Przybojewski Stefan, Andronikou Savvas, Wilmshurst Jo
Department of Radiology, Stellenbosch University Medical School, P.O. Box 19063, Tygerberg 7505, South Africa.
Pediatr Radiol. 2006 Jul;36(7):687-96. doi: 10.1007/s00247-006-0160-z. Epub 2006 Apr 26.
There are no widely accepted objective criteria to determine the presence of basal enhancement on CT in children with suspected tuberculous meningitis (TBM).
To test nine recently described objective CT criteria for the presence of abnormal basal enhancement in children with suspected TBM against the definite diagnosis as determined by cerebrospinal fluid (CSF) culture.
CT scans of patients with a clinical suspicion of TBM who had undergone lumbar puncture for CSF culture spanning a period of 4 years were reviewed for the presence of nine recently described criteria for the presence of abnormal basal enhancement. The radiologists were blinded to the final diagnosis based on CSF culture against which the criteria were tested. The criteria have been named: the 'Y-sign', 'linear enhancement', 'double lines', 'infundibular recess of the third', 'ill-defined edge', 'nodular enhancement', 'join the dots', 'contrast filling the cisterns', and 'asymmetry'.
A total of 65 patients were included in the study, 34 with culture-proven TBM and 31 with other diagnoses. Four individual criteria had a specificity of 100%, but the sensitivities of these criteria ranged from 15% to 53% only. Three other criteria had specificities of 97% and sensitivities ranging from 62% to 82%. The presence of more than one criterion in the same patient showed a specificity of 97% and sensitivity of 91%.
Very high specificity was demonstrated for all nine criteria, including 100% specificity for four individual criteria. Sensitivity was at best 82%, but improved to 91% when more than one criterion was present. These criteria need to be tested for inter- and intraobserver variability to prove their clinical usefulness.
对于疑似结核性脑膜炎（TBM）的儿童，目前尚无广泛接受的客观标准来判定CT上是否存在基底节强化。
针对通过脑脊液（CSF）培养确诊的疑似TBM儿童，检验最近描述的9种用于判定基底节异常强化的客观CT标准。
回顾了4年间因临床怀疑TBM而接受腰椎穿刺进行CSF培养的患者的CT扫描图像，以确定是否存在最近描述的9种基底节异常强化标准。放射科医生对基于CSF培养的最终诊断不知情，而该诊断正是对这些标准进行检验的对照。这些标准分别命名为：“Y征”、“线性强化”、“双线征”、“第三脑室漏斗隐窝”、“边缘不清”、“结节状强化”、“连点征”、“脑池内造影剂充盈”及“不对称”。
本研究共纳入65例患者，其中34例经培养证实为TBM，31例为其他诊断。4项单独标准的特异性为100%，但这些标准的敏感性仅在15%至53%之间。另外3项标准的特异性为97%，敏感性在62%至82%之间。同一患者出现不止一项标准时，特异性为97%，敏感性为91%。
所有9项标准均显示出非常高的特异性，其中4项单独标准的特异性为100%。敏感性最高为82%，但当出现不止一项标准时，敏感性提高到91%。这些标准需要进行观察者间和观察者内变异性测试，以证明其临床实用性。
