磁共振三维颅脑容积成像增强扫描在颅内结核影像诊断中的应用

doi:10.19982/j.issn.1000-6621.20250207

摘要/Abstract

摘要：

目的: 探讨磁共振三维颅脑容积成像(three-dimension brain volume imaging,3D BRAVO)增强扫描在颅内结核影像诊断中的价值。方法: 收集2021年4月至2024年8月首都医科大学附属北京胸科医院临床确诊及资料完整的122例颅内结核患者作为研究对象。所有患者均进行了结核病相关实验室检查(包括脑脊液检测)、头颅磁共振平扫及增强扫描检查,以及磁共振3D BRAVO增强扫描检查。分析研究对象头颅磁共振常规增强扫描及3D BRAVO增强扫描的影像学特点,并评价磁共振3D BRAVO增强扫描在颅内结核影像诊断中的价值。结果: 患者临床表现存在结核中毒症状和呼吸系统症状(如咳嗽、咳痰、胸痛等)者32例(26.2%,32/122);出现发热、头痛者81例(66.4%,81/122);具有神经系统症状和体征者73例(59.8%,73/122),其中,脑脊液实验室检查常规和生化异常者113例(92.6%,113/122)。所有患者均行腰椎穿刺术检查,颅内压高于180mmH₂O(1mmH₂O=0.0098kPa)者57例(46.7%,57/122)。122例患者头颅常规磁共振增强扫描:30例(24.6%,30/122)显示为脑膜型,40例(32.8%,40/122)显示为脑实质型,29例(23.8%,29/122)显示为混合型(脑膜及脑实质病变并存),23例(18.9%,23/122)未见颅内结核病变;磁共振3D BRAVO增强扫描:43例(35.2%,43/122)显示为脑膜型,22例(18.0%,22/122)显示为脑实质型,45例(36.9%,45/122)为混合型,12例(9.8%,12/122)未见颅内结核病变。磁共振3D BRAVO增强扫描对颅内结核患者病灶检出率明显高于头颅磁共振常规增强扫描,差异有统计学意义(χ²=9.091,P=0.001);对脑膜结核的检出率明显高于头颅磁共振常规增强扫描,差异有统计学意义(χ²=27.034,P<0.001)。磁共振3D BRAVO增强扫描122例患者中,9例并发脑积水、29例并发脑梗死、10例并发脑神经病变。结论: 磁共振3D BRAVO增强扫描对颅内结核的分型和早期发现具有重要辅助诊断价值。

关键词: 结核, 脑膜, 磁共振成像, 成像, 三维, 诊断, 鉴别, 对比研究

Abstract:

