PDF(Pubmed)
Abstract：
BACKGROUND: A clearer understanding is needed about the use of brain MRI in non-HIV patients with cryptococcal meningitis.
METHODS: Cerebral CT and MRI were studied in 62 patients in a multicenter study of cryptococcal meningitis in non-HIV patients. CT was performed in 51 and MRI in 44. MRI results are reported for the images read at NIH for 29 of the 44 patients. CT reports obtained from the original REDCap database were added to calculate the incidence of normal findings.
RESULTS: CTs were read as normal in 24 of 51 (47%), MRIs were normal in 10% (three of 29). The most characteristic lesions of cryptococcal meningitis on MRI were small basal ganglia lesions representing dilated perivascular spaces in 24% and basal ganglia lesions with restricted diffusion (infarcts) in 38%. In the 18 patients who received contrast, contrast-enhancing lesions, likely representing masses of cryptococci and inflammatory cells, were found in the basal ganglia in 22% and elsewhere in the brain in 22%. Meningeal enhancement was seen in 56%, ependymal enhancement in 24%, and choroid plexus enhancement in 11%. Hydrocephalus was found in five (18%), though increased intacranial pressure was not detected. Suboptimal imaging (n = 6), lack of contrast administration (n = 11) and lack of follow-up, however, markedly limited the accurate assessment of abnormalities in multiple cases.
CONCLUSIONS: MRI characteristics of non-HIV cryptococcal meningitis include hydrocephalus, meningeal and ependymal enhancement and basal ganglia lesions. Optimal imaging is, however, necessary to maximize the diagnostic and prognostic usefulness of MRI.
METHODS: Cerebral CT and MRI were studied in 62 patients in a multicenter study of cryptococcal meningitis in non-HIV patients. CT was performed in 51 and MRI in 44. MRI results are reported for the images read at NIH for 29 of the 44 patients. CT reports obtained from the original REDCap database were added to calculate the incidence of normal findings.
RESULTS: CTs were read as normal in 24 of 51 (47%), MRIs were normal in 10% (three of 29). The most characteristic lesions of cryptococcal meningitis on MRI were small basal ganglia lesions representing dilated perivascular spaces in 24% and basal ganglia lesions with restricted diffusion (infarcts) in 38%. In the 18 patients who received contrast, contrast-enhancing lesions, likely representing masses of cryptococci and inflammatory cells, were found in the basal ganglia in 22% and elsewhere in the brain in 22%. Meningeal enhancement was seen in 56%, ependymal enhancement in 24%, and choroid plexus enhancement in 11%. Hydrocephalus was found in five (18%), though increased intacranial pressure was not detected. Suboptimal imaging (n = 6), lack of contrast administration (n = 11) and lack of follow-up, however, markedly limited the accurate assessment of abnormalities in multiple cases.
CONCLUSIONS: MRI characteristics of non-HIV cryptococcal meningitis include hydrocephalus, meningeal and ependymal enhancement and basal ganglia lesions. Optimal imaging is, however, necessary to maximize the diagnostic and prognostic usefulness of MRI.
摘要：
背景：需要更清楚地了解在非HIV合并隐球菌性脑膜炎患者中使用脑MRI的情况。
方法：在一项非HIV患者的隐球菌性脑膜炎的多中心研究中，对62例患者进行了脑CT和MRI研究。CT51例，MRI44例。报告了44例患者中29例在NIH读取的图像的MRI结果。添加从原始REDCap数据库获得的CT报告以计算正常发现的发生率。
结果：在51人中有24人（47％）将CT读取为正常，10％的MRI正常（29个中的3个）。MRI上隐球菌性脑膜炎的最典型病变是24％的小基底神经节病变，代表血管周围间隙扩张，38％的基底神经节病变，弥散受限（梗塞）。在接受造影剂的18名患者中，对比增强病变，可能代表大量的隐球菌和炎症细胞，在22％的基底神经节中发现，在22％的大脑其他地方发现。56%的患者出现脑膜增强,24％的室管膜增强，和11％的脉络丛增强。5人(18%)发现脑积水，尽管未检测到颅内压升高。次优成像(n=6)，缺乏对比剂管理（n=11）和缺乏随访，然而,在多个病例中对异常的准确评估明显受限。
结论：非HIV隐球菌性脑膜炎的MRI特征包括脑积水，脑膜和室管膜增强和基底节病变。最佳成像是，然而,必须最大限度地提高MRI的诊断和预后有用性。
方法：在一项非HIV患者的隐球菌性脑膜炎的多中心研究中，对62例患者进行了脑CT和MRI研究。CT51例，MRI44例。报告了44例患者中29例在NIH读取的图像的MRI结果。添加从原始REDCap数据库获得的CT报告以计算正常发现的发生率。
结果：在51人中有24人（47％）将CT读取为正常，10％的MRI正常（29个中的3个）。MRI上隐球菌性脑膜炎的最典型病变是24％的小基底神经节病变，代表血管周围间隙扩张，38％的基底神经节病变，弥散受限（梗塞）。在接受造影剂的18名患者中，对比增强病变，可能代表大量的隐球菌和炎症细胞，在22％的基底神经节中发现，在22％的大脑其他地方发现。56%的患者出现脑膜增强,24％的室管膜增强，和11％的脉络丛增强。5人(18%)发现脑积水，尽管未检测到颅内压升高。次优成像(n=6)，缺乏对比剂管理（n=11）和缺乏随访，然而,在多个病例中对异常的准确评估明显受限。
结论：非HIV隐球菌性脑膜炎的MRI特征包括脑积水，脑膜和室管膜增强和基底节病变。最佳成像是，然而,必须最大限度地提高MRI的诊断和预后有用性。
