125例改良抗酸染色确诊的结核性脑膜炎临床分期与影像学分析

发布时间：2018-01-27 15:53

  本文关键词： 结核性脑膜炎 临床分期 磁共振扫描 改良抗酸染色　出处：《中风与神经疾病杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的探讨结核性脑膜炎(TBM)患者头部CT及MR检查特点及在各病程分期中的诊断价值,为临床诊治提供参考。方法选取2013年2月-2016年6月我院收治的125例结核性脑膜炎患者为研究对象,所选患者均为脑脊液改良抗酸染色阳性的确诊患者。患者中男性78例,女性47例,患者年龄在14~76岁之间,中位数年龄为37岁,所有患者均进行头部CT及MRI影像学检查,其中28例同时行增强MRI扫描,分析其临床分期与影像学表现。结果 125例结脑患者中,Ⅰ期患者31例,Ⅱ期55例,Ⅲ期39例。影像学结果显示,最常见的表现依次是脑膜强化、脑积水、结核瘤等。随着患者临床分期的增加,CT及MRI对颅内病灶的敏感度提高。Ⅰ期患者主要表现为脑膜强化、基底池渗出;Ⅱ和Ⅲ期患者影像学表现多样,为脑积水、脑梗死、结核瘤、炎性病灶等表现。CT发现异常者41例,敏感度为33%,其中Ⅰ期为13%,Ⅱ期为33%,Ⅲ期为49%。MRI发现异常者为90例,敏感度为72%,其中Ⅰ期为48%,Ⅱ期为78%,Ⅲ期为82%。增强MRI发现异常为23例,敏感度为82%,并可发现头部CT和MRI平扫阴性的病变。结论头部影像学特别是MRI能清楚显示结核性脑膜炎的各种病理改变,敏感度随着临床分期的增加而增加。早期检查阳性率低、表现单一;中晚期检查阳性率高、表现多样。结合增强MRI可提高结核性脑膜炎检出率并为临床诊断结核性脑膜炎提供可靠依据。
[Abstract]:Objective to investigate the CT and Mr features of head in patients with tuberculous meningitis (TBM) and its diagnostic value in different stages of the disease course. Methods 125 cases of tuberculous meningitis treated in our hospital from February 2013 to June 2016 were selected as the research object. All the patients were diagnosed with positive CSF modified acid-fast staining. 78 cases were male and 47 cases were female. The age of the patients was between 14 and 76 years old, the median age was 37 years old. All the patients were examined by CT and MRI, 28 of them were examined by enhanced MRI, and their clinical staging and imaging findings were analyzed. The imaging findings showed that the most common manifestations were meningeal enhancement hydrocephalus tuberculoma and so on. The sensitivity of CT and MRI to intracranial lesions was increased. In stage I patients, meningeal enhancement and basal cistern exudation were the main manifestations. The imaging manifestations of patients with stage 鈪，

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