粟粒性脑结核的MRI诊断

目的 观察粟粒性脑结核的MRI征象.方法 回顾性分析16例临床确诊并经抗结核治疗痊愈或有效的粟粒性脑结核患者的MRI和相关临床资料.MR检查采用常规轴位SE T1WI和FSE T2WI序列,Gd-DTPA增强扫描包括轴位和冠状位SE T1WI序列;抗结核治疗后进行3次以上MR随访.结果 急性期MR平扫大多只能显示水肿,亚急性期可在水肿中心观察到等或稍长T1、稍长或长T2信号小结节;增强扫描结节明显强化,分布较均匀,大小接近,直径≤3.0 mm.亚急性期结节强化不均匀,并见点状无强化干酪坏死区,脑膜不同程度强化.经抗结核治疗.早期表现为水肿程度减轻.随后结节缩小、强化程度减弱或消失.幕上白质区病灶较幕下和顶叶者吸收消散速度快.结论 MRI能为粟粒性脑结核的诊断和鉴别诊断提供客观形态学依据,并在一定程度上反映病程,是监测治疗效果的首选方法.

MR diagnosis of cerebral miliary tuberculosis

Objective To observe the MR features of miliary tuberculosis of the brain. Methods MR and clinical data of 16 patients with miliary tuberculosis of the brain confirmed clinically and recovered after treatment were analyzed retrospectively. MR plain scan icluded SE sequence on T1WI and FSE on T2WI, Gd-DTPA enhanced scan included axial and coronal SE T1WI. More than 3 times follow-up with MR scan were performed after antituberculotic treatment. Results Most of acute findings displayed edema merely, while subacute nodus were high signals on T2WI, T1WI showed isointense and low signals in the center of edema. The enhancement of nodus after Gd-DTPA injection was remarkable, the lesion's size, shape and distribution were closed to each other. Meningeal enhancement could be observed to some extent. After effective treatment, edema relieved firstly, and then enhancement reduced, lesions became smaller or disappeared. Conclusion MRI is helpful to the early detection of miliary tuberculosis and evaluation of response to treatment.