结核性脊膜炎MRI表现及治疗后动态变化研究

doi:10.19982/j.issn.1000-6621.20210711

摘要/Abstract

摘要：

目的: 研究结核性脊膜炎MRI表现、治疗后演变及患者预后情况,以提高临床认识。方法: 通过《首都医科大学附属北京胸科医院病案电子化管理系统》和《图像获取及传输系统》(PACS),收集2012年1月1日至2016年12月31日确诊并有完整MRI资料的31例结核性脊膜炎患者,记录脊膜、蛛网膜下腔及脊髓改变。 结果: 96.8%(30/31)的患者有脊膜增厚和强化。48.4%(15/31)的患者蛛网膜下腔不规则或狭窄,12.9%(4/31)的患者蛛网膜下腔闭塞,6.5%(2/31)的患者有髓外硬膜内结核瘤。脊髓炎见于51.6%(16/31)的患者,而髓内结核瘤见于9.7%(3/31)的患者。58.3%(7/12)的患者在随访MRI中显示病情缓解,25.0%(3/12)的患者有进展,16.7%(2/12)患者的MRI表现无变化。71.0%(22/31)的结核性脊膜炎患者预后不良,包括13例死亡及9例残疾。结论: MRI增强扫描能发现增厚强化的脊膜、脊髓及蛛网膜下腔改变,并且能观察抗结核治疗后的疗效,可以作为结核性脊膜炎患者首选的影像检查方法。

关键词: 结核,脑膜, 软脑脊膜, 磁共振成像

Abstract:

Objective: To describe MRI characteristics of spinal tuberculous meningitis, the changes after anti-tuberculosis treatment and the prognosis of patients. Methods: Using the electronic medical record management system of Beijing Chest Hospital Affiliated to Capital Medical University and Picture Archiving and Communication System (PACS), 31 patients whose complete MRI data were maintained and diagnosed as tuberculous spinal meningitis from 2012 to 2016 were selected as study objects. Two radiologists reviewed MRI retrospectively and the changes of spinal meninges, subarachnoid space and spinal cord were recorded. Results: The MRI showed that 96.8% (30/31) patients had thickened and enhanced meninges, 48.4% (15/31) had irregular or narrow subarachnoid space, 12.9% (4/31) had obliteration of the subarachnoid space, and 6.5% (2/31) had intradural extramedullary tuberculomas. Myelitis was detected in 51.6% (16/31) patients, while intramedullary tuberculoma was detected in 9.7% (3/31) patients. Furthermore, 58.3% (7/12) patients showed remission in the follow-up MRI, 25.0% (3/12) patients had progression; and 16.7% (2/12) patients showed no change in MRI. 71.0% patients (22/31) had a poor prognosis, including 13 deaths and 9 disability cases. Conclusion: Enhanced MRI can show the thickened and enhanced meninges, change in the subarachnoid space and in the spinal cord. MRI can also reflect the changes after anti-tuberculosis treatment. Enhanced MRI should be the first choice of imaging examination for patients with tuberculous spinal meningitis.

Key words: Tuberculosis,meningeal, Pia mater, Magnetic resonance imaging

中图分类号:

R529.3
R81

李多, 吕岩, 吕平欣. 结核性脊膜炎MRI表现及治疗后动态变化研究[J]. 中国防痨杂志, 2022, 44(3): 258-263. doi: 10.19982/j.issn.1000-6621.20210711

LI Duo, LYU Yan, LYU Ping-xin. Study of MRI characteristics of spinal tuberculous meningitis and the change after anti-tuberculosis treatment[J]. Chinese Journal of Antituberculosis, 2022, 44(3): 258-263. doi: 10.19982/j.issn.1000-6621.20210711

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参考文献 13

[1]	Wadia NH, Dastur DK. Spinal meningitides with radiculo-myelopathy. 1. Clinical and radiological features. J Neurol Sci, 1969, 8(2):239-260. doi: 10.1016/0022-510x(69)90112-9. doi: 10.1016/0022-510x(69)90112-9 pmid: 5805757
[2]	Anderson NE, Somaratne J, Mason DF, et al. Neurological and systemic complications of tuberculous meningitis and its treatment at Auckland City Hospital, New Zealand. J Clin Neurosci, 2010, 17(9):1114-1118. doi: 10.1016/j.jocn.2010.01.006. doi: 10.1016/j.jocn.2010.01.006 pmid: 20605462
[3]	Gupta R, Garg RK, Jain A, et al. Spinal cord and spinal nerve root involvement (myeloradiculopathy) in tuberculous meningitis. Medicine (Baltimore), 2015, 94(3):e404. doi: 10.1097/MD.0000000000000404. doi: 10.1097/MD.0000000000000404 URL
[4]	Pasoglou V, Janin N, Tebache M, et al. Familial adhesive arachnoiditis associated with syringomyelia. AJNR Am J Neuroradiol, 2014, 35(6):1232-1236. doi: 10.3174/ajnr.A3858. doi: 10.3174/ajnr.A3858 URL
[5]	Li Q, Song J, Li X, et al. Differentiation of Intraspinal Tuberculosis and Metastatic Cancer Using Magnetic Resonance Imaging. Infect Drug Resist, 2020, 13:341-349. doi: 10.2147/idr.S224238. doi: 10.2147/idr.S224238 URL
[6]	Lolge S, Chawla A, Shah J, et al. MRI of spinal intradural arachnoid cyst formation following tuberculous meningitis. Br J Radiol, 2004, 77(920):681-684. doi: 10.1259/bjr/90641678. doi: 10.1259/bjr/90641678 URL
[7]	Garg RK, Malhotra HS, Gupta R. Spinal cord involvement in tuberculous meningitis. Spinal cord, 2015, 53(9):649-657. doi: 10.1038/sc.2015.58. doi: 10.1038/sc.2015.58 pmid: 25896347
[8]	Jeong DK, Kwon YM. Intradural Extramedullary Tuberculoma of the Spinal Cord Following Tuberculous Meningitis. Korean J Spine, 2015, 12(2):107-110. doi: 10.14245/kjs.2015.12.2.107. doi: 10.14245/kjs.2015.12.2.107 URL
[9]	Muthukumar N, Sureshkumar V, Ramesh VG. En plaque intradural extramedullary spinal tuberculoma and concurrent intracranial tuberculomas: paradoxical response to antituberculous therapy. Case report. J Neurosurg Spine, 2007, 6(2):169-173. doi: 10.3171/spi.2007.6.2.169. doi: 10.3171/spi.2007.6.2.169 URL
[10]	Chang KH, Han MH, Choi YW, et al. Tuberculous arachnoiditis of the spine: findings on myelography, CT, and MR imaging. AJNR Am J Neuroradiol, 1989, 10(6):1255-1262.
[11]	Sahu R, Chaudhari TS, Junewar V, et al. Spinal cord tuberculosis: a paradoxical response to antituberculous therapy. BMJ Case Rep, 2014, 2014:bcr2014203639. doi: 10.1136/bcr-2014-203639. doi: 10.1136/bcr-2014-203639
[12]	Takahashi H, Ito S, Kojima S, et al. Intradural extramedullary tuberculoma of the thoracic spine: paradoxical response to antituberculous therapy. Intern Med, 2008, 47(8):797-798. doi: 10.2169/internalmedicine.47.0839. doi: 10.2169/internalmedicine.47.0839 URL
[13]	Dastur HM. Diagnosis and neurosurgical treatment of tuberculous disease of the CNS. Neurosurg Rev, 1983, 6(3):111-117. doi: 10.1007/BF01742762. doi: 10.1007/BF01742762 pmid: 6371589

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