摘要
目的:分析颅内结核的MRI特点及抗结核治疗动态观察,为临床及时调整治疗方案提供依据,以改善患者预后。方法:选取2018年1月~2018年12月期间我院70例确诊的颅内结核患者进行回顾性分析,其中脑实质结核者40例,结核性脑膜炎者22例,混合型者8例。70例患者均接受动态随访检查,并按上述分型进行MRI特点、抗结核治疗动态情况。结果:70例患者中,脑实质病灶40例共882个病灶,粟粒病灶、结核结节、结核瘤均匀强化病灶分别为230(53.99%)、44(13.29%)、0(0%);环形强化实性中心不强化病灶分别为196(46.01%)、280(84.59%)、96(76.8%);环形强化液化中心病灶分别为0(0%)、7(2.12%)、29(23.2%)。X^2值分别约209.700、130.769、138.100,P<0.001,其强化特征差异有统计学意义;其中结核瘤中心干酪坏死但未液化时T2WI呈低信号亦具有特征性;同时结核瘤也是有呈簇状聚集的特点。动态观察发现,治疗3个月,粟粒病灶、结核结节、结核瘤消除率分别为52.35%、28.70%、0%;治疗后6个月后,三组病灶消除率分别为86.62%、63.44%、2.4%。其X^2值分别约127.293、306.94,P<0.001,消除差异有统计学意义,说明粟粒病灶吸收效果较其他病灶好。而结核性脑膜炎(22例)或混合型颅内结核(8例)短期疗效(3个月)较差。结论:笔者认为用粟粒型(结节≤3mm)、结节型(结节>3mm但≤5mm)及结核瘤型(结节>5mm)3种分型,可以将脑实质结核的MRI表现描述的较为客观,同时通过对结核性脑膜炎患者的MRI特点观察,笔者认为其MRI表现、特别是在发病部位及分布上有一定特征;另本次研究还通过对该组患者进行动态观察追踪,总结出颅内结核病灶在抗结核治疗过程中的演变过程,以此准确把握结核病灶的变化特点,从而更好的为临床治疗方案的调整提供依据。
Objective:to analyze the MRI features of intracranial tuberculosis and the dynamic observation of anti-tuberculosis treatment,so as to provide evidence for timely adjustment of treatment plan and improve the prognosis of patients.Methods:From January 2018 to December 2018,70 cases of intracranial tuberculosis were analyzed retrospectively,including 40 cases of cerebral parenchyma tuberculosis,22 cases of tuberculous meningitis,8 cases of mixed type.All the 70 patients accepted the dynamic follow-up examination,and according to the above classification,MRI features,anti-tuberculosis treatment dynamic situation.Results:Brain parenchymal lesions in 70 patients included 882 lesions in 40 cases.The uniformly enhanced lesions of miliary lesions,tuberculous nodules,and tuberculosis were 230(53.99%),44(13.29%),and 0(0%).The intensified lesions were 196(46.01%),280(84.59%),and 96(76.8%);the annular enhanced liquefaction center lesions were 0(0%),7(2.12%),and 29(23.2%),respectively.The X^2 values were about 209.700,130.769,and 138.100,respectively,and P<0.001.The enhancement characteristics were statistically significant.Among them,the T2 WI showed a low signal when the tuberculosis was necrotic but not liquefied.At the same time,the tuberculosis also showed clusters.Gathering characteristics.After 3 months treatment,Dynamic observations found that the elimination rates of miliary lesions,tuberculosis nodules,and tuberculosis were 52.35%,28.70%,and 0%,respectively;after 6 months of treatment,the lesion elimination rates of the three groups were 86.62%,63.44%,2.4%,respectively.The X^2 values were about 127.293,306.94,P<0.001,and the elimination difference was statistically significant,indicating that the absorption effect of millet lesions was better than other lesions.The short-term effect(3 months)of tuberculous meningitis or mixed intracranial tuberculosis is poor.Conclusion:The authors consider that MRI manifestations of cerebral parenchyma tuberculosis can be described objectively by three types:Miliary type(nodule≤3
作者
黎惠如
谢智恩
刘曾维
Li Huiru;Xie Zhien;Liu Zengwei(Department of Radiology,Guangzhou Chest Hospital,Guangzhou,Guangdong 510095)
出处
《现代医用影像学》
2021年第1期42-46,共5页
Modern Medical Imageology
关键词
颅内结核
MRI特点
抗结核疗效
Intracranial tuberculosis
MRI features
Antituberculous effect
