颅内环形强化病变在艾滋病机会感染中的鉴别诊断
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摘要
目的总结颅内环形强化病变在艾滋病(AIDS)患者机会性感染中的诊断及鉴别的MRI影像特征。方法回顾性分析2008～2017年本院AIDS患者合并颅内感染的临床和影像资料,纳入标准为MRI增强扫描发现脑内病变,并在临床试验性治疗好转或经手术活检证实的患者。结果共收集符合条件病例29例,其中弓形虫脑病9例,脑结核13例,神经梅毒2例,细菌性脑脓肿2例,隐球菌脑病3例。CD4+计数中位数为34cells/ul。AIDS颅内感染病变主要分布区域以大脑灰白交界区、基底节区为主,不同感染构成比例略有差异。多发粟粒结节在脑结核多见,其他多呈环形病变。特征性征象如:弓形虫脑病出现偏心性靶征(33.3%),近中线侧壁增厚(20.5%),脑结核呈簇状分布融合呈分隔样、分叶状(25.9%),隐球菌胶样囊病变(100%)。弓形虫脑病、脑结核、脑脓肿病变周围水肿明显(76.9%、67.9%、75%)。弥散加权成像DWI(b=1000)弓形虫脑病高信号显示率(5.1%)低于其他感染病变(约50%)。结论对于艾滋病患者,颅内环形强化病变病因复杂,在出现特征性的MR征象时对提示病因诊断有一定参考价值。
Objective To analyse the MR imaging characters of cerebral ring-enhancing lesions and differential diagnosis between different opportunity infections in AIDS patients. Methods The retrospective analysis of all AIDS patients with cerebral infections from 2008 to 2017 were included,who were with abnormal MR imaging and got final diagnosis by either tentative therapy relief or pathological tissue slice. Results 29 patients were in all, including 9 cases of cerebral toxoplasmosis, 13 of tuberculosis, 2 of neurosyphilis, 3 of bacterial abscess, and 3 of cryptococcosis. The medium and ranges of CD4+ counts were 34 cells/ul. The ring-like lesions mainly located in corticomedullary junction and basal ganglia, with constituent ratios slightly different. Diffuse miliary nodules commonly met in tuberculosis, others were ring-like lesions. Characters were as follows: "Eccentric target sign" were seen in approximately 33.3%, the rate of widening margins of mid-line was 20.5% in cerebral toxoplasmosis. Gluster or flower-like appearances were 25.9% in cerebral tuberculosis.gelatinous pseudocysts were 100% in cryptococcosis. The marginal edema was apparent among toxoplasmosis, tuberculosis and bacterial abscess groups(respectively 76.9%, 67.9%, 75%). It exhibited 5.1% reduced diffusion in diffusion-weighted imaging in toxoplasmosis, which was lower than other opportunity infections. Conclusion Cerebral ring-enhancing lesions were resulted from complicated causes. MR imaging characteristic demonstrations can help us get a clue of etiology.
Objective To analyse the MR imaging characters of cerebral ring-enhancing lesions and differential diagnosis between different opportunity infections in AIDS patients. Methods The retrospective analysis of all AIDS patients with cerebral infections from 2008 to 2017 were included,who were with abnormal MR imaging and got final diagnosis by either tentative therapy relief or pathological tissue slice. Results 29 patients were in all, including 9 cases of cerebral toxoplasmosis, 13 of tuberculosis, 2 of neurosyphilis, 3 of bacterial abscess, and 3 of cryptococcosis. The medium and ranges of CD4+ counts were 34 cells/ul. The ring-like lesions mainly located in corticomedullary junction and basal ganglia, with constituent ratios slightly different. Diffuse miliary nodules commonly met in tuberculosis, others were ring-like lesions. Characters were as follows: "Eccentric target sign" were seen in approximately 33.3%, the rate of widening margins of mid-line was 20.5% in cerebral toxoplasmosis. Gluster or flower-like appearances were 25.9% in cerebral tuberculosis.gelatinous pseudocysts were 100% in cryptococcosis. The marginal edema was apparent among toxoplasmosis, tuberculosis and bacterial abscess groups(respectively 76.9%, 67.9%, 75%). It exhibited 5.1% reduced diffusion in diffusion-weighted imaging in toxoplasmosis, which was lower than other opportunity infections. Conclusion Cerebral ring-enhancing lesions were resulted from complicated causes. MR imaging characteristic demonstrations can help us get a clue of etiology.
引文
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[8] 陈殿森,李宏军,李莉.艾滋病相关性颅内新型隐球菌感染的MRI诊断[J].放射学实践,2011,26(6):586-589.
[9] Patkar D,Narang J,Yanamandala R,et al.Central nervous system tuberculosis:pathophysiology and imaging findings[J].Neuroimaging Clin N Am,2012,22(4):677-705.
[10] Smith AB,Smirniotopoulos JG,Rushing EJ.From the archives of the AFIP:central nervous system infections associated with human immunodeficiency virus infection:radiologic-pathologic correlation [J].Radiographics,2008,28(7):2033-2058.
[11] Ermak TN,Peregudova AB.Location of foci in cerebral toxoplasmosis in HIV-infected patients [J].Ter Arkh,2014,86(11):24-28.
[12] 沈训泽,龚向阳,蒋定尧,等.磁共振扩散加权成像诊断脑脓肿的价值[J].中国医学影像学杂志,2005,13(2):112-115.
[2] Garg RK,Sinha MK.Multiple ring-enhancing lesions of the brain [J].J Postgrad Med,2010,56(4):307-316.
[3] Narra R,Kamaraju SK.Giant eccentric target sign [J].Neurol India,2015,63(1):124-125.
[4] 喻奇志,钟正.AIDS相关性颅内病变MRI分析[J].暨南大学学报(自然科学与医学版),2012,33(4):418-421.
[5] 汪文胜,郭耀平,宋亭,等.弓形体脑病的MRI表现[J].实用放射学杂志,2005,21(6):582-584,588.
[6] Shih RY,Koeller KK.Bacterial,fungal,and parasitic infections of the central nervous system:radiologic-pathologic correlation and historical perspectives [J].Radiographics,2015,35(4):1141-1169.
[7] Hamdeh S,Abbas A,Fraker J,et al.Intracranial toxoplasmosis presenting as panhypopituitarism in an immunocompromised patient [J].Am J Emerg Med,2015,33(12):1841-1848.
[8] 陈殿森,李宏军,李莉.艾滋病相关性颅内新型隐球菌感染的MRI诊断[J].放射学实践,2011,26(6):586-589.
[9] Patkar D,Narang J,Yanamandala R,et al.Central nervous system tuberculosis:pathophysiology and imaging findings[J].Neuroimaging Clin N Am,2012,22(4):677-705.
[10] Smith AB,Smirniotopoulos JG,Rushing EJ.From the archives of the AFIP:central nervous system infections associated with human immunodeficiency virus infection:radiologic-pathologic correlation [J].Radiographics,2008,28(7):2033-2058.
[11] Ermak TN,Peregudova AB.Location of foci in cerebral toxoplasmosis in HIV-infected patients [J].Ter Arkh,2014,86(11):24-28.
[12] 沈训泽,龚向阳,蒋定尧,等.磁共振扩散加权成像诊断脑脓肿的价值[J].中国医学影像学杂志,2005,13(2):112-115.