Objective: To investigate the value of three-dimensional brain volume imaging (3D BRAVO) contrast-enhanced magnetic resonance imaging (MRI) in the imaging diagnosis of intracranial tuberculosis. Methods: A total of 122 patients with intracranial tuberculosis who were clinically diagnosed and had complete data at Beijing Chest Hospital affiliated to Capital Medical University from April 2021 to August 2024 were collected as the research subjects. All patients underwent tuberculosis related laboratory tests (including cerebrospinal fluid testing), cranial MRI plain and enhanced scans, and 3D BRAVO enhanced MRI scans. The imaging characteristics of the study subjects’ skull magnetic resonance conventional enhanced scan and 3D BRAVO enhanced scan were analyzed, and the value of magnetic resonance 3D BRAVO enhanced scan in the imaging diagnosis of intracranial tuberculosis was evaluated. Results: Thirty-two cases (26.2%, 32/122) had clinical manifestations of tuberculosis poisoning and respiratory symptoms (such as cough, sputum, chest pain, etc.); 81 cases (66.4%, 81/122) experienced fever and headache; 73 cases (59.8%, 73/122) had neurological symptoms and signs, among which 113 cases (92.6%, 113/122) had routine and biochemical abnormalities in cerebrospinal fluid laboratory tests. All patients underwent lumbar puncture examination, and 57 cases (46.7%, 57/122) had intracranial pressure higher than 180 mmH₂O (1 mmH₂O=0.0098 kPa). All patients underwent routine magnetic resonance enhanced scans of their heads: 30 cases (24.6%, 30/122) showed meningeal type; 40 cases (32.8%, 40/122) showed parenchymal type, 29 cases (23.8%, 29/122) showed mixed type (meningeal and parenchymal lesions coexisted), 23 cases (18.9%, 23/122) showed no intracranial tuberculosis; Magnetic resonance 3D BRAVO enhanced scan: 43 cases (35.2%, 43/122) showed meningeal type; 22 cases (18.0%, 22/122) showed cerebral parenchyma type, 45 cases (36.9%, 45/122) showed mixed type, and 12 cases (9.8%, 12/122) showed no intracranial tuberculosis. The detection rate of lesions in intracranial tuberculosis patients by 3D BRAVO enhanced magnetic resonance imaging was significantly higher than that by conventional enhanced head magnetic resonance imaging, and the difference was statistically significant (χ²=9.091, P=0.001); The detection rate of meningeal tuberculosis was significantly higher than that of routine enhanced head magnetic resonance imaging, and the difference was statistically significant (χ²=27.034, P<0.001). Among 122 patients who underwent 3D BRAVO enhanced magnetic resonance imaging, 9 had concurrent hydrocephalus and 29 had concurrent cerebral infarction; 10 cases of concurrent cerebral neuropathy. Conclusion: Magnetic resonance 3D BRAVO enhanced scanning has important auxiliary diagnostic value for the classification and early detection of intracranial tuberculosis.

Key words: Tuberculosis, meningeal, Magnetic resonance imaging, Imaging, three-dimensional, Diagnosis, differential, Comparative study

中图分类号:

宁锋钢, 房坤, 王珏, 吕岩, 贺伟, 侯代伦. 磁共振三维颅脑容积成像增强扫描在颅内结核影像诊断中的应用[J]. 中国防痨杂志, 2025, 47(11): 1489-1494. doi: 10.19982/j.issn.1000-6621.20250207

Ning Fenggang, Fang Kun, Wang Jue, Lyu Yan, He Wei, Hou Dailun. Application of magnetic resonance 3D BRAVO enhanced scanning in the imaging diagnosis of intracranial tuberculosis[J]. Chinese Journal of Antituberculosis, 2025, 47(11): 1489-1494. doi: 10.19982/j.issn.1000-6621.20250207

