【作者】 张明亚；

【导师】 罗良平；

【作者基本信息】 暨南大学 ， 影像医学， 2010， 硕士

【摘要】 研究目的探讨艾滋病脑部病变的临床和CT表现特点,提高对其诊断与鉴别诊断的水平。材料与方法回顾性分析72例艾滋病脑部病变患者的临床和影像学资料,所有病例均行颅脑CT平扫,其中12例同时行增强扫描。比较不同脑部病变的CT阳性率、CT征象及其与CD4+T淋巴细胞的关系,同时将不同脑部病变的死亡率进行分组比较。结果1、72例艾滋病患者中,39例CT检查有异常表现,其中HIV脑炎10例,弓形虫脑病6例,隐球菌性脑膜炎4例,结核性脑膜炎19例,不同病种的CT出现异常改变的发生率有所不同(P=0.03)。2、AIDS脑部病变的CT异常征象及比较(1)10例HIV脑炎,表现为低密度灶3例,其中1例增强扫描未见强化；出现脑室扩大征象2例；脑萎缩7例,其中脑沟、脑池、脑裂明显增宽,蛛网膜下腔增宽5例,仅有脑沟增宽2例。(2)6例弓形虫脑病,均行CT平扫及增强扫描。6例平扫均出现低密度病灶,3例边界不清,3例边界清楚；增强扫描有4例见环状强化。5例伴有占位效应,1例伴有脑室扩大。(3)4例隐球菌性脑膜炎,表现为低密度灶1例,侧脑室、第3脑室轻度扩大(脑积水)1例,脑萎缩2例,脑室缩小、脑沟、脑池消失1例(脑疝形成)。(4)19例结核性脑膜炎,表现为低密度灶12例,占位效应者2例,脑室扩大者3例,脑室积水者4例,边界清楚者5例。5例行增强扫描,其中脑膜强化2例,环状强化1例。不同脑病间的征象比较：(1)低密度灶：在弓形虫脑病的出现率高于HIV脑炎(P=0.011)。(2)占位效应：在弓形虫脑病的出现率高于HIV脑炎(P=0.001)；在弓形虫脑病的出现率高于结核性脑膜炎(P=0.002)。(3)脑萎缩：在HIV脑炎的出现率高于弓形虫脑病(P=0.011)；在HIV脑炎的出现率高于结核性脑膜炎(P=0.000)；在隐球菌性脑膜炎的出现率高于结核性脑膜炎(P=0.024)。3、艾滋病脑部出现各种机遇性感染及HIV脑炎和CD4+T淋巴细胞的减少关系较为密切,当CD4+T淋巴细胞少于200个／μl时出现感染的机会较大,结核性脑膜炎与非结核性脑病CD4+T淋巴细胞计数的差别有统计学意义(Z=-2.784,P=0.005)。4、艾滋病患者晚期的死亡率较高,本组39例患者在住院期间10例死亡,艾滋病合并结核性脑膜炎组与合并非结核性脑病组的死亡率没有统计学差异(P=0.716)。结论1、艾滋病合并脑部病变的CT表现包括低密度灶、占位效应、脑室扩大、脑室积水、病灶环状强化、脑膜强化及脑萎缩等改变。上述改变互相混杂,而低密度灶为最常见征象。2、艾滋病合并脑部病变随着CD4+T淋巴细胞的降低发病率明显升高,CD4+T淋巴细胞>100个／μl时,结核感染多见；弓形虫、隐球菌等机遇性感染多出现在CD4+T淋巴细胞<50个／μl。3、艾滋病合并脑部感染性病变尤其是出现影像学异常时死亡率很高,因此提高对艾滋病患者合并HIV脑炎以及机遇性感染的影像学诊断水平具有重要意义。更多还原

