目的 探讨增强T2FAIR系列在结核性脑膜炎(TBM)中的诊断价值。方法 选择临床疑似TBM并初次行MR检查的患者80例,根据TBM诊断评分标准和颅内结核影像学分型专家共识作为临床确诊依据。最终56例经临床确诊为TBM(脑脊液结核杆菌抗酸检测阳性)。行常规系列颅脑扫描后增加增强T2FIR系列扫描。由三位经验丰富从事影像专业诊断不同级别的医师分别进行独立分析诊断,以明显强化、轻度强化和无明显强化对比分析增强三维快速扰相梯度回波T1WI(T1GRE3D-FS)序列和增强T2FIR系列对TBM脑膜病变和脑实质的显示程度。结果 增强T2FLAIR系列52例显示脑膜明显强化占92.5%;4例不明显强化占7.5%。T1GRE3D-FS序列 8例明显强化占14%,39例轻度强化占70%;9例无明显强化占16%。增强T2FLAIR系列43例显示脑实质明显强化占76.8%;13例轻度强化占23.2%。T1GRE3D-FS序列48例明显强化占86%;8例轻度强化占14%。两系列对脑实质的显示均有轻度强化。结论 增强T2FAIR系列可作为TBM早期常规系列用于TBM的MR增强检查,能显著提高TBM影像诊断的准确性,,弥补了常规MR增强TlWI对结核性脑膜炎诊断的不足。

Objective To investigate the diagnostic value of enhanced T2FAIR series in tuberculous meningitis (TBM) patients. Methods 80 patients with suspected clinical TBM and initial MR examination were selected as the basis for clinical diagnosis according to the TBM diagnostic scoring standard and the expert consensus of intracranial tuberculosis imaging classification. Finally,56 cases were clinically confirmed as positive for acid resistance in TBM. Enhanced T2FIR series scans were added after routine series craniocerebral scanning. Independent diagnostic analysis was performed by three experienced imaging specialists. By different levels of diagnosis with significant enhancement, mild enhancement and no mild enhancement, we made contrast analysis in display of enhanced three-dimensional fast scrambling phase gradient echo T1WI (T1GRE3D-FS) sequence and enhanced T2FIR series on TBM meningeal lesions and brain parenchyma. Results 52 cases of enhanced T2FLAIR series showed significant enhancement of the meninges in 92.5%; in 4 cases,7.5% were not significantly enhanced. 8 cases of T1GRE3D-FS sequences were significantly enhanced, accounting for 14%, 39 cases of mild enhancement accounted for 70%; no significant enhancement was found in 9 cases, accounting for 16%. Enhanced T2FLAIR series of 43 cases showed significant enhancement of brain parenchyma accounted for 76.8%; 13 cases of mild enhancement accounted for 23.2%. 48 cases of T1GRE3D-FS sequences were significantly enhanced accounted for 86%; 8 cases of mild enhancement accounted for 14%. Both series showed mild enhancement of brain parenchyma. Conclusion The enhanced T2FAIR series can be used as TBM early routine series for MR enhanced examination, it may significantly improve the accuracy of TBM imaging diagnosis, to make up the deficiency of conventional MR.

目的 探讨以肺间质改变为主的不典型肺结核的CT特征。方法 收集2018 年1月—2018 年12月期间44例经我院临床及实验室确诊的以肺间质改变为主的不典型肺结核的CT影像学资料,进行归纳总结,分析其影像特点。结果 44例以肺间质改变为主的不典型肺结核其中14例患者在肺叶的分布呈局限性分布,其中主要分布于右肺上叶占13例;30例呈弥漫性分布;以间质改变为主的局限性分布及弥漫性分布的不典型肺结核均以细网织影、微结节、细支气管壁增厚、小叶间隔增厚为主要表现,树芽征、磨玻璃影在弥漫性分布中相对常见,其合并空洞、支气管扩张、纵膈淋巴结肿大钙化、胸膜炎、肺大疱的比例高于局限性分布患者;以肺间质改变为主的不典型肺结核呈局限性分布(14例)的患者预后良好,13例呈显著吸收,1例吸收良好;弥漫性分布(30例)的患者中,18例显著吸收,其中6例未吸收或吸收欠佳。结论 以肺间质为改变为主的非典型肺结核具有其特征性,了解其CT特点有助于提高临床诊断及更好的评价治疗预后。

Objective To discuss value of the CT features of atypical pulmonary tuberculosis with pulmonary interstitial changes and improve the early diagnosis of pulmonary tubeculosis. Methods The CT imaging data of 44 patients with atypical pulmonary tuberculosis with interstitial changes was collected from January 2018 to December 2018,and the imaging characteristics were analyzed. Results In 44 cases of atypical pulmonary tuberculosis,14 cases of atypical pulmonary tubeculosis were the localized distribution,13 cases were mainly in the right upper lobe,and 30 cases were diffuse distribution. The atypical pulmonary tuberculosis of the localized and diffuse distribution mainly with interstitial changes was characterized by tine reticular shadow,micnodule,thickening of bronchiole wall and thickening of interlobular Septa. Tree-bud sign and ground-glass shadow were common in diffuse distribution,and the proportions of cavity,bronchiectasis,mediastinal lymphadenopathy calcification,pleurisy and bullae were higher than that in localized distribution. The atypical pulmonary tuberculosis patients with localized pulmonary interstitial changes (14 cases) have a favourable prognosis,13 cases with significant absorption,1 case with favourable absorption,and 18 cases with the atypical pulmonary tuberculosis patients with diffuse pulmonary interstitial changes (30 cases) with significant absorption,6 cases with no absorption or poor absorption. Conclusion The atypical pulmonary tuberculosis with interstitial changes has its characteristics,and the CT features is helpful to improve the clinical diagnosis and better evaluation of treatment prognosis.