图/表 3

图1~3

图8~11

表1

参考文献 20

[1]	Gupta RK, Kumar S. Central nervous system tuberculosis. Neuroimaging Clin N Am, 2011, 21(4):795-814, vii-viii. doi:10.1016/j.nic.2011.07.004.
[2]	Murray CJL, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs)for 291 diseases and injuries in 21 regions,1990—2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859):2197-2223. doi:10.1016/S0140-6736(12)61689-4.
[3]	Brancusi F, Farrar J, Heemskerk D. Tuberculous meningitis in adults: a review of a decade of developments focusing on prognostic factors for outcome. Future Microbiol, 2012, 7(9): 1101-1116. doi:10.2217/fmb.12.86. pmid: 22953709
[4]	刘淑玲, 郝爱华, 曾庆娟, 等. 颅内结核的MRI诊断. 中国中西医结合影像学杂志, 2012, 10(5):420-422. doi:10.3969/j.issn.1672-0512.2012.05.012.
[5]	宁锋钢, 周新华, 侯代伦, 等. 成年血行播散性肺结核并发颅内结核的临床及头颅MRI表现特征. 中国防痨杂志, 2020, 42(1): 19-25. doi:10.3969/j.issn.1000-6621.2020.01.007.
[6]	陈雨琪, 邹秋婷, 尼玛. 结核性脑膜炎的MRI表现. 中国中西医结合影像学杂志, 2019, 17(1):71-73. doi:10.3969/j.issn.1672-0512.2019.01.021.
[7]	黄麦玲, 马艳, 王桂荣, 等. 头颅MR增强扫描在急性血行播散性肺结核患者中筛查结核性脑膜炎的价值. 中国防痨杂志, 2019, 41(1):36-41. doi:10.3969/j.issn.1000-6621.2019.01.009.
[8]	殷慧康, 耿承军, 叶黛西, 等. MR三维颅脑容积成像增强扫描序列在静脉窦血栓中的应用. 医学影像学杂志, 2021, 31(4):550-555.
[9]	刘小红, 刘伟, 陈亮. 3D-BRAVO增强联合ESWAN 对微小脑转移瘤临床诊断价值. 实用放射学杂志, 2024, 40(11):1762-1765. doi:10.3969/j.issn.1002-1671.2024.11.002.
[10]	王重阳, 吴玲, 杨凯华, 等. MR三维颅脑容积成像增强扫描序列在小儿颅内肿瘤中的运用. 贵州医药, 2024, 48(6):950-953. doi:10.3969/j.issn.1000-744X.2024.06.041.
[11]	Marais S, Thwaites G, Schoeman JF, et al. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis, 2010, 10(11): 803-812. doi:10.1016/S1473-3099(10)70138-9. pmid: 20822958
[12]	中华医学会结核病学分会, 颅内结核影像学分型专家共识编写组. 颅内结核影像学分型专家共识. 中华结核和呼吸杂志, 2015, 38(11):805-809. doi:10.3760/cma.j.issn.1001-0939.2015.11.003.
[13]	Kalita J, Prasad S, Maurya PK, et al. MR angiography in tuberculous meningitis. Acta Radiol, 2012, 53(3):324-329. doi:10.1258/ar.2012.110712. pmid: 22371623
[14]	吕岩, 李成海, 周新华, 等. 脑膜结核147例核磁共振影像分析. 中华结核和呼吸杂志, 2015, 38(11):815-820. doi:10.3760/cma.j.issn.1001-0939.2015.11.005.
[15]	贺伟, 宁锋钢, 周新华, 等. 脑实质结核的核磁共振影像特点及动态分析. 中华结核和呼吸杂志, 2015, 38(11):821-827. doi:10.3760/cma.j.issn.1001-0939.2015.11.006.
[16]	过丽芳, 吕岩, 周新华, 等. 颅内结核的MRI特点及抗结核治疗动态分析. 中华放射学杂志, 2014, 48(3):202-206. doi:10.3760/cma.j.issn.1005-1201.2014.03.008.
[17]	Lu TT, Lin XN, Zhang L, et al. Magnetic resonance angiography manifestations and prognostic significance in HIV-negative tuberculosis meningitis. Int J Tuberc Lung Dis, 2015, 19(12): 1448-1454. doi:10.5588/ijtld.15.0113. pmid: 26614185
[18]	李保灿, 杨岳松. 结核性脑膜炎神经系统损害的MRI诊断. 临床放射学杂志, 2000, 19(11):678-680. doi:10.3969/j.issn.1001-9324.2000.11.004.
[19]	Amitava AK, Alarm S, Hussain R. Neuro-ophthalmic features in pediatric tubercular meningoencephalitis. J Pediatr Ophthalmol Strabismus, 2001, 38(4): 229-234. doi:10.3928/0191-3913-20010701-10. pmid: 11495311
[20]	Sinha MK, Garg RK, Anuradha HK, et al. Vision impairment in tuberculous meningitis: predictors and prognosis. J Neurol Sci, 2010, 290(1-2):27-32. doi:10.1016/j.jns.2009.12.012. pmid: 20056252

型别	例数	并发症[例(发生率,%)]			颅内压升高 [例(发生率,%)]
型别	例数	脑梗死	脑积水	脑神经病变	颅内压升高 [例(发生率,%)]
脑膜结核	43	13(30.2)	7(16.3)	5(11.6)	30(69.8)
脑实质结核	22	4(18.2)	0(0.0)	1(4.5)	13(59.1)
混合型颅内结核	45	12(24.4)	2(4.4)	4(8.8)	14(31.1)