Andronikou Savvas, Wieselthaler Nicky, Smith Bruce, Douis Hassan, Fieggen A Graham, van Toorn Ronald, Wilmshurst Jo
Department of Radiology, University of Cape Town, Cape Town, South Africa.
Pediatr Radiol. 2005 Nov;35(11):1092-9. doi: 10.1007/s00247-005-1549-9. Epub 2005 Aug 4.
The value of CT in the diagnosis of tuberculous meningitis (TBM) in children is well reported. Follow-up CT scanning for these patients is, however, not well described and, in particular, the value of early follow-up CT has not been addressed for children with TBM.
To assess the value of early follow-up CT in children with TBM in identifying diagnostic, prognostic and therapeutically relevant features of TBM.
A retrospective 4-year review of CT scans performed within 1 week and 1 month of initial CT in children with proven (CSF culture-positive) and probable TBM (CSF profile-positive but culture-negative) and comparison with initial CT for the diagnostic, prognostic and therapeutic CT features of TBM.
The CT scans of 50 children were included (19 "definite" TBM; 31 "probable" TBM). Of these, 30 had CT scans performed within 1 week of the initial CT. On initial CT, 44 patients had basal enhancement. Only 24 patients had contrast medium-enhanced follow-up scans. Important findings include: 8 of 29 patients (who were not shunted) developed new hydrocephalus. New infarcts developed in 24 patients; 45% of those who did not have infarction initially developed new infarcts. Three of the six patients who did not show basal enhancement on initial scans developed this on the follow-up scans, while in seven patients with pre-existing basal enhancement this became more pronounced. Two patients developed hyperdensity in the cisterns on non-contrast medium scans. Eight patients developed a diagnostic triad of features. Three patients developed CT features of TBM where there was none on the initial scans.
Early follow-up CT is useful in making a diagnosis of TBM by demonstrating features that were not present initially and by demonstrating more sensitive, obvious or additional features of TBM. In addition, follow-up CT is valuable as a prognostic indicator as it demonstrates additional infarcts which may have developed or become more visible since the initial study. Lastly, follow-up CT has therapeutic value in demonstrating hydrocephalus, which may develop over time and may require drainage. We advise routine follow-up CT in patients with suspected TBM within the first week of initial CT and optionally at 1 month.
CT在儿童结核性脑膜炎（TBM）诊断中的价值已有充分报道。然而，对于这些患者的随访CT扫描描述并不充分，尤其是早期随访CT对TBM患儿的价值尚未得到探讨。
评估早期随访CT对TBM患儿在识别TBM的诊断、预后及治疗相关特征方面的价值。
对确诊（脑脊液培养阳性）和疑似TBM（脑脊液检查结果阳性但培养阴性）患儿在首次CT检查后1周和1个月内进行的CT扫描进行回顾性4年研究，并将其与首次CT扫描进行比较，以观察TBM的诊断、预后及治疗相关CT特征。
纳入50例患儿的CT扫描资料（19例“确诊”TBM；31例“疑似”TBM）。其中，30例在首次CT检查后1周内进行了CT扫描。首次CT扫描时，44例患者有基底节强化。仅有24例患者进行了对比剂增强随访扫描。重要发现包括：29例未行分流术的患者中有8例出现了新的脑积水。24例患者出现了新的梗死灶；最初没有梗死的患者中有45%出现了新的梗死灶。首次扫描时未显示基底节强化的6例患者中有3例在随访扫描时出现了强化，而7例原有基底节强化的患者强化变得更明显。2例患者在非增强扫描时脑池出现高密度影。8例患者出现了三联征诊断特征。3例患者出现了TBM的CT特征，而首次扫描时未出现这些特征。
早期随访CT通过显示最初不存在的特征以及更敏感、明显或额外的TBM特征，有助于TBM的诊断。此外，随访CT作为预后指标很有价值，因为它显示了自首次检查以来可能出现或变得更明显的额外梗死灶。最后，随访CT在显示脑积水方面具有治疗价值，脑积水可能随时间发展且可能需要引流。我们建议对疑似TBM的患者在首次CT检查后的第一周内进行常规随访CT检查，必要时在1个月时进行。
