脑囊虫病的MRI诊断及病理分析

脑囊虫病的MRI诊断及病理分析作者：郭会利张敏程敬亮孙骏谟

【摘要】目的分析脑囊虫病的病理演变特点，探讨脑囊虫病的MRI特征及诊断价值。方法分析36例脑囊虫病的MRI表现特点，并结合12例手术后病理材料进行比较。结果脑实质型18例，脑室型4例，脑膜型3例，混合型11例，主要MRI特点：(1)囊虫存活期，病灶呈圆型，多发常见，附壁囊虫头节呈偏心型小点状影，T1WI呈略高信号，T2WI呈中低信号；囊液T1WI呈低信号，T2WI呈高信号；在FLAIR 上脑脊液呈低信号，而囊液呈相对高信号；周围水肿不明显。(2)囊虫退变坏死期，头节消失，囊腔扩大，周围水肿明显。(3)病灶钙化后，T1WI及T2WI均呈低信号，周围水肿消失。(4)增强扫描表现为：囊壁环状增强(24/36)，或不增强(12/36)；囊内小点状影增强(22/36)，或不增强(14/36)。(5)脑室型：常发生于第三、四脑室，其中第三脑室1例(1/36)，第四脑室3例(3/36)，均引起阻塞性脑积水。(6)脑膜型：因蛛网膜粘连，而引起脑积水(2/36)。结论脑囊虫病在病理演变过程中，具有特征性的MRI表现；MRI对确定脑囊虫病的数目、大小、部位等发病特点及病理演变过程具有很高的诊断价值。

【关键词】脑囊虫病磁共振成像诊断价值病理分析

【Abstract】 Objective To analyze the pathological and developmental characteristics of cerebral cysticercosis (CC) and explore the MRI characteristics of CC and its diagnostic value.Methods The MRI findings of 36 CC cases were analyzed and

compared with the postoperative pathological materials of 12 cases.Results The thirty-six cases included 18 of cerebral-parenchymal type，4 of cerebral-ventricular type，3 of meningeal type，and 11 of mixed type.The CC MRI findings are characterized mainly by：(1)frequently-encountered multiple circular foci during the cysticercus survival：small excentric spotty images of the mural cysticercus scolex ：slightly high signs on T1WI and middle-lower signs on T2WI；lower signs on T1WI and high signs on T2WI of the capsular liquid；lower signs of the cerebrospinal fluid but relatively high signs of the capsular liquid on FLAIR；and unremarkable peripheral edema；

(2)scolex disappearance，enlarged capsular cavity and remarkable peripheral edema during cysticercus degeneration and necrosis；(3)lower signs on T1WI and T2WI and peripheral edema disappearance after the focal calcification；(4)findings shown by the enhanced scanning：strengthened (24/36) or non-strengthened (12/36) cyst-wall circular images；strengthened (22/36) or non-strengthened (14/36) small intracapsular spotty images；(5)cerebral-ventricular type often occurring in the third and fourth ventricles：one case in the third ventricle (1/36) and three cases in the fourth ventricle (3/36)，all of which suffered from obstructive hydrocephalus；

(6)hydrocephalus caused by arachnoid adhesion (2/36) in meningeal type.Conclusion During the pathological development，CC has characteristic MRI findings and MRI has a high diagnostic value for determining the pathogenic characteristics，such as the number，size，location，etc，and the pathological developmental process of CC.

【Key words】 cerebral cysticercosis MRI diagnostic value pathological analysis

脑囊虫病是猪肉绦虫的囊尾蚴寄生于人脑内所引起的疾病，占全身囊虫病的80%，是中枢神经系统最常见的寄生虫感染性疾病。以往CT诊断脑囊虫病的报道不少，但MRI诊断脑囊虫病的报道却很少。笔者收集资料完整、经临床以及手术后病理证实的36例脑囊虫病的MRI 诊断及病理分析报告如下。

1 资料与方法

1.1 一般资料选择2001年1月～2002年7月分别在河南省洛阳正骨医院(8例)、郑州大学一附院(23例)及武汉大学中南医院(5例)行MRI检查且资料完整的脑囊虫病患者36例。男25例，女11例，年龄12～68岁，平均38岁，其中18～45岁者30例，占83%以上。本组患者均经临床表现、病史、囊虫补体结合试验阳性以及特征性MRI 表现而确诊，其中12例手术后经病理证实。

1.2 扫描方法采用美国Marconi公司生产的1.5T超导型MR扫描仪。选用头颅线圈、SE和FSE、液体衰减反转恢复(FLAIR)序列。平