.11%(44/72)、30.56%(22/72);研究组分别为38.89%(28/72)、8.33%(6/72),两组比较差异均有统计学意义(χ^(2)=7.111、11.350,P=0.008、0.001)。结论脑实质结核患者病灶多发,当病灶<0.3cm时,以结节全瘤强化为主要表现,当病灶≥0.3cm时,以环形强化为主要表现。脑实质结核增强MRI扫描更易检出簇状强化、病灶外周无强化低信号环、环形强化壁厚薄均匀、中心细小分隔、中心轻度强化环(环中环);脑转移瘤增强MRI扫描更易检出环形强化壁厚薄不均、内壁结节。两者的增强MRI细节征象有区别,可为临床早期诊断与治疗提供帮助。Objective To analyze the detailed features of contrast-enhanced MRI in patients with brain parenchymal tuberculosis and metastasis,and explore the similarities and differences between the two.Method A retrospective analysis of 72 cases of brain parenchyma tuberculosis(research group)clinically diagnosed in Guangzhou Chest Hospital from January 2019 to December 2020,at the same time,72 patients(control group)with brain metastases who met the inclusion criteria in the same period were collected for comparative analysis,the matching principle was the same sex and age difference within 2 years.Through the comparison of the detailed signs of enhanced MRI in the two groups,objective to analyze the detailed features of brain parenchyma tuberculosis on enhanced MRI.Result①Multiple lesions of brain parenchyma tuberculosis(research group):65 cases(90.28%);when the focus was<0.3cm,it mainly enhanced by the whole nodule,the detection rate in this group was 22 cases(35.56%);when the focus was≥0.3cm,it mainly annular strengthening,the detection rate in this group was 58 cases(80.56%).②In the research Group,the detection rates of lustered enhancement,no enhanced low signal ring around the lesion,uniform thickness of annular enhancement wall,small central partition,and mild central enhancement ring(ring in the ring)were 30.56%(22/72),44.44%(32/72),63.89%(46/72),38.89(28/72)、16.67%(12/72)respectively;In the control group,they were 13.89%(10/72),23.61%(17/72),31.94%(23/72),16.67%(12/72),4.17%(3/72)respectively;The difference between the two groups was statistically significant(All P<0.05).In the control group,the detection rates of uneven thickness of annular enhanced wall and inner wall nodules were 61.11%(44/72)and 30.56%(22/72)respectively;In the study group,they were 38.89%(28/72)、8.33%(6/72)respectively;The difference between the two groups was statistically significant(χ^(2)=7.111、11.350,P=0.008、0.001 respectively).Conclusion Multiple lesions was the main manifestations of cerebral tuberculosis,when the focus

关 键 词：脑结核 脑转移瘤 磁共振成像 动态增强 细节表现 比较分析 

分 类 号：R529.3[医药卫生—内科学]