摘要
目的评价MRI和脑脊液检查在颅内结核诊断作用,探讨颅内结核诊断难点,明确诊断思路。方法回顾性分析71例颅内结核患者的临床资料,分析其MRI和脑脊液检查结果。结果 MRI结果显示,单纯脑实质异常32例,脑实质和脑膜同时异常28例;单纯脑实质结核患者中,典型结核性脑膜炎脑脊液改变4例,不典型脑脊液改变7例,单纯颅压增高4例。脑脊液检查结果显示,脑脊液改良抗酸染色发现结核菌12例,脑脊液结核菌培养阳性31例,颅内高压27例,脑脊液常规细胞数升高49例,脑脊液蛋白升高35例,脑脊液糖降低39例,氯化物降低42例,腺苷脱氨酶升高39例。71例颅内结核患者,MRI阳性60例(84.5%),脑脊液检测阳性54例(76.0%),2种方法检出阳性率差异无统计学意义(P>0.05),Kappa值=-0.232,提示2种方法的一致性并不好,各具优势。结论头颅MRI和脑脊液检查在颅内结核诊断中均有不可替代的作用,各有优势,临床疑似颅内结核病例,脑脊液细菌学检查阴性时,应进行头颅磁共振平扫+强化联合脑脊液细胞学及生化检查,以提高颅内结核的检出率。
Objective To evaluate the role of MRI and cerebrospinal fluid examination in the diagnosis of intracranial tuberculosis, to explore the difficulties in the diagnosis of intracranial tuberculosis, and to clarify the diagnostic ideas. Methods The clinical data of 71 patients with intracranial tuberculosis were retrospectively analyzed. The results of MRI and cerebrospinal fluid examination were analyzed. Results The results of MRI showed that 32 cases had abnormal brain parenchyma, 28 cases had abnormal brain parenchyma and meninges at the same time;only 4 cases had typical changes of cerebrospinal fluid in tuberculous meningitis, 7 cases had atypical changes of cerebrospinal fluid, and 4 cases had simple increase of intracranial pressure. The results of cerebrospinal fluid examination showed that 12 cases of tuberculosis were detected by modified acid-fast staining of cerebrospinal fluid, 31 cases were positive for cerebrospinal fluid tuberculosis culture, 27 cases were intracranial hypertension, 49 cases were increased in cerebrospinal fluid routine cells, 35 cases were increased in cerebrospinal fluid protein, 39 cases were decreased in cerebrospinal fluid sugar, 42 cases were decreased in chloride and 39 cases were increased in adenosine deaminase. There were 71 cases of intracranial tuberculosis, 60 cases(84.5%) were positive by MRI, 54 cases(76.0%) were positive by cerebrospinal fluid examination. There was no significant difference in the positive rate between the two methods(P>0.05), and the Kappa value was-0.232, suggesting that the consistency of the two methods was not good and each method had advantages. Conclusion Brain magnetic resonance plain scan plus enhanced scan and cerebrospinal fluid examination play an irreplaceable role in the diagnosis of intracranial tuberculosis. Each has its own advantages. When clinical suspected cases of intracranial tuberculosis and cerebrospinal fluid bacteriological examination is negative, the detection rate of intracranial tuberculosis should be improved by plain s
作者
李雯
陈颜强
张雪萍
白洪忠
LI Wen;CHEN Yan-qiang;ZHANG Xue-ping;BAI Hong-zhong(Department of Radiology,Hebei Chest Hospital,Shijiazhuang 050041,China;Department of Neurology,Hebei Chest Hospital,Shijiazhuang 050041,China;Department of Gynaecology and Obstetrics,Hebei Chest Hospital,Shijiazhuang 050041,China;President Office,Hebei Chest Hospital,Shijiazhuang 050041,China)
出处
《河北医科大学学报》
CAS
2019年第6期701-705,共5页
Journal of Hebei Medical University
基金
河北省医学科学研究重点课题(20150139)
关键词
颅内结核
磁共振成像
脑脊液检查
intracranial tuberculosis
magnetic resonance imaging
cerebrospinal fluid examination
