颅内结核MRI特征及抗结核治疗过程中的影像表现分析

摘要/Abstract

摘要： 目的探讨颅内结核的解剖部位、病理变化,以及在抗结核治疗过程中MRI影像特征和变化的规律。方法回顾性分析2017年11月至2019年11月广州市胸科医院确诊和临床诊断的255例颅内结核患者临床资料与MRI影像检查资料,探讨其MRI影像特征;并对其中218例抗结核治疗过程的MRI表现变化进行分析。结果 ①在255例颅内结核患者中,有脑膜型70例（27.45%）、脑实质型77例（30.20%）和混合型108例（42.35%）;脑膜增厚161例(63.14%)、脑实质结核结节143例(56.07%%)、脑实质结核瘤73例(28.63%)、脑膜结节54例(21.18%)、脑膜结核瘤46例(18.04%)、结核性脑炎18例(7.06%)和结核性脓肿5例(1.96%),在结核瘤中,分别有13例脑膜结核瘤和10例脑实质结核瘤呈簇状。②在218例抗结核治疗过程观察病例中,116例(53.21%)成功治疗患者在治疗1~3月期间出现原病灶增大、增多或有新病变产生等MRI影像学“恶化”表现;抗结核化疗12个月或18个月后,脑实质结核结节、脑膜增厚、脑实质结核瘤、脑膜结核结节、脑膜结核瘤、脑实质结核性脓肿、脑膜/脑实质簇状结核瘤、脑实质结核性脑炎等相应病变MRI影像消失率分别为相应病变病例数的89.58%、77.03%、75.00%、67.74%、37.04%、20.00%、0、0和95.83%、82.43%、85.00%、85.19%、55.56%、20.00%、0、0。结论颅内结核MRI影像以脑膜增厚、结核结节、结核瘤为主,可累及脑膜、脑实质各个部位。患者经抗结核治疗后病变MRI影像多数消失;但对脑实质结核性脓肿、脑膜/脑实质簇状结核瘤、脑实质结核性脑炎等发生频率较低的病变,抗结核化疗后病变MRI影像大多无好转。

关键词: 颅内结核, 磁共振成像, 动态MRI变化

Abstract: Objective To explore the MRI imaging features of intracranial tuberculosis,including the anatomic location and pathological changes, and the patterns of MRI imaging changes during antituberculosis chemotherapy. Methods The clinical and MRI data of 255 cases with intracranial tuberculosis diagnosed in Guangzhou Chest Hospital from November 2017 to November 2019 was analyzed retrospectively for exploring the MRI features. Furthermore,the changes of MRI imaging during antituberculosis chemotherapy of 218 cases, of which treatment courses were normative and treatment records were complete,were collected for analyzing the MRI imaging change patterns.Results Firstly, there are 255 patients with intracranial tuberculosis including 70 cases of meningeal type, 77 cases of parenchymal type and 108 cases of mixed type, accounted for 27.45%, 30.20% and 42.35% respectively. Their pathological MRI included meningeal thickening, nodules of brain parenchymal tuberculosis, cerebral parenchymal tuberculosis,meningeal nodules, meningeal tuberculoma,tuberculous encephalitis and tuberculous abscess. Their number and percentage were 161, 143, 73, 54, 46, 18, 5 and 63.14%、56.07%、28.63%、21.18%、18.04%、7.06%, 1.96% respectively. Especially, 23 cases of tuberculoma, including 13 cases located at meninges and 10 cases located at brain parenchyma, presented cluster.Secondly, of the 218 cases observed during antituberculosis chemotherapy, MRI imaging of 116 cured patients presented “deterioration” signs during the 1 to 3 months of antituberculosis chemotherapy course, such as enlarged primary lesions, increased or new lesions.After 12 months and 18 months of treatment,the disappearance rates of MRI imaging of corresponding lesions(including brain parenchymal tuberculosis nodule, meningeal thickening, brain parenchymal tuberculosis, meningeal tuberculosis nodule, meningeal tuberculosis, parenchymal tuberculous abscess, meningeal or brain parenchymal tuberculosisandbrain parenchymal tuberculous encephalitis) were 89.58%, 77.03%, 75.00%, 67.74%, 37.04%, 20.00%, 0, 0 and 95.83%, 82.43%, 85.00%, 85.19%, 55.56%, 20.00%, 0, 0 respectively. Conclusion Various parts of the meninges and brain parenchyma may be involved with intracranial tuberculosis . The MRI imaging presents mainly meningeal thickening, tuberculous nodules, and tuberculomas,and most of the pathological MRI imaging can disappear after antituberculosis chemotherapy for these cases.But,the vast majority of the pathological MRI imaging after antituberculosis chemotherapy have not improved much for cases such as brain parenchymal tuberculous abscess, meningeal or brain parenchymal tuberculosis and brain parenchymal tuberculous encephalitis.It is suggested that comprehensive treatment involving multidisciplinary must be considered at the beginning of treatment for these cases.

Key words: Intracranial tuberculosis, Magnetic resonance imaging, Serial dynamic MRI findings

方伟军, 宋敏, 韩远远, 刘志辉. 颅内结核MRI特征及抗结核治疗过程中的影像表现分析[J]. 新发传染病电子杂志, 2020, 5(2): 107-112.

Fang Weijun, Song Min, Han Yuanyuan, Liu Zhihui. Analysis of MRI imaging features with intracranial tuberculosis and changes of imaging during antituberculosis treatment[J]. Electronic Journal of Emerging Infectious Diseases, 2020, 5(2): 107-112.

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