化脓性脑室炎的CT和MR成像特征
CT and MR imaging features of pyogenic ventriculitis.
作者信息
Fukui M B, Williams R L, Mudigonda S
机构信息
Division of Neuroradiology, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
出版信息
AJNR Am J Neuroradiol. 2001 Sep;22(8):1510-6.
BACKGROUND AND PURPOSE
Pyogenic ventriculitis is an uncommon manifestation of severe intracranial infection that might be clinically obscure. We hypothesized that determining characteristic imaging features of pyogenic ventriculitis in patients with appropriate risk factors might improve recognition of this severe infection.
METHODS
Review of the medical records from 1990 to 2000 revealed 17 cases (12 men, five women) that satisfied inclusion criteria of abscess (n = 3) and/or positive cultures or increased white cells and protein in ventricular (n = 12) or cisternal (n = 1) cerebrospinal fluid. In one case, the diagnosis of ventriculitis was based on the combination of bacterial growth in lumbar cerebrospinal fluid and follow-up imaging. Staphylococcus species and Enterobacter species were the most common organisms. Two neuroradiologists independently evaluated imaging studies for hydrocephalus, ventricular debris, periventricular attenuation or signal abnormality, ependymal enhancement, and signs of meningitis or abscess. Sixteen studies in 11 patients were performed after the intravenous administration of contrast material.
RESULTS
Ventricular debris was detected in 16 (94%) of 17 cases and was irregular in 13 (81%) of 16 cases. Hydrocephalus was present in 13 (76%) of 17 cases. Periventricular hyperintense signal was present in most (seven [78%] of nine) cases with MR imaging and was most conspicuous on fluid-attenuated inversion recovery sequences. Ependymal enhancement was detected in seven (64%) of 11 cases in which contrast material was administered. Signs of meningitis (eg, pial or duraarachnoid signal abnormality or enhancement) were present in 13 (76%) of 17 cases. Three cases had imaging signs of abscess.
CONCLUSION
Ventricular debris was the most frequent sign of ventriculitis in this series. An irregular level was characteristic of debris in ventriculitis. Hydrocephalus and ependymal enhancement were less frequent signs. Detection of ventricular debris might facilitate diagnosis of pyogenic ventriculitis, a potentially fatal infection, and thus permit appropriate therapy.
背景与目的
化脓性脑室炎是严重颅内感染的一种罕见表现，在临床上可能较为隐匿。我们推测，确定具有适当危险因素的患者化脓性脑室炎的特征性影像学表现，可能会提高对这种严重感染的识别。
方法
回顾1990年至2000年的病历，发现17例（12例男性，5例女性）符合脓肿（n = 3）和/或阳性培养结果或脑室（n = 12）或脑池（n = 1）脑脊液中白细胞和蛋白质增加的纳入标准。在1例中，脑室炎的诊断基于腰段脑脊液中的细菌生长及后续影像学检查。葡萄球菌属和肠杆菌属是最常见的病原体。两名神经放射科医生独立评估影像学研究，以观察脑积水、脑室内碎屑、脑室周围衰减或信号异常、室管膜强化以及脑膜炎或脓肿的征象。11例患者中的16项研究是在静脉注射造影剂后进行的。
结果
17例中的16例（94%）检测到脑室内碎屑，16例中的13例（81%）脑室内碎屑形态不规则。17例中的13例（76%）存在脑积水。在大多数（9例中的7例[78%]）进行磁共振成像的病例中出现脑室周围高信号，在液体衰减反转恢复序列上最为明显。在11例注射造影剂的病例中，7例（64%）检测到室管膜强化。17例中的13例（76%）有脑膜炎征象（如软脑膜或硬脑膜蛛网膜信号异常或强化）。3例有脓肿的影像学征象。
结论
在本系列中，脑室内碎屑是脑室炎最常见的征象。不规则形态是脑室炎中碎屑的特征。脑积水和室管膜强化是较不常见的征象。检测到脑室内碎屑可能有助于诊断化脓性脑室炎，这是一种潜在致命的感染，从而能进行适当的治疗。
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