Miszkiel K A, Hall-Craggs M A, Miller R F, Kendall B E, Wilkinson I D, Paley M N, Harrison M J
Imaging Department, UCL Hospital (NHS) Trust, London UK.
Clin Radiol. 1996 Dec;51(12):842-50. doi: 10.1016/s0009-9260(96)80080-8.
We retrospectively reviewed the cranial MRI appearances of 25 patients with AIDS and microbiologically proven central nervous system (CNS) cryptococcosis. Four patients had a normal scan. Ten patients had dilated perivascular Virchow-Robin spaces that were hyperintense on T2-weighted images. Nine of these patients developed progressive cryptococcomas, eight in the basal ganglia and one in the cerebral white matter. The cryptococcomas displayed high signal on T2-weighted and intermediate to low signal on T1-weighted images. None enhanced after dimeglumine gadopentetate. No abnormal dural or leptomeningeal enhancement was detected in any patient. One patient developed an acquired arachnoid cyst during treatment of CNS cryptococcosis which was thought to represent a focal collection of organisms and mucoid material within the subarachnoid space. In addition either cerebral atrophy and/or background white matter hyperintensity on T2-weighted images was present in 19/25 patients. In two patients the neuropathological findings at autopsy correlated well with the imaging abnormalities. In conclusion, this spectrum of MRI appearances in CNS cryptococcosis reflects the pathological mechanism of invasion by the fungus, but a normal scan or one with features of CNS HIV infection such as atrophy or white matter hyperintensity does not exclude the diagnosis.
我们回顾性分析了25例经微生物学证实患有中枢神经系统（CNS）隐球菌病的艾滋病患者的头颅MRI表现。4例患者扫描结果正常。10例患者的血管周围间隙（Virchow-Robin间隙）增宽，在T2加权像上呈高信号。其中9例患者发展为进行性隐球菌瘤，8例位于基底节，1例位于脑白质。隐球菌瘤在T2加权像上呈高信号，在T1加权像上呈中等至低信号。静脉注射钆喷酸葡胺后均无强化。所有患者均未检测到硬脑膜或软脑膜异常强化。1例患者在CNS隐球菌病治疗期间出现后天性蛛网膜囊肿，被认为是蛛网膜下腔内微生物和黏液样物质的局灶性聚集。此外，19/25例患者存在脑萎缩和/或T2加权像上的脑白质高信号。2例患者尸检时的神经病理学发现与影像学异常高度相关。总之，CNS隐球菌病的这一系列MRI表现反映了真菌侵袭的病理机制，但扫描结果正常或具有CNS HIV感染特征（如萎缩或白质高信号）并不能排除诊断。
