Department of Neurology, The First Affiliated Hospital of Sun Yat-Sen University, No. 58, Zhongshan Road II, Guangzhou, Guangdong Province, 510080, People's Republic of China.
Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, Guangdong Province, People's Republic of China.
Eur J Clin Microbiol Infect Dis. 2017 Aug;36(8):1367-1372. doi: 10.1007/s10096-017-2941-8. Epub 2017 Feb 28.
Magnetic resonance (MR) scanning has become an important diagnostic and management tool in cryptococcal meningitis (CM). However, there are only isolated case reports documenting neuroradiological findings in human immunodeficiency virus (HIV)-negative patients with CM and none has clearly addressed the relationship between cerebral lesions on magnetic resonance imaging (MRI) and prognosis. The MR brain images available from 114 HIV-negative patients with CM were retrospectively analysed. Patients were divided into Group I with one or more CM-related lesions and Group II without CM-related lesions. Initial clinical and biochemical markers and prognosis were collected and compared between the two groups. In the present study, the most common pattern of CM-related lesions by MRI was radiological meningitis, following by Virchow-Robin (VR) dilatation, hydrocephalus, intracerebral nodules and pseudocysts, which was different from previous studies reporting that the main MR findings of cerebral cryptococcosis in HIV-infected patients include dilated VR spaces, masses and pseudocysts. Compared to the patients without CM-related lesions, patients with CM-related lesions presented with a higher percentage of male patients, a higher frequency of altered mental status, a higher positive rate of Cryptococcus culture in cerebrospinal fluid (CSF) and a lower ratio of CSF glucose/blood glucose. Poor outcomes were more frequent in patients with presence of CM-related lesions compared to patients without CM-related lesions. In conclusion, the main pattern of cryptococcosis-related lesions on MR scanning differ between non-HIV- and HIV-positive patients with CM. The presence of CM-related lesions was significantly associated with predictors for poor outcome. Neuroimaging on MR scanning is a useful tool to evaluate the initial severity and prognosis of CM without HIV infection.
磁共振（MR）扫描已成为隐球菌性脑膜炎（CM）的重要诊断和治疗工具。然而，仅有孤立的病例报告记录了人类免疫缺陷病毒（HIV）阴性的 CM 患者的神经放射学发现，并且没有明确解决磁共振成像（MRI）上的脑损伤与预后之间的关系。回顾性分析了 114 例 HIV 阴性 CM 患者的 MR 脑图像。患者分为有或无 CM 相关病变的 I 组和 II 组。收集并比较两组患者的初始临床和生化标志物及预后。在本研究中，CM 相关病变的最常见 MRI 表现为放射性脑膜炎，其次是 Virchow-Robin（VR）扩张、脑积水、脑内结节和假性囊肿，与之前报道的 HIV 感染患者脑隐球菌病的主要 MR 表现为 VR 空间扩张、肿块和假性囊肿不同。与无 CM 相关病变的患者相比，有 CM 相关病变的患者中男性患者比例较高，精神状态改变的频率较高，脑脊液（CSF）中隐球菌培养阳性率较高，CSF 葡萄糖/血糖比值较低。与无 CM 相关病变的患者相比，有 CM 相关病变的患者预后不良的发生率更高。总之，CM 非 HIV 阳性和 HIV 阳性患者的 MR 扫描中隐球菌病相关病变的主要模式不同。CM 相关病变的存在与不良预后的预测因素显著相关。MR 扫描神经影像学是一种评估无 HIV 感染的 CM 初始严重程度和预后的有用工具。
