Cao Xin, Yang Qingluan, Zhou Xian, Lv Kun, Zhou Zhe, Sun Feng, Ruan Qiaoling, Zhang Jun, Shao Lingyun, Geng Daoying
Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China.
Center for Shanghai Intelligent Imaging for Critical Brain Diseases Engineering and Technology Reasearch, Shanghai 200040, China.
Diagnostics (Basel). 2022 May 19;12(5):1264. doi: 10.3390/diagnostics12051264.
Background: Magnetic resonance imaging (MRI) is widely used in the diagnosis of tuberculous meningitis (TBM) and its complications. We aimed to explore the relationship between MRI features and neurological deficits and TBM patients’ prognosis. Methods: patients diagnosed with TBM were subjected to a neurological evaluation on admission and divided into groups based on the Medical Research Council (MRC) scale. After several years of follow-up, the patients were further divided into groups according to the Modified Rankin Score (MRS). Their MR images were analyzed for meningeal enhancement, tuberculomas, infarction, hydrocephalus, and abscess, including the location and size of the lesion. Any changes in MRI features during the follow-up were recorded. MRI features between groups were compared, and the relationship between dynamic changes in images and Rankin grading was explored. Results: We found significant differences in acute cerebral infarction (ACI) and old cerebral infarctions (OCI) between the MRC groups, and the ORs of ACI and OCI were 21.818 (95% CI: 2.440−195.075) and 6.788 (95% CI: 1.516−30.392), respectively. There were significant differences in ACI, OCI, and Evan’s ratio between the MRS groups (p < 0.05), and the ORs of ACI, OCI, and hydrocephalus were 6.375 (95% CI: 1.501−27.080), 5.556 (95% CI: 1.332−23.177), and 9.139 (95% CI: 2.052−40.700), respectively. The changes of Evan’s ratio were related to the MRS grading (r = 0.335, p = 0.040). Conclusions: For patients with TBM, the presence of ACI or OCI is associated with neurological deficits, and ACI, OCI, and hydrocephalus can be regarded as poor prognostic predictors. Changes in Evan’s ratio will affect the outcome.
磁共振成像（MRI）广泛应用于结核性脑膜炎（TBM）及其并发症的诊断。我们旨在探讨MRI特征与神经功能缺损及TBM患者预后之间的关系。方法：对诊断为TBM的患者入院时进行神经功能评估，并根据医学研究委员会（MRC）量表分组。经过数年随访，患者再根据改良Rankin量表（MRS）进一步分组。分析其MR图像的脑膜强化、结核瘤、梗死、脑积水及脓肿情况，包括病变的位置和大小。记录随访期间MRI特征的任何变化。比较组间MRI特征，并探讨图像动态变化与Rankin分级之间的关系。结果：我们发现MRC组之间急性脑梗死（ACI）和陈旧性脑梗死（OCI）存在显著差异，ACI和OCI的比值比分别为21.818（95%可信区间：2.440−195.075）和6.788（95%可信区间：1.516−30.392）。MRS组之间ACI、OCI和Evan比值存在显著差异（p<0.05），ACI、OCI和脑积水的比值比分别为6.375（95%可信区间：1.501−27.080）、5.556（95%可信区间：1.332−23.177）和9.139（95%可信区间：2.052−40.700）。Evan比值的变化与MRS分级相关（r = 0.335，p = 0.040）。结论：对于TBM患者，ACI或OCI的存在与神经功能缺损相关，ACI、OCI和脑积水可被视为不良预后的预测指标。Evan比值的变化会影响预后。
