Chang K H, Han M H, Roh J K, Kim I O, Han M C, Kim C W
Department of Diagnostic Radiology, College of Medicine, Seoul National University, Korea.
AJNR Am J Neuroradiol. 1990 Jan-Feb;11(1):69-76.
Plain and Gd-DTPA-enhanced MR images of the brain were obtained in 18 consecutive patients with meningitis (eight with tuberculous, five with bacterial, three with viral, and two with fungal infections); the MR images were compared with CT scans. MR images were obtained on a 2.0-T superconducting unit with both T1- and T2-weighted pulse sequences before injection and with a T1-weighted sequence after injection of Gd-DTPA (0.1 mmol/kg) in all patients. In tuberculous meningitis, MR imaging depicted ischemia/infarct, hemorrhagic infarct of basal ganglia, meningeal enhancement at either basal cistern or convexity surface of brain, and associated small granulomas in a few more patients than CT did. In bacterial meningitis, primary foci of extracranial inflammation (i.e., mastoid, paranasal sinuses) and adjacent intracranial lesions including localized dural inflammation, subdural fluid collection, and/or brain parenchymal lesions were demonstrated much better on MR than on CT. Otherwise, MR images generally matched the CT scan. Although the plain MR images, both T1- and T2-weighted, were the most sensitive in delineating ischemia/infarct, hemorrhage, and edema, they were not as specific as Gd-DTPA-enhanced T1-weighted images and postcontrast CT scans in defining the active inflammatory process of the meninges and focal lesions precisely. We conclude that if Gd-DTPA is used, MR imaging appears to be superior to CT in the evaluation of patients with suspected meningitis. Precontrast MR is needed to delineate ischemia/infarct, edema, and subacute hemorrhage.
对18例连续的脑膜炎患者（8例结核性、5例细菌性、3例病毒性、2例真菌性感染）进行了脑部平扫及钆喷酸葡胺（Gd-DTPA）增强磁共振成像（MR）检查，并将MR图像与计算机断层扫描（CT）进行比较。所有患者均在2.0-T超导设备上，于注射Gd-DTPA（0.1 mmol/kg）前采用T1加权和T2加权脉冲序列获取MR图像，注射后采用T1加权序列获取图像。在结核性脑膜炎中，与CT相比，MR成像显示出更多患者存在缺血/梗死、基底节区出血性梗死、脑基底池或脑凸面脑膜强化以及相关小肉芽肿。在细菌性脑膜炎中，MR比CT能更好地显示颅外炎症的原发灶（即乳突、鼻窦）以及相邻的颅内病变，包括局限性硬脑膜炎症、硬膜下积液和/或脑实质病变。除此之外，MR图像总体上与CT扫描结果相符。尽管平扫MR图像（T1加权和T2加权）在显示缺血/梗死、出血和水肿方面最为敏感，但在精确界定脑膜的活动性炎症过程和局灶性病变方面，它们不如Gd-DTPA增强T1加权图像和增强后CT扫描具有特异性。我们得出结论，如果使用Gd-DTPA，MR成像在疑似脑膜炎患者的评估中似乎优于CT。需要进行平扫MR来显示缺血/梗死、水肿和亚急性出血。
