【摘要】 目的分析63例结核性脑膜炎的CT及41例MRI检查表现,以便提高对结核性脑膜炎的认识。方法全部病例均用Philips Brillance16层全身CT进行了头颅扫描,其中26例同时注入对比剂作了增强扫描。41例先后用GESIGNA EXCITE1.5T MRI作了扫描,有15例静脉注入了Gd-DTPA重复横断面T1WI扫描。结果63例中CT检查有54例有异常征象,分别为基底池、鞍上池或侧裂池变窄、闭塞31例,不同程度脑积水29例,脑内低密度改变39例,单发或多发结核瘤11例,增强扫描见基底池、鞍上池强化,大脑半球凸面脑膜明显强化,部分血管走行不规则、粗细不均匀等征象。MRI检查者基底池、侧裂池在T1加权像上呈高信号,T2加权像上也为较高信号,MRI增强见蛛网膜间隙异常强化、聚集成簇、额顶叶区脑膜不规则强化。结论对肺部有结核尤其是血行播散性肺结核者,临床有症状疑有结核性脑膜炎的患者应尽早做CT检查,必要时加以增强扫描。而CT检查阴性应根据患者的经济能力及病情需要进一步行MRI检查。两种影像检查方法互相配合可以提高结核性脑膜炎的诊断阳性率。更多还原

【Abstract】 Objective To analyze 63 cases of tuberculous meningitis CT performance and the performance of 41 cases of MRI,and to improve cognition of tuberculous meningitis in the two imaging methods.Methods All cases were carried out using Philips Brillance 16-storey full-body spiral CT plain skull,among them 26 cases had injection of contrast medium enhanced CT done. 41 cases of the use of GE SIGNA EXCITE 1.5T MRI scans carried out,of which 15 cases of intravenous injection of Gd-DTPA repeat cross-sectional T1WI scanning.Results Among the 63 cases,54 cases showed the signs of abnormal CT,31 cases of basal cistern,suprasellar sylvian pool or pool narrowed and occluded,39 cases of varying degrees of hydrocephalus,27 cases of low-density changes in the brain,and 11 cases of single or multiple tuberculoma. Basal cistern,suprasellar pool was enhanced,convex hemisphere meningeal was enhanced obviously,part of vascular traveling was irregular,uneven thickness etc in CT enhancement scan. MRI examinations could be seen in both basal cistern,and sylvian pool was high in T1WI signal,T2WI as well as high signal. Enhanced MRI showed abnormal enhancement arachnoid space,clustered together,and the amount of irregular meningeal parietal areas.Conclusion Suspected clinical symptoms of patients with tuberculous meningitis CT examination should be done as soon as possible using enhanced scan,if needed,for pulmonary tuberculosis,especially hematogenous disseminated pulmonary tuberculosis. However,Patients should be based on the capacity and condition of the economy need to further MRI examination for negative CT examination. Two imaging methods can complement each other to improve the accuracy of the diagnosis of tuberculous meningitis.更多还原