关键词: 结核, 脑膜, 磁共振成像, 图像增强, 诊断技术和方法, 多相筛查, 对比研究, 急性血行播散性肺结核

Abstract:

Objective To explore the screening value of cranial MR enhancement scan for tuberculous meningitis in patients with acute hematogenous disseminated pulmonary tuberculosis.Methods The clinical data of 415 patients with acute hematogenous disseminated pulmonary tuberculosis admitted to Beijing Chest Hospital from January 2012 to May 2018 were collected. Two hundred and thirty-five patients with cranial MR enhancement scan and cerebrospinal fluid routine and biochemistry were selected, the ratio of male to female was 1.12∶1 (124/111), age ranged from 15 to 87 years, mean age was (36±18) years, and patients aged 15-35 years accounted for 62.1% (146/235). We used Chi-square test to compare the count data. The corrected Chi-square test was used when the total number was >40 and 1P<0.05.Results Of 235 patients with acute hematogenous disseminated pulmonary tuberculosis, the abnormal rate of cranial (89.8%,211/235) was higher than that of cerebrospinal fluid (63.0%,148/235), the difference was statistically significant (McNemar test,P=0.000). The abnormal rate of cranial MR enhancement scan (96.3%,211/219) was higher than that of cerebrospinal fluid (67.6%,148/219) in 219 cases with tuberculous meningitis, and the difference was statistically significant (McNemar test,P=0.000). Of 143 patients with central nervous system symptoms, the abnormal rate of cranial MR enhancement scan (95.8%,137/143) was significantly different from that of cerebrospinal fluid (88.1%,126/143) (McNemar test,P=0.035). Of 76 patients without central nervous system symptoms, the abnormal rate of cranial MR enhancement scan (97.4%,74/76) was higher than that of cerebrospinal fluid (28.9%,22/76), the difference was statistically significant (McNemar test,P=0.000). There was no significant difference in abnormal rate of cranial MR enhancement scan between patients with and without central nervous system symptoms (95.8%(137/143) vs 97.4%(74/76)) (adjusted χ ² test,P=0.834).The abnormal rate of cerebrospinal fluid (88.1%(126/143) vs 28.9%(22/76)) was higher in patients with central nervous system symptoms than that without central nervous system symptoms, and the difference was statistically significant (χ ²=79.286,P=0.000). Conclusion Granial MR enhancement scan has a high rate of detection of intracranial lesions in patients with acute hematogenous disseminated pulmonary tuberculosis. Especially for patients with tuberculous meningitis without neurological symptoms, the abnormal rate of cerebrospinal routine and biochemical fluid is low, and the abnormal rate of cranial MR enhancement scan is still higher than 95%.

Key words: Tuberculosis, meningeal, Magnetic resonance imaging, Image enhancement, Diagnostic techniques and procedures, Multiphasic screening, Comparative study, Acute hematogenous disseminated pulmonary tuberculosis