艾滋病合并新型隐球菌脑膜脑炎的影像学表现

目的:探讨艾滋病合并新型隐球菌脑膜脑炎的影像特点,并与非艾滋病患者新型隐球菌脑膜脑炎作对比分析.方法:回顾分析经病原学证实的12例艾滋病和14例非艾滋病合并新型隐球菌脑膜脑炎患者头颅CT及MRI的表现,比较艾滋病合并新型隐球菌脑膜脑炎与非艾滋病患者新型隐球菌脑膜脑炎的影像差别.结果:艾滋病患者局限性脑水肿和脑内强化病灶明显少于非艾滋病患者(0/10,0/10;4/9,4/7,P<0.05),VR间隙扩大、胶样假囊、脑膜强化和脑积水、脑萎缩两者间无明显差异(P>0.05).结论:艾滋病合并新型隐球菌脑膜脑炎的影像表现与非艾滋病患者新型隐球菌脑膜脑炎相仿,但患者炎症反应的影像表现轻于非艾滋病患者,结合临床有助于艾滋病合并新型隐球菌脑膜脑炎的诊断.     

艾滋病脑内合并机遇性感染的影像学诊断

目的研究艾滋病（AIDS）合并脑内机遇性感染的影像学表现，评估CT，MRI对脑内机遇性感染的诊断能力。方法56例AIDS合并脑内机遇性感染的病人均通过CT和MRI检查，25例又经GD—DTPA增强扫描。结果56例AIDS出现脑内机遇性感染的影像表现，其中，脑弓形体感染8例，病毒性脑炎2例，结核瘤2例，结核性脑膜炎2例，隐球菌感染脑膜炎和脑脓肿2例，梅毒瘤4例．淋巴瘤3例，脑白质脱髓鞘病4例，脑梗死13例，脑萎缩4例，HIV脑动脉血管狭窄、痉挛8例，上颌窦炎3例，右侧额叶囊肿伴Veger腔形成1例。结论AIDS合并脑内机遇性感染的影像表现有一定特点，CT和MRI扫描对颅内机遇性感染的诊断有重要意义，但在临床定性诊断时需要结合实验室检测和组织活检。     

艾滋病相关性颅内隐球菌感染的MRI表现分析

目的总结AIDS(acquired immunodeficiency syndrome,AIDS)合并颅内隐球菌感染患者的MRI特征,提高本病的早期诊断符合率,从而改善预后及疗效评估。方法回顾41例通过脑脊液检测确诊隐脑并且排除其他感染的AIDS患者的颅脑MRI图像。由两名神经影像专家对MR图像进行判读,对MR特征(边缘,数目,位置,信号特点)进行统计分析,总结其特征表现。结果 41例确诊为隐脑的AIDS患者中MR表现阳性患者19例。阳性组与阴性组之间两组间年龄、性别没有显著差异(P0.05),MR表现阳性组中发病部位多位于基底节及侧脑室周围(78.9%)。MR常见征象是基底节区VR间隙(Virchow-Robin spaces)扩大(42.1%);弥散受限的胶样假性囊肿(21.1%);脑室扩张或脑积水(15.8%)。隐球菌脑膜炎(21.1%)多发生在额、顶、颞叶的脑膜增厚强化,邻近脑组织水肿。发生于脑内的隐球菌肉芽肿形成(21.1%)多为T_1低信号T_2高信号,增强后不均匀轻度强化。隐球菌室管膜炎(5.3%),表现为两侧脑室周围对称性晕状T_1低信号T_2高信号。结论隐脑在MR表现为基底节区VR间隙扩大,也可表现为基底节区异常信号,粟粒状强化,周围水肿。其中弥散受限的胶样假性囊肿与脑室扩张或脑积水具有一定特征。隐球菌脑膜炎时多为额、顶、颞叶软脑膜增厚强化,邻近脑组织水肿。隐球菌室管膜炎,表现为两侧脑室周围对称性晕状异常信号。     

