MRI与脑脊液检查在颅内结核诊断中的价值
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摘要
目的评价MRI和脑脊液检查在颅内结核诊断作用,探讨颅内结核诊断难点,明确诊断思路。方法回顾性分析71例颅内结核患者的临床资料,分析其MRI和脑脊液检查结果。结果 MRI结果显示,单纯脑实质异常32例,脑实质和脑膜同时异常28例;单纯脑实质结核患者中,典型结核性脑膜炎脑脊液改变4例,不典型脑脊液改变7例,单纯颅压增高4例。脑脊液检查结果显示,脑脊液改良抗酸染色发现结核菌12例,脑脊液结核菌培养阳性31例,颅内高压27例,脑脊液常规细胞数升高49例,脑脊液蛋白升高35例,脑脊液糖降低39例,氯化物降低42例,腺苷脱氨酶升高39例。71例颅内结核患者,MRI阳性60例(84.5%),脑脊液检测阳性54例(76.0%),2种方法检出阳性率差异无统计学意义(P>0.05),Kappa值=-0.232,提示2种方法的一致性并不好,各具优势。结论头颅MRI和脑脊液检查在颅内结核诊断中均有不可替代的作用,各有优势,临床疑似颅内结核病例,脑脊液细菌学检查阴性时,应进行头颅磁共振平扫+强化联合脑脊液细胞学及生化检查,以提高颅内结核的检出率。
Objective To evaluate the role of MRI and cerebrospinal fluid examination in the diagnosis of intracranial tuberculosis, to explore the difficulties in the diagnosis of intracranial tuberculosis, and to clarify the diagnostic ideas. Methods The clinical data of 71 patients with intracranial tuberculosis were retrospectively analyzed. The results of MRI and cerebrospinal fluid examination were analyzed. Results The results of MRI showed that 32 cases had abnormal brain parenchyma, 28 cases had abnormal brain parenchyma and meninges at the same time; only 4 cases had typical changes of cerebrospinal fluid in tuberculous meningitis, 7 cases had atypical changes of cerebrospinal fluid, and 4 cases had simple increase of intracranial pressure. The results of cerebrospinal fluid examination showed that 12 cases of tuberculosis were detected by modified acid-fast staining of cerebrospinal fluid, 31 cases were positive for cerebrospinal fluid tuberculosis culture, 27 cases were intracranial hypertension, 49 cases were increased in cerebrospinal fluid routine cells, 35 cases were increased in cerebrospinal fluid protein, 39 cases were decreased in cerebrospinal fluid sugar, 42 cases were decreased in chloride and 39 cases were increased in adenosine deaminase. There were 71 cases of intracranial tuberculosis, 60 cases(84.5%) were positive by MRI, 54 cases(76.0%) were positive by cerebrospinal fluid examination. There was no significant difference in the positive rate between the two methods(P>0.05), and the Kappa value was-0.232, suggesting that the consistency of the two methods was not good and each method had advantages. Conclusion Brain magnetic resonance plain scan plus enhanced scan and cerebrospinal fluid examination play an irreplaceable role in the diagnosis of intracranial tuberculosis. Each has its own advantages. When clinical suspected cases of intracranial tuberculosis and cerebrospinal fluid bacteriological examination is negative, the detection rate of intracranial tuberculosis should be improved by plain scan plus enhanced combined with cytological and biochemical examination of cerebrospinal fluid.
Objective To evaluate the role of MRI and cerebrospinal fluid examination in the diagnosis of intracranial tuberculosis, to explore the difficulties in the diagnosis of intracranial tuberculosis, and to clarify the diagnostic ideas. Methods The clinical data of 71 patients with intracranial tuberculosis were retrospectively analyzed. The results of MRI and cerebrospinal fluid examination were analyzed. Results The results of MRI showed that 32 cases had abnormal brain parenchyma, 28 cases had abnormal brain parenchyma and meninges at the same time; only 4 cases had typical changes of cerebrospinal fluid in tuberculous meningitis, 7 cases had atypical changes of cerebrospinal fluid, and 4 cases had simple increase of intracranial pressure. The results of cerebrospinal fluid examination showed that 12 cases of tuberculosis were detected by modified acid-fast staining of cerebrospinal fluid, 31 cases were positive for cerebrospinal fluid tuberculosis culture, 27 cases were intracranial hypertension, 49 cases were increased in cerebrospinal fluid routine cells, 35 cases were increased in cerebrospinal fluid protein, 39 cases were decreased in cerebrospinal fluid sugar, 42 cases were decreased in chloride and 39 cases were increased in adenosine deaminase. There were 71 cases of intracranial tuberculosis, 60 cases(84.5%) were positive by MRI, 54 cases(76.0%) were positive by cerebrospinal fluid examination. There was no significant difference in the positive rate between the two methods(P>0.05), and the Kappa value was-0.232, suggesting that the consistency of the two methods was not good and each method had advantages. Conclusion Brain magnetic resonance plain scan plus enhanced scan and cerebrospinal fluid examination play an irreplaceable role in the diagnosis of intracranial tuberculosis. Each has its own advantages. When clinical suspected cases of intracranial tuberculosis and cerebrospinal fluid bacteriological examination is negative, the detection rate of intracranial tuberculosis should be improved by plain scan plus enhanced combined with cytological and biochemical examination of cerebrospinal fluid.
