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目的 分析脑膜结核的磁共振(MR)影像特点,提高诊断准确率.方法 回顾性分析我院2009年10月至2014年10月住院治疗的147例临床确诊的脑膜结核病例的磁共振成像(MRI)图像数据,男77例,女70例,年龄14～70岁,平均(32±13)岁,全部病例均行MRI平扫及增强扫描,26例行3D TOF序列扫描并MR血管成像(MRA),分析脑膜病变的形态和信号特点及颅内继发改变的特征.收集同期56例肺癌脑膜转移患者,男29例,女27例,年龄36～ 78岁,平均(58±11)岁,将其MRI表现与脑膜结核进行对比.计数资料采用x2检验,logistic多因素回归分析,计量资料采用t检验,P＜0.05为差异有统计学意义.结果 147例脑膜结核病例中146例累及软脑膜(99％),位于基底池及外侧裂池脑膜病变分别为104例及108例,其余为大脑纵裂池(46例)、大脑凸面(35例)及小脑背面(17例).MRI平扫阴性11例;阳性136例,阳性表现为病变脑膜不同程度增厚,相应脑池、室、沟狭窄,T2加权像(T2WI)可见不规则或结节状稍低信号77例;增强扫描病变全部强化,均匀和(或)不均匀强化,其中85例在脑膜增厚基础上,合并结节1 105个,结节呈散在分布23例,簇状分布62例,结节均匀强化452个,环状强化653个,簇状分布的结节多以环状强化或融合成团的分隔状强化为主.颅内继发改变:脑积水94例,大脑前动脉受累17例,大脑中动脉受累58例,大脑后动脉受累9例,脑梗死42例,视神经受累49例.脑膜结核与肺癌脑膜转移的MRI对比,脑膜受累类型、病灶分布部位、边缘是否光整、病变与脑膜的相对位置及脑膜结节的分布比较,除蛛网膜病变外(P=0.066),其余两组比较差异有统计学意义(P =0.000).结论 脑膜结核的MRI影像表现为大脑基底池脑膜增厚为主,合并簇状分布的脑膜结节,结节在T2WI上出现低信号,增强扫描结节呈环形及分隔状强化等征象以及继发性脑积水、脑内前循环血管炎、脑梗死等继发改变对脑膜结核的诊断均具有一定价值,增强扫描对脑膜结核的诊断具有重要意义.

Objective To investigate the MRI features of meningeal tuberculosis.Methods The MR images of meningeal tuberculosis were retrospectively analyzed in 147 patients who were clinically diagnosed from 2009 to 2014 years in our hospital,including 77 males,and 70 females.Their age ranged from 14 to 70 years,and the average age was(32 ± 13)years.All cases underwent MR plain scan and enhancement scan,and 26 cases underwent 3D TOF sequence and MRA vascular reconstruction.The characteristics of the morphological change,MR signal of meningeal lesions and the secondary changes were investigated for 56 cases of meningeal carcinomatosis due to lung cancer,including 29 males and 27 females.Their age ranged from 36 to 78 years old,and the average age was (58 ± 11) years.The MR imaging characteristics of meningeal lesions were compared with those of meningeal tuberculosis.Chi-square test and logistic regression analysis were used for count data analysis,and t-test was used for measurement data.P ＜ 0.05 was regarded as statistically significant.Results Among 147 cases of meningeal tuberculosis,146 (99.32％) had involvement of the cerebral pia mater,104 of the basal cistern,and 108 of the cistern of lateral fissure pools.Lesions located in fissura longitudinalis cerebri pool,convexity of brain and cerebellar back were found in 46,35 and 17 cases,respectively.MRI findings in plain scan were normal in 11 patients,and abnormal in 136 cases.Thickening meningeal lesions with different degrees were shown in the abnormal cases,with irregular or nodular slightly low signal intensity in T2 WI in 77 cases.The meningeal lesions of all cases had homogeneous or inhomogeneous enhancement in enhanced scanning.There were 85 cases with meningeal nodules,including nodules with scattered distribution in 23 cases,and cluster distribution in 62 cases.The number of nodules was up to 1 105,including 452 nodules with homogeneous enhancement,and 653 nodules with ring enhancement.Most nodules of cluster distribution showed ring enhancement or separate enhancement.Secondary changes included hydrocephalus in 94 cases,anterior cerebral artery involvement in 17 cases,middle cerebral artery involvement in 58 cases,posterior cerebral artery involvement in 9 cases,42 cases complicated with cerebral infarction and optic nerve involvement in 49 cases.Comparison of MR manifestations of meningeal tuberculosis and meningeal metastasis showed that,the location,type of meningeal involvement,edge of lesions,relative position of lesions and meninges,distribution of nodules were significantly different (P ＜ 0.05),except arachnoid lesions (P =0.066).Conclusion The MRI characteristics of meningeal tuberculosis were thickening of cerebral basilar cistern meninges.These signs were valuable for MRI diagnosis of meningeal tuberculosis,including cases complicated with meningeal nodules of cluster distribution.The nodules were of low signal on T2WI,with ring enhancement or separate enhancement,with secondary hydrocephalus,cerebral vasculitis in anterior circulation,and brain infarction.The result also showed that contrast-enhanced MRI was valuable for diagnosis of meningeal tuberculosis as well.