颅内环形强化病变在艾滋病机会感染中的鉴别诊断

目的总结颅内环形强化病变在艾滋病(AIDS)患者机会性感染中的诊断及鉴别的MRI影像特征。方法回顾性分析2008~2017年本院AIDS患者合并颅内感染的临床和影像资料,纳入标准为MRI增强扫描发现脑内病变,并在临床试验性治疗好转或经手术活检证实的患者。结果共收集符合条件病例29例,其中弓形虫脑病9例,脑结核13例,神经梅毒2例,细菌性脑脓肿2例,隐球菌脑病3例。CD4+计数中位数为34cells/ul。AIDS颅内感染病变主要分布区域以大脑灰白交界区、基底节区为主,不同感染构成比例略有差异。多发粟粒结节在脑结核多见,其他多呈环形病变。特征性征象如:弓形虫脑病出现偏心性靶征(33.3%),近中线侧壁增厚(20.5%),脑结核呈簇状分布融合呈分隔样、分叶状(25.9%),隐球菌胶样囊病变(100%)。弓形虫脑病、脑结核、脑脓肿病变周围水肿明显(76.9%、67.9%、75%)。弥散加权成像DWI(b=1000)弓形虫脑病高信号显示率(5.1%)低于其他感染病变(约50%)。结论对于艾滋病患者,颅内环形强化病变病因复杂,在出现特征性的MR征象时对提示病因诊断有一定参考价值。     

艾滋病合并马红球菌肺部感染的影像表现与病理对照

目的：探讨艾滋病合并马红球菌肺部感染的影像学表现及其病理基础。方法：回顾性分析13例艾滋病合并马红球菌肺部感染的影像病理资料,10例行胸部CT检查,13例行X线胸片检查,所有病例经细菌培养证实,其中1例CT引导下肺部穿刺活检证实,1例经支气管活检证实。结果：13例艾滋病合并肺部马红球菌感染的影像学表现多为单侧肺门区的中心型类似球形密度增高阴影,9例,占70%,合并空洞及液平面10例,占77%,胸腔积液3例,占23%,病灶发生在肺的内带10例,占77%,发生在外带1例,占7%;病理表现为肺泡内出血及淋巴细胞浸润,肉芽组织增生,符合坏死性肺炎的病理发展过程。8个月随访13例艾滋病患者抗马红球菌治疗后病灶明显吸收,9例肺部空洞缩小。1例死亡,1例失访,1例病灶完全吸收,1例尚无复查。结论：艾滋病合并马红球菌性肺部感染的影像学表现为单侧肺门区的中心型类似球形密度增高阴影,实变,继发空洞,肺野毛玻璃样变,小结节及树芽征;影像表现具有一定特征性,但缺乏特异性。     

肺隐球菌病CT表现及误诊分析

目的 分析28例肺隐球菌病(PC)CT表现及探讨误诊原因,提高该病诊断符合率.方法 回顾性分析经病理及细胞学证实的28例肺隐球菌病CT征象.结果 28例肺隐球菌病CT表现为:①结节或肿块型19例,其中孤立12例,多发7例,可合并"晕征"或空洞等,无胸膜凹陷征;②浸润实变型4 例,见支气管空气征及周边密度趋淡;③磨玻璃样型2例,1例合并网状影;④混合型3例,呈两肺广泛分布.28例肺隐球菌病影像诊断误诊26例,9例误诊为肺癌,7例误诊为肺结核,10例为一般炎症.结论 肺隐球菌病的CT表现多种多样,也存在一定相对特征性改变,结合临床病史,做出全面分析和诊断,可以减少该病误诊率.     

颅内隐球菌病的CT

新型隐球菌感染常作为机遇性感染发生于免疫抑制的患者、癌症或糖尿病的衰竭患者、接受激素或化疗的患者,最多见于AIDS患者。作者复习了35例颅内隐球菌感染的CT。年龄26—84岁。男31例,女4例。其中28例(80%)为AIDS患者。     

艾滋病相关颅内淋巴瘤的MRI影像特征及鉴别诊断

目的探讨艾滋病相关颅内淋巴瘤的MRI影像特征,以提高对其诊断及鉴别诊断水平。方法回顾性分析2013年7月～2017年10月我院经手术和病理证实的15例艾滋病相关颅内淋巴瘤患者的MRI影像资料,结合文献总结分析艾滋病相关颅内淋巴瘤的MRI影像特征。结果 15例艾滋病相关颅内淋巴瘤的病理类型均为B细胞淋巴瘤,其中弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma, DLBCL)11例,4例为伯基特淋巴瘤(burkitt lymphoma, BL),以幕上多见,多发病灶为主(本组合计32个病灶,2例为脑膜型),多靠近中线或脑室周围,侵犯皮层并累及灰白质。本组病例单发4例,多发9例,2例为脑膜型。位于幕上10例,幕下2例,幕上下多发1例。MRI表现为实性、囊实性肿块及结节、多发不规则斑点、片状病灶,DWI病灶不同程度受限,以不规则环状高信号为主,ADC值降低,10例患者(12个病灶)T_1WI可见不规则高信号或稍高信号,增强扫描后病灶呈肿块样、结节样及点、片状明显强化、不规则厚壁环形强化或环状强化,周围轻度水肿或无水肿,其中3例为重度水肿,1例沿室管膜匍匐生长,1例可见室管膜播散。结论艾滋病相关颅内淋巴瘤MRI影像表现复杂多样、具有一定的特征性,但部分病变表现不典型,易与弓形体脑炎等病变混淆,必须结合临床并仔细分析其MRI特征有助于提高诊断率。     

