Khan Nausheen, Hiesgen Juliane
Kalafong Hospital, University of Pretoria, South Africa.
SA J Radiol. 2017 Nov 14;21(2):1215. doi: 10.4102/sajr.v21i2.1215. eCollection 2017.
Computerised tomography (CT) scans of 30 patients, admitted with HIV-associated cryptococcal meningoencephalitis (CM), were retrospectively reviewed and the different neuroradiological findings categorised. In addition to the characterisation of the cohort, we looked at whether positive CT scans can indicate negative outcomes when compared with normal imaging.
We identified all patients admitted with CM to Kalafong Hospital in Pretoria, South Africa, over a 2-year period and selected those who underwent brain CT. Abnormal findings were divided into cryptococcal-related lesions and other pathological findings. Clinical data, as well as laboratory data and information about the outcomes were collected.
Thirty-nine (44.8%) out of 87 patients had a CT done during the hospital admission, of which 30 were reviewed and independently reported by the authors. The majority of CT scans were non-contrasted ( = 21). Four patients (13.3%) had normal imaging. Amongst the 26 patients with abnormal CTs, we found 16 brain scans (53.3%) with changes most likely attributed to CM. Dilated Virchow-Robin (VR) spaces, found on eight scans (26.7%), were the most common CT finding related to neurocryptococcosis. Global cerebral atrophy, present in 17 patients (56.7%), was the prevailing generalised abnormality. The mortality of all patients who underwent imaging was similar (33.3%) to the mortality in the total cohort of patients with cryptococcal meningitis (31%). In the group with cryptococcal-related changes on imaging, the mortality was higher (53.3%) than in both groups and a subgroup of five patients with hydrocephalus showed 100% mortality.
Computerised tomography brain imaging was performed in 44.8% of all patients admitted with CM into our hospital. More than half of the images showed cryptococcal-related pathological findings, of which dilated VR spaces were the most common. Only 13.3% of scans were normal. Mortality was higher in the patients with cryptococcal-related pathology (53.3% vs. 31%), with hydrocephalus being associated with a 100% mortality. No scan in our cohort showed any pathology requiring neurosurgical intervention or contraindicating the procedure of a lumbar puncture.
回顾性分析30例因HIV相关隐球菌性脑膜脑炎（CM）入院患者的计算机断层扫描（CT）结果，并对不同的神经放射学表现进行分类。除了对该队列进行特征描述外，我们还探讨了与正常影像学相比，阳性CT扫描是否可预示不良预后。
我们确定了南非比勒陀利亚卡拉丰医院在两年期间收治的所有CM患者，并选择了那些接受脑部CT检查的患者。异常发现分为隐球菌相关病变和其他病理发现。收集了临床数据、实验室数据及预后信息。
87例患者中有39例（44.8%）在入院期间进行了CT检查，其中30例由作者进行回顾性分析并独立报告。大多数CT扫描未增强（n = 21）。4例患者（13.3%）影像学正常。在26例CT异常的患者中，我们发现16例脑部扫描（53.3%）的改变最可能归因于CM。8例扫描（26.7%）发现的扩张的维氏-罗宾（VR）间隙是与神经隐球菌病相关的最常见CT表现。17例患者（56.7%）存在全脑萎缩，是主要的全身性异常。所有接受影像学检查的患者死亡率（33.3%）与隐球菌性脑膜炎患者总队列的死亡率（31%）相似。在影像学上有隐球菌相关改变的组中，死亡率（53.3%）高于其他两组，5例脑积水患者亚组的死亡率为100%。
我院收治的所有CM患者中，44.8%进行了脑部CT成像。超过一半的图像显示有隐球菌相关病理表现，其中扩张的VR间隙最为常见。只有13.3%的扫描结果正常。有隐球菌相关病理表现的患者死亡率较高（53.3%对31%），脑积水患者死亡率为100%。我们队列中的扫描未显示任何需要神经外科干预或禁忌腰椎穿刺的病理情况。
