脑膜血管型神经梅毒的MRI表现分析

摘要/Abstract

摘要： 目的分析脑膜血管型神经梅毒（meningeal vascular type of syphilis,MVTS）的MRI表现,以提高对该病的诊断能力。方法回顾性收集6例经脑脊液和血清学检查确诊的MVTS的MRI资料,分析其MRI表现。结果 MVTS可以表现FLAIR序列蛛网膜下腔或软脑膜表面多发的高信号小结节影,伴有邻近软脑膜及脑回肿胀、脑沟变窄,脑膜梅毒树胶肿可以伴发有脑内多发结节状梅毒肉芽肿,脑膜梅毒树胶肿花冠样强化,脑内梅毒肉芽肿可环形强化或结节样强化,FLAIR序列复查可显示脑内病灶高信号范围增大,DWI见稍高信号的范围逐渐缩小,FLAIR与DWI可显示病灶由细胞毒性脑水肿向血管源性脑水肿转变。结论 MVTS的MRI表现具有多样性,MRI检查对明确诊断MVTS仍具有重要意义。

关键词: 神经梅毒, 脑膜血管型, 磁共振成像

Abstract: Objective To analyze the MRI imaging demonstrations of meningeal vascular type of syphilis (MVTS) so as to improve the diagnosis of the disease. Methods We retrospectively collected and analyzed MRI data of 6 cases of MVTS. All the cases were definitely diagnosed by cerebrospinal fluid examination and serological test. Results FLAIR sequencing demonstrated MVTS as multiple high signals of small nodular opacity in subarachnoid space or on the surface of the pia mater, accompanied by the adjacent pia mater and gyrus swelling and narrowed sulcus. Meningeal gumma could be accompanied by multiple nodular granuloma of syphilis in the brain, which was demonstrated as corolla-like enhancement. The granuloma of brain syphilis was shown with annular or nodular enhancement; Reexamination by FLAIR sequence revealed enlarged lesions range with high signal in the brain. DWI showed gradually decreased range of slightly high signal. FLAIR and DWI showed the transformation of lesions from cytotoxic brain edema to vasogenic brain edema. Conclusion MRI demonstrations of MVTS are diverse. However, MRI still plays important role in definitive diagnosis of MVTS.

Key words: Neurosyphilis, Meningeal vascular type, Magnetic resonance imaging

刘仁伟, 方进智, 张玉忠. 脑膜血管型神经梅毒的MRI表现分析[J]. 新发传染病电子杂志, 2018, 3(1): 25-29.

LIU Ren-wei, FANG Jin-zhi, ZHANG Yu-zhong. MRI demonstrations of meningeal vascular type of neurosyphilis[J]. Electronic Journal of Emerging Infectious Diseases, 2018, 3(1): 25-29.

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