【摘要】 目的 探讨老年脑脓肿患者的MRI影像学特征，并分析其与多重耐药菌(MDRO)感染的相关性与危险因素，以期为临床早期识别及抗感染治疗策略优化提供依据。方法 回顾性分析2018年1月至2023年12月在本院神经内科住院的老年脑脓肿患者87例，所有患者年龄≥60岁，均接受MRI检查及病原学检测。根据微生物培养及药敏结果，分为MDRO感染组(n=32)与非MDRO感染组(n=55)。提取MRI影像学指标，包括囊壁厚度、周围水肿范围、DWI高信号区域占比、ADC值及SWI低信号表现等；同时收集患者人口学信息、基础疾病、住院前抗菌药物使用史、颅内穿刺或引流操作及ICU住院情况等临床变量。采用单因素分析筛选潜在危险因素，进一步纳入多因素Logistic回归模型，计算OR值及95%CI;使用ROC曲线分析评估影像指标的预测效能。结果 MDRO感染率为36.78%(32/87),主要病原包括耐碳青霉烯类肺炎克雷伯菌(43.75%)、耐甲氧西林金黄色葡萄球菌(31.25%)及耐多药铜绿假单胞菌(15.63%)。与非MDRO组相比，MDRO组患者囊壁厚度明显增加，周围水肿范围更广，DWI高信号占比≥70%者比例升高，SWI低信号检出率亦更高。多因素Logistic回归分析显示，住院前使用抗菌药物(OR=3.824,95%CI:1.053-13.889,P=0.042)、颅内引流操作(OR=4.107,95%CI:1.097-15.375,P=0.036)、DWI高信号占比≥70%(OR=4.451,95%CI:1.164-17.018,P=0.029)、SWI低信号阳性(OR=3.682,95%CI:1.119-12.109,P=0.032)为MDRO感染的独立危险因素。ROC分析显示，SWI低信号预测MDRO感染的AUC为0.658,DWI高占比AUC为0.664,二者联合构建的模型AUC提升至0.753,敏感度为56.25%,特异度为85.45%。结论 老年脑脓肿患者中MDRO感染比例较高，其MRI影像表现具有特征性，表现为囊壁增厚、周围水肿加重、DWI弥散受限范围扩大及SWI低信号显现。影像学指标结合临床变量可有效预测MDRO感染风险，有助于实现早期识别与个体化抗感染干预，具有临床指导意义。更多还原

【Abstract】 Objective This study aimed to investigate the magnetic resonance imaging(MRI) features of brain abscesses in elderly patients and to analyze their association with multidrug-resistant organism(MDRO) infections, in order to provide evidence for early clinical identification and optimized antimicrobial therapy. Methods We retrospectively reviewed 87 elderly inpatients(aged ≥60 years) diagnosed with brain abscesses at our neurology department from January 2018 to December 2023. All patients underwent brain MRI and microbiological culture with antimicrobial susceptibility testing. Based on microbiological results, patients were divided into the MDRO group(n=32) and the non-MDRO group(n=55). MRI variables, including abscess wall thickness, extent of perilesional edema, proportion of hyperintense signal on diffusion-weighted imaging(DWI),apparent diffusion coefficient(ADC) values, and susceptibility-weighted imaging(SWI) hypointensity, were extracted. Clinical variables such as demographics, comorbidities, prior antibiotic use, history of intracranial puncture or drainage procedures, and ICU admission were also collected. Univariate analysis was used to identify potential risk factors, which were then entered into a multivariate logistic regression model to calculate odds ratios(ORs) and 95% confidence intervals(CIs). Receiver operating characteristic(ROC) curve analysis was performed to evaluate the predictive performance of imaging features. Results The overall MDRO infection rate was 36.78%(32/87). The predominant pathogens were carbapenem-resistant Klebsiella pneumoniae(43.75%),methicillin-resistant Staphylococcus aureus(31.25%),and multidrug-resistant Pseudomonas aeruginosa(15.63%). Compared to the non-MDRO group, patients with MDRO infections had significantly increased abscess wall thickness, larger perilesional edema, higher proportion of DWI hyperintensity ≥70%,and elevated incidence of SWI hypointensity. Multivariate Logistic regression analysis showed that. The use of antibiotics before hospitalization(OR=3.824,95%CI:1.053-13.889,P=0.042),intracranial drainage operation(OR=4.107,95%CI:1.097-15.375,P=0.036),DWI high signal ratio ≥70%(OR=4.451,95%CI:1.164-17.018,P=0.029),SWI low signal positive(OR=3.682,95%CI:1.119-12.109,P=0.032) were independent risk factors for MDRO infection. ROC analysis demonstrated that the AUCs of SWI hypointensity and DWI hyperintensity were 0.658 and 0.664,respectively, while their combined model achieved an AUC of 0.753 with a sensitivity of 56.25% and specificity of 85.45%. Conclusion Elderly patients with brain abscesses have a high prevalence of MDRO infections, which exhibit characteristic MRI findings, including abscess wall thickening, pronounced perilesional edema, expanded DWI restriction, and SWI hypointensity. Integration of imaging features with clinical variables offers valuable insights for early prediction of MDRO infections and supports individualized antimicrobial strategies, thereby improving diagnostic efficiency and patient outcomes.更多还原