引文
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[12] 关鸿志,周祥琴,陈琳,等.脑多发性结核瘤11例的临床、脑脊液细胞学与病理特点[J].中华神经科杂志,2006,39(12):810-813.
[13] 李美杰,何俊瑛,张楠,等.结核性脑膜炎伴脑实质损害6例诊治分析[J].河北医科大学学报,2010,31(10):1219-1221.
[14] 何红彦,邵艳新,殷智晔,等.结核性脑膜炎临床特点观察与治疗分析[J].河北医科大学学报,2015,36(8):878-880.
[15] 答嵘,王伟,刘军辉,等.脑脊液生化指标在中枢神经系统感染诊断中的价值[J].国际检验医学杂志,2015,36(18):2635-2637.
[16] 吕翠环,李玉静,郑立恒,等.脑脊液细胞计数与实时荧光定量PCR检测结核菌在结核性脑膜炎诊断中的相关性分析[J].河北医科大学学报,2015,36(4):433-436.
[2] 何红彦,殷智晔,李敬,等.结核性脑膜炎患者中几种病原诊断检测技术的应用[J].中国感染与化疗杂志,2016,16(5):336-339.
[3] 崔会娟,何俊瑛.脑脊液检测诊断结核性脑膜炎[J].河北医科大学学报,2006,27(5):498-500.
[4] 刘怀军,张琳,武柏林,等.颅内结核病的MRI表现[J].河北医科大学学报,2002,23(3):92-94.
[5] 方军杰,孙微,夏建笔.颅内结核MRI影像特点分析[J].浙江临床医学,2016,18(6):1147-1148.
[6] 何红彦,郑立恒,李军霞,等.脑脊液细胞学与改良抗酸染色在结核性脑膜炎早期诊断中的价值探讨[J].河北医科大学学报,2015,36(11):1250-1253.
[7] 邹月丽,白鸽,卜晖,等.改良抗酸染色法在结核性脑膜炎诊断中的应用[J].中国神经精神疾病杂志,2014,40(3):149-152.
[8] 陈文胜,包嘉辉,高如珍,等.血行播散性肺结核并发结核性脑膜炎18例头部MRI特点分析[J].中国医药科学,2014,4(1):126-127,149.
[9] 梁瑞霞,吴寒,白汉林.增强磁共振对血行播散型肺结核患者脑部病变的诊断价值[J].中国实用神经疾病杂志,2015,18(23):56-57.
[10] 艾英,赖力,杨靖逸,等.CT与磁共振在中枢神经系统感染的诊断价值[J].中华医院感染学杂志,2016,26(4):807-809.
[11] 陶胜忠,尹先印,张鹏远,等.脑结核瘤的诊断及治疗(附17例报告)[J].中国神经精神疾病杂志,2012,38(8):496-498.
[12] 关鸿志,周祥琴,陈琳,等.脑多发性结核瘤11例的临床、脑脊液细胞学与病理特点[J].中华神经科杂志,2006,39(12):810-813.
[13] 李美杰,何俊瑛,张楠,等.结核性脑膜炎伴脑实质损害6例诊治分析[J].河北医科大学学报,2010,31(10):1219-1221.
[14] 何红彦,邵艳新,殷智晔,等.结核性脑膜炎临床特点观察与治疗分析[J].河北医科大学学报,2015,36(8):878-880.
[15] 答嵘,王伟,刘军辉,等.脑脊液生化指标在中枢神经系统感染诊断中的价值[J].国际检验医学杂志,2015,36(18):2635-2637.
[16] 吕翠环,李玉静,郑立恒,等.脑脊液细胞计数与实时荧光定量PCR检测结核菌在结核性脑膜炎诊断中的相关性分析[J].河北医科大学学报,2015,36(4):433-436.