艾滋病患者中枢神经系统隐球菌感染的磁共振成像特征

发布时间：2018-12-30 11:58

【摘要】：目的:探讨艾滋病(acquired immune deficiency syndrome,AIDS)人群中枢神经系统隐球菌感染的磁共振成像(magnetic resonance imaging,MRI)特征。方法:回顾分析2011年7月至2017年3月期间收治的AIDS合并隐球菌性脑膜炎(cryptococcal meningitis,CM),且尚未接受抗反转录病毒治疗患者的颅脑MRI以及临床资料。明确的或者临床怀疑合并中枢神经系统其他疾病的患者未纳入分析。结果:共有39例患者纳入分析,其中位CD4细胞计数为13×106/L[(0~205)×106/L],94.9%(37/39)的患者CD4细胞计数100×106/L。39例患者中26例患者存在颅脑异常MRI信号,可表现为多部位受累,最常累及的部位为基底节区(20/26,76.9%)。该基底节区病灶常表现为血管周围间隙(Virchow-Robin space,VRS)扩大/胶样假囊(18/20,90%),增强后未见明显强化;脑隐球菌肉芽肿的发生率为35%(7/20),增强后未见明显强化(3/5,60%)或有轻度强化(2/5,40%)。73.0%(19/26)患者存在基底节区以外的病灶,其中68.4%(13/19)的患者亦合并基底节病灶。基底节区外病灶常表现为VRS扩大/胶样假囊(12/19,63.1%),增强后未见明显强化;隐球菌肉芽肿和脑膜增厚强化的发生率分别为15.7%(3/19)和26.3%(5/19)。结论:AIDS合并中枢神经系统隐球菌感染时颅脑MRI异常发生率可能并不低,病灶多位于基底节区,常见为VRS扩大/胶样假囊,亦可表现为脑隐球菌肉芽肿。MRI增强时这些病灶往往未见强化或仅轻度强化。
[Abstract]:Objective: to investigate the magnetic resonance imaging (magnetic resonance imaging,MRI) features of cryptococcal infection in central nervous system (CNS) in (acquired immune deficiency syndrome,AIDS patients. Methods: the craniocerebral MRI and clinical data of patients with cryptococcal meningitis (cryptococcal meningitis,CM) treated with AIDS from July 2011 to March 2017 were retrospectively analyzed. Clear or clinically suspected patients with other central nervous system diseases were not included in the analysis. Results: a total of 39 patients were included in the analysis. The CD4 cell count was 13 脳 10 6 / L [(0 / 205) 脳 10 6 / L], and the CD4 cell count was 94. 9% (37 / 39). 26 of the 100 脳 106/L.39 patients had abnormal MRI signal. The most common site involved was basal ganglia (20 / 2676. 9%). The lesions in the basal ganglia were usually characterized by enlargement of the perivascular space (Virchow-Robin space,VRS) / colloid pseudocyst (18 / 2090%) and no obvious enhancement after enhancement. The incidence of Cryptococcus granuloma was 35% (7 / 20), no significant enhancement (3 / 560%) or mild enhancement (2 / 5% 40%) after enhancement. 73.0% (19 / 26) patients had lesions outside the basal ganglia. Of these, 68.4% (13 / 19) also had basal ganglion lesions. The lesions outside the basal ganglia often showed VRS enlargement / colloid pseudocyst (12 / 19) (63.1%), and no obvious enhancement was found after enhancement. The incidence of Cryptococcus granuloma and meningeal thickening was 15.7% (3 / 19) and 26. 3% (5 / 19), respectively. Conclusion: the incidence of craniocerebral MRI abnormalities in patients with AIDS complicated with cryptococcal infection in the central nervous system may not be low. Most of the lesions are located in the basal ganglia, and the most common lesions are VRS enlargement / colloid pseudocyst. Cryptococcus cerebralis granuloma is also present. These lesions are often not enhanced or only slightly enhanced when MRI is enhanced.
【作者单位】：南京医科大学附属南京医院放射科;南京市第二医院放射科;南京市第二医院感染科;
【基金】：江苏省“十三五科教强卫工程”青年医学人才项目(QNRC2016059) 江苏省临床医学科技专项课题(BL2013004) 南京市医学科技发展项目(ZKX14029)~~
【分类号】：R445.2;R512.91

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