全身播散性隐球菌病的CT表现

目的: 探讨全身播散性隐球菌病的CT表现.材料和方法: 回顾性分析1例经临床证实的全身播散性隐球菌病患者的胸部、腹部及头颅CT表现.结果: 胸部CT表现为双肺野网状阴影及弥漫性粟粒状微结节影;腹部CT表现为肝脾肿大、腹膜后淋巴结肿大及腹膜后肿块;头颅CT表现为片状低密度灶(隐球菌性脑炎),结节灶(隐球菌性肉芽肿)及脑膜增厚、弥漫性脑膜增强及进行性脑积水(隐球菌性脑膜炎).结论: 隐球菌病CT表现复杂,形式多样,缺乏特异性,误诊率高.     

隐球菌性脑膜脑炎的CT和MRI表现

目的:探讨CT和MRI在隐球菌性脑膜脑炎诊断中的应用.方法:回顾性分析通过脑脊液墨汁染色或培养证实的隐球菌性脑膜脑炎21例,其中男13例,女8例,年龄8～53岁,主要症状有头痛、恶心、呕吐、发热.21例患者中6例同时行头颅CT和MRI检查,6例仅行MRI检查,9例仅行CT检查.结果:21例患者20例影像学检查为阳性,主要表现有软脑膜异常强化13例,脑内斑片样损害灶4例,基底节区、半卵圆中心多发点片状异常信号或密度灶5例,脑积水5例.结论:CT及MRI表现能够反映隐球菌性脑膜脑炎的病理学特征,软脑膜强化及伴发的深部脑组织病变是隐脑的常见表现.     

Nervous system manifestations and neuroradiologic findings in acquired immunodeficiency syndrome (AIDS)

Summary We report a series of thirteen patients with nervous system complications out of a total of thirty AIDS patients admitted to our hospital over the last two years for which CT and/or MRI have been performed. Five were homosexual men and eight patients (5 men, 3 women) were of African origin (Zaïre and Rwanda) (n=5) or had had sexual intercourse with the local African population (n=3). The nervous system complications encountered included: toxoplasma gondii brain abscess (2 patients); cryptococcus neoformans meningitis+toxoplasmosis (1 patient); toxoplasmosis+lymphoma (2 patients); progressive multifocal leucoencephalopathy (1 patient); lymphocytic meningitis or encephalitis (3 patients); lymphoma (1 patient); polyradiculoneuritis (3 patients). Three of thirteen patients had multiple intracranial abnormalities: one had concomitant intraparenchymal toxoplasma abscess and cryptococcal meningitis; in one patient a lymphoma developed after the successful medical treatment of a toxoplasma abscess; conversely, one patient developed a toxoplasma abscess two years after mediastinal radiotherapy for a systemic non-Hodgkin lymphoma. In conclusion, in our experience, nervous system toxoplasmosis is the most frequent AIDS related CNS complication. Our series demonstrates the high frequency of a second neurological disease occurring either concomitantly or separately. In these cases, while CT may readily identify the intracranial abnormalities, it contributes little towards an etiological diagnosis. Finally, our series illustrates the importance of a central African endemic focus for AIDS.     

