Sparacia G, Brancatelli G, Sarno C, De Maria M, Lagalla R, Filosto L
Istituto di Radiologia P. Cignolini, Università degli Studi, Palermo.
Radiol Med. 1998 Jul-Aug;96(1-2):23-8.
We investigated the role of Magnetic Resonance Imaging (MRI) in the diagnosis of neurotoxoplasmosis and in the evaluation of drug treatment response.
Twenty-six AIDS patients (22 men and 4 women, mean age 26.7 years) with clinical suspicion of neurotoxoplasmosis were examined. A patient was considered to have neurotoxoplasmosis if there were signs of focal neurologic impairment and a positive/questionable response to the serum test for Toxoplasma gondii. MR images were acquired with T1-weighted spin-echo (SE) and inversion recovery (IR) sequences and with T2-weighted SE sequences. Gd-DTPA was administered in all cases. After the beginning of therapy with sulfadiazine and pyrimethamine all patients were submitted to clinical and neuroradiologic follow-up for 60 days.
MR examinations on admission demonstrated at least one brain lesion in all patients and multifocal involvement in 70% of cases. Enhancing lesions were found in 90% of patients (83% ring enhancement, 4% focal enhancement, 3% mixed patterns). The most frequent lesion sites were the basal ganglia and thalami (70%). The brain lesions were subdivided into 4 groups by their morphology and signal patterns.
The time course of clinical and neuroradiologic responses demonstrates a rapid improvement after the first week of therapy, which stabilized after the second week. Pearson correlation between clinical and neuroradiologic treatment responses showed a nearly linear correlation (r = .97; p < .001). The diagnosis was then confirmed in all patients based on the positive response to the serum test for Toxoplasma gondii (IgG > 12 UI/mL) and/or clinical and neuroradiologic improvement after therapy.
This study demonstrates the accuracy of MRI in the detection of toxoplasmosis brain lesions and in the evaluation of treatment response.
我们研究了磁共振成像（MRI）在神经型弓形虫病诊断及药物治疗反应评估中的作用。
对26例临床怀疑患有神经型弓形虫病的艾滋病患者（22例男性，4例女性，平均年龄26.7岁）进行了检查。如果患者有局灶性神经功能损害的体征且弓形虫血清学检测呈阳性/可疑反应，则被认为患有神经型弓形虫病。采用T1加权自旋回波（SE）序列、反转恢复（IR）序列以及T2加权SE序列采集MR图像。所有病例均静脉注射钆喷酸葡胺（Gd-DTPA）。在开始使用磺胺嘧啶和乙胺嘧啶治疗后，所有患者均接受了60天的临床和神经放射学随访。
入院时的MR检查显示所有患者至少有一处脑病变，70%的病例为多灶性受累。90%的患者发现有强化病变（83%为环形强化，4%为局灶性强化，3%为混合模式）。最常见的病变部位是基底节和丘脑（70%）。根据脑病变的形态和信号模式将其分为4组。
临床和神经放射学反应的时间进程表明，治疗第一周后病情迅速改善，第二周后趋于稳定。临床和神经放射学治疗反应之间的Pearson相关性显示出几乎呈线性相关（r = 0.97；p < 0.001）。随后根据弓形虫血清学检测阳性反应（IgG > 12 UI/mL）和/或治疗后临床及神经放射学改善情况，所有患者的诊断均得到证实。
本研究证明了MRI在检测弓形虫脑病损及评估治疗反应方面的准确性。
