Magnetic resonance imaging study of cryptococcal neuroradiological lesions in HIV-negative cryptococcal meningitis
Magnetic resonance imaging study of cryptococcal neuroradiological lesions in HIV-negative cryptococcal meningitis
复制标题
HIV阴性隐球菌脑膜炎隐球菌神经放射学病变的磁共振成像研究。
DOI：
10.1007/s10096-017-2941-8
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发表时间：
2017-08-01
影响因子：
4.5
通讯作者：
Zhang, W.
中科院分区：
文献类型：
--
作者：
Zhong, Y.;Zhou, Z.;Zhang, W.
磁共振（MR）扫描已成为隐球菌脑膜炎（CM）的重要诊断和管理工具。然而，只有孤立的病例报告记录了人类免疫缺陷病毒（HIV）阴性的CM患者的神经放射学发现，没有明确的磁共振成像（MRI）脑病变和预后之间的关系。回顾性分析了114例HIV阴性CM患者的MR脑图像。患者被分为I组与一个或多个CM相关的病变和组II没有CM相关的病变。收集并比较两组患者的初始临床和生化指标以及预后。在本研究中，CM相关病变的MRI最常见的模式是放射性脑膜炎，其次是Virchow-Robin（VR）扩张，脑积水，脑内结节和假性囊肿，这与以前的研究报告不同，HIV感染患者的脑隐球菌病的主要MR表现包括扩张的VR空间，肿块和假性囊肿。与无CM相关病变的患者相比，有CM相关病变的患者中男性患者比例较高，精神状态改变的频率较高，脑脊液（CSF）中隐球菌培养阳性率较高，CSF葡萄糖/血糖比值较低。与无CM相关病变的患者相比，存在CM相关病变的患者的不良结局更常见。总之，隐球菌病相关病变的主要模式在非HIV阳性和HIV阳性CM患者的MR扫描上不同。CM相关病变的存在与预后不良的预测因子显著相关。MRI是评估非HIV感染CM早期严重程度和预后的有效工具。
Magnetic resonance (MR) scanning has become an important diagnostic and management tool in cryptococcal meningitis (CM). However, there are only isolated case reports documenting neuroradiological findings in human immunodeficiency virus (HIV)-negative patients with CM and none has clearly addressed the relationship between cerebral lesions on magnetic resonance imaging (MRI) and prognosis. The MR brain images available from 114 HIV-negative patients with CM were retrospectively analysed. Patients were divided into Group I with one or more CM-related lesions and Group II without CM-related lesions. Initial clinical and biochemical markers and prognosis were collected and compared between the two groups. In the present study, the most common pattern of CM-related lesions by MRI was radiological meningitis, following by Virchow-Robin (VR) dilatation, hydrocephalus, intracerebral nodules and pseudocysts, which was different from previous studies reporting that the main MR findings of cerebral cryptococcosis in HIV-infected patients include dilated VR spaces, masses and pseudocysts. Compared to the patients without CM-related lesions, patients with CM-related lesions presented with a higher percentage of male patients, a higher frequency of altered mental status, a higher positive rate of Cryptococcus culture in cerebrospinal fluid (CSF) and a lower ratio of CSF glucose/blood glucose. Poor outcomes were more frequent in patients with presence of CM-related lesions compared to patients without CM-related lesions. In conclusion, the main pattern of cryptococcosis-related lesions on MR scanning differ between non-HIV- and HIV-positive patients with CM. The presence of CM-related lesions was significantly associated with predictors for poor outcome. Neuroimaging on MR scanning is a useful tool to evaluate the initial severity and prognosis of CM without HIV infection.