【Abstract】 Objective:To investigate the clinical manifestations and CT findings of the brain lesions in AIDS in order to improve the skills of their diagnosis and differential diagnosis.Methods:Retrospectively analyzed the clinical informations and imaging findings of the brain lesions in 72 cases with AIDS, which all cases were given plane CT scan while 12 cases had CT enhancement scan. Compared CT positive rate, CT features, and their relation to CD4+T lymphocytes among different brain lesions. In addition, studied the mortality rate in different cerebral changes by group comparison.Results:1.39 cases had abnormal CT pictures in 72 patients with AIDS. Among the abnormal CT findings, there were 10 cases with HIV encephalitis,6 with toxoplasmic encephalopathy,4 with cryptococcal meningitis, and 19 with tuberculous meningitis. The incidence rates of CT abnormalities were different in different disorders (P=0.03).2. CT changes and comparison of the brain lesions in AIDS included (1) 3 cases of low signal intensity in 10 HIV encephalitis patients, and no positive findings in one CT enhancement scan; 2 of enlargement of ventricular system; 7 of cerebral atrophy with obvious enlargement of sulcus, cisterna, and cerebral fissure, among them 5 cases with large subarachnoid cavity while only 2 with sucus widened. (2) 6 cases with toxoplasmic encephalopathy were given both plane and enhancement CT scan.6 pictures with low signal intensity in plane CT,3 of bluring border while 3 of clear border were detected; 4 cases of circular changes were found in enhancement CT scan; 5 with mass effect and 1 with enlargement of ventricular system were discovered. (3) In 4 cases of cryptococcal meningitis, CT pictures showed 1 of low signal intensity,1 of enlargement of lateral ventricle and the third ventricle (hydrocephalus),2 of cerebral atrophy, and 1 with both narrow ventricle and sulcus, cisterna disappeared (cerebral hernia). (4) In 19 cases of tuberculous meningitis, CT changes included 12 of low signal intensity,2 of mass effect, 3 of enlargement of ventricular system,4 of hydrocephalus, and 5 of clear border. There were 2 cases with meningeal enhancement and 1 with circular enhancement among 5 cases of CT enhancement scan. Comparison of CT findings in different brain lesions:(1) Low signal intensity:the incidence rate of toxoplasmic encephalopathy was higher than that of HIV encephyalitis(P=0.011). (2) Mass effect:the incidence rate of toxoplasmic encephalopathy was higher than that of HIV encephyalitis(P=0.001); the incidence rate of toxoplasmic encephalopathy was higher than that of tuberculous meningitis (P=0.002). (3) Cerebral atrophy:the incidence rate of HIV encephalitis was higher than that of toxoplasmic encephalopathy (P=0.011); the incidence rate of HIV encephyalitis was higher than that of tuberculous meningitis (P=0.000); the incidence rate of cryptococcal meningitis was higher than that of tuberculous meningitis (P=0.024).3. The relationship between opportunistic infections and the brain lesions of AIDS, reduction of CD4+T lymphocyte count and HIV encephalitis were found close. When CD4+T lymphocyte count decreased to less than 200/μl, the infections occurred in a higher morbidity rate. There was statistically significant difference of CD4+T lymphocyte count between tuberculous meningitis and the other disorders (Z=-2.784, P=0.005).4. The mortality rate was high in AIDS victims at the advanced stage.10 of 39 cases suffering from AIDS had died during hospitalization. There was no statistically significant difference of death rate between the group of AIDS accompanied by tuberculous meningitis and that of non-tuberculous disorders (P=0.716).Conclusion:1. CT findings of the brain lesions in AIDS include low signal intensity, mass effect, enlargement of ventricular system, hydrocephalus, circular enhancement, enhancement of meninges, cerebral atrophy, etc. These pictures occurred singly or together. The most common change was low signal intensity.2. The morbidity rate of AIDS accompanied by the brain lesions increased greatly with the reduction of CD4+T lymphocyte count. When CD4>100/μl,<200/μl, tuberculous infection was common while toxoplasmic and cryptococcal opportunistic infections occurred if CD4<50/μl.3. The mortality rate was extremely high in AIDS patients accompanied by cerebral infection, esp. presented with imaging abnormalities. Accordingly, it is extraordinary important to increase the imaging diagnostic level of AIDS with HIV encephalitis and opportunistic infections.更多还原