八例人类获得性免疫缺陷综合征患者尸体的病理与影像表现对照分析

目的 探讨人类获得性免疫缺陷综合征(AIDS)合并症的影像与病理表现特点.方法 回顾性分析8例AIDS尸体的解剖资料及影像、病理资料.对其不同的部位进行常规CT扫描和(或)MR检查;7具尸体在冷冻状态下行横断断层解剖观察,1具行大体解剖;在各断层面和各脏器取材行病理检查,对比分析受累脏器影像改变以及其病理改变基础,从病理结果中作出病因学诊断.结果 8例AIDS患者中,寄生虫感染5例、细菌感染3例(2例结核菌感染,1例肺炎球菌肺炎)、真菌感染2例、病毒感染2例、B细胞性淋巴瘤1例、1例巨细胞病毒(CMV)感染患者同时合并脑大面积梗死.5例肺部卡氏肺孢子虫肺炎(PCP)感染者CT表现为以肺门为中心的对称性毛玻璃状阴影;2例肺部结核CT表现为肺部片状阴影、散在分布的结节影及弥漫粟粒性均匀分布的结节影和结核性胸膜炎;2例真菌感染CT表现为云雾状模糊密度阴影及多灶性慢性炎症表现;曲霉菌典型表现为曲霉菌肿.2例肺部CMV感染表现为肺部网格状及实变影.1例肠道肿瘤CT表现为肠管壁增厚,管腔狭窄.1例CMV脑炎CT表现为脑组织低密度影,及MR表现为长T_1、长T_2信号,MRA显示脑组织液化区血管中断.1例脑弓形虫感染CT表现左侧内囊部位可见片状低密度区.1例脑部隐球菌感染CT表现大脑基底节区多发小片状低密度区.结论 AIDS患者可同时或先后合并多个器官多种病原体感染或肿瘤发生,影像表现多样化,无明显特异性,鉴别诊断困难,病理表现更复杂.影像表现与病理结合有助于明确诊断.     

Cryptococcus meningoencephalitis in AIDS: parenchymal and meningeal forms

CT and MRI in one case of Cryptococcus neoformans infection showed contrast-enhancing parenchymal lesions resembling granulomata or abscesses. After an initial phase without contrast enhancement, the full extent of the lesions was visible within 2 weeks of presentation. The enhancing masses were assumed to represent intracerebral cryptococcomas. Despite evidence of massive meningeal infection on cerebrospinal fluid (CSF) examination, no radiological signs of meningitis, invasion of the Virchow-Robin spaces or ventriculitis could be demonstrated. With antimycotic treatment the contrast enhancement disappeared and cystic, partly calcified lesions remained. Recurrence of meningeal infection without radiological correlates was apparent in this stage. In a second case of proven cryptococcus meningitis, dilation of Virchow-Robin spaces or cysts in the adjacent parenchyma were the main abnormalities on MRI. Enhancing masses were not detected. These cases may represent two different reactions of the immunocompromised hosts to infection with C. neoformans: widening of the perivascular spaces as a correlate of the more typical meningeal infection and enhancing parenchymal lesions as a sign of further invasion from the CSF spaces. Enhancement of cryptococcomas, indicating an inflammatory response in the surrounding brain, is not typical in patients with impairment of immune function. Received: 11 March 1998 Accepted: 19 June 1998     

GM-CSF抗体在免疫正常格特隐球菌感染中的作用研究

目的探讨抗粒细胞-巨噬细胞集落刺激因子(GM-CSF)抗体在免疫正常格特隐球菌感染患者中的作用。方法分为两组,病例组为7例无免疫异常状态的隐球菌性脑膜脑炎患者,健康对照组为7名健康人,分别检测抗GM-CSF抗体。并对隐球菌性脑膜脑炎患者的脑脊液进行菌株分离培养及鉴定。结果 7例患者中6例为新生隐球菌感染,1例为格特隐球菌感染。抗GM-CSF抗体只在格特隐球菌感染的患者血浆中发现,而在新生隐球菌感染的患者中未发现。健康对照组中1例检测到抗GM-CSF抗体。结论在"免疫正常"的隐球菌脑膜脑炎患者中,抗GM-CSF抗体可能为格特隐球菌感染的危险因素,而与新生隐球菌感染无关。     

Intracranial tuberculosis in AIDS: CT and MRI findings

Summary CT and MRI findings in 35 patients with the acquired immune deficiency syndrome (AIDS) and proven intracranial tuberculosis (TB) are presented. Over 90% of the patients were intravenous drug abusers and in two-thrids TB was the first manifestation of AIDS. CT was normal in one quarter, the most frequent findings being hydrocephalus (51%) and meningeal enhancement (41%), commonly seen together (31.5%). Meningeal enhancement was seen in 48% of the CT studies with intravenous contrast medium and in 3 cases studied with MRI and iv gadolinium DPTA, in 2 of which CT was negative. Parenchymal involvement was found in 37% of cases; MRI was more sensitive than CT for its detection. One quarter of the patients had ischaemic lesions, mainly in the basal ganglia. We confirm the usefulness of CT and the superiority of MRI in the diagnosis of intracranial TB and in differential diagnosis from other conditions likely to be found in these patients.     

AIDS脑部病变影像学表现分析

目的总结AIDS脑部病变影像学表现,为AIDS脑部病变的影像诊断提供依据。方法回顾性分析19例神经系统型AIDS患者脑部CT和MRI表现。结果5例HIV脑炎中,3例表现为双侧大脑半球白质区对称性异常信号,2例表现为脑萎缩。2例弓形体脑炎影像学表现为基底节区和额顶叶多发密度或/和信号异常,增强T1WI呈多发环状高信号。3例脑淋巴瘤分别表现为双侧大脑半球单发或多发结节,周围伴水肿,增强T1WI呈结节状或不均匀强化。3例脑梗塞表现为基底节区局限性低密度影。2例进行性多灶性白质脑病表现为额顶叶脑白质区多发斑片状异常信号。1例霉菌感染表现为脑干信号异常,增强T1WI呈环状强化;1例霉菌性脑膜炎和2例单纯颅内压增高患者,影像学无异常表现。结论CT和MRI检查可以发现大部分AIDS脑部病变,并可根据影像学表现和其它相关检查做出定性诊断。     

Hepatobiliary and pancreatic MRI and MRCP findings in patients with HIV infection

OBJECTIVE: The purpose of this article is to describe the spectrum of MRI and MR cholangiopancreatography (MRCP) findings of hepatic, pancreatic, and biliary manifestations in patients with HIV infection. CONCLUSION: The spectrum of MRI and MRCP findings in HIV-infected patients includes acute or chronic hepatitis (or both), pancreatitis, cholangitis, acalculous cholecystitis, and biliary strictures that may resemble primary sclerosing cholangitis. The presence of segmental extrahepatic biliary strictures is characteristic of AIDS cholangiopathy.     

线粒体脑肌病的MRI诊断价值

目的 探讨线粒体脑肌病的脑部MRI表现及其诊断价值。资料与方法 对13例线粒体脑肌病患者的临床、实验室及MRI表现进行回顾性分析。结果 13例头部MRI检查均显示异常，对病变的检出率为100％，主要MRI表现为3类：（1）大脑半球多发单侧或双侧病变（7例），4例呈对称性，病变呈片状等长T1、长T2信号，以一侧或两侧颞顶枕时皮层和皮层下白质最常受累。（2）大脑半球皮层和深部灰质核团同时出现片状等长T1、长T2信号2例。上述两类脑内病变有5例合并脑萎缩。（3）脑实质信号正常，但有脑萎缩4例，其中桥脑、延髓及小脑萎缩3例，大脑半球、脑干、小脑萎缩1例。结论 MRI对线粒体脑肌病的脑内病变显示敏感且准确，对其早期诊断、指导治疗、判断疗效和提示预后具有重要价值。     

Intracranial tuberculoma: CT and MRI

The appearances of intracranial tuberculoma on CT and MRI are described. Eight patients (6 males and 2 females) with intracranial tuberculomas studied over the past 4 years are presented. Four patients had AIDS and among the four non-AIDS patients 1 had undergone hepatic transplantation. All the cases were studied with CT and 6 underwent MRI. Five lesions were infratentorial, and 2 patients had double lesions. In 2 patients obstructive triventricular hydrocephalus was present. No patient had meningeal involvement. The stage of evolution was cerebritis in 1 case, incipient tuberculoma in 3 cases, mature tuberculoma in 1 case and tuberculous abscess in 5 cases. Diagnosis of intracranial tuberculoma was determined histologically in 5 patients and by good response to specific therapy in the remaining patients. Although CT allows differentiation between incipient and mature tuberculoma, MRI allows a better determination of the evolutonary stage. In most cases combined CT and MRI examinations provide an accurate diagnosis of intracranial tuberculoma.Correspondence to: N. Bargallo     

The imaging appearances of intracranial CNS infections in adult HIV and AIDS patients

The spectrum of pathology affecting the central nervous system (CNS) in patients suffering from acquired immunodeficiency syndrome (AIDS) is broad and comprises predominantly opportunistic infections and neoplasms. It is estimated that approximately one-third of all patients with AIDS develop neurological complications. The organisms responsible for AIDS are human retroviruses: primarily the human immunodeficiency virus type 1 (HIV). In this review we shall focus on the neurological complications of HIV and AIDS which are applicable to the more frequently occurring intracranial infective organisms. Attention will be paid specifically to those CNS manifestations occurring in the adult HIV and AIDS population as infection in the paediatric HIV and AIDS group, although bearing some similarities, demonstrates some important differences.