CHRONIC MENINGITIS - THE ROLE OF MENINGEAL OR CORTICAL BIOPSY
CHRONIC MENINGITIS - THE ROLE OF MENINGEAL OR CORTICAL BIOPSY
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DOI：
10.1227/00006123-199404000-00004
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发表时间：
1994-04-01
期刊：
影响因子：
4.8
通讯作者：
PIEPGRAS, DG
中科院分区：
文献类型：
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作者：
CHENG, TM;ONEILL, BP;PIEPGRAS, DG
在1985年至1993年（磁共振成像时代）期间，对37例原因不明的慢性脑膜炎患者（25例男性和12例女性;平均年龄54岁）进行了脑膜和皮质活检。钆对比剂磁共振成像是最有用的诊断成像技术，32例患者中有15例（47%）显示脑膜增强。只有2/32（6%）的CT扫描显示增强。41例活检中有16例（39%）得到明确诊断，但在磁共振成像或计算机断层扫描显示增强的病例中，80%（15例中有12例）得到诊断。只有2/22例（9%）来自非增强区的活检诊断。虽然强化部位分布均匀，但枕下和翼点开颅活检的诊断率最高（50%）。此外，如果活检是从增强区域获得的，这两种方法的产率分别增加到84%和100%。在18例脑膜和皮质均活检的病例中，仅1例仅累及皮质。因此，在16例确诊病例中，有15例（94%）的脑膜被确诊。4例需要进行第二次活检，其中3例来自增强区的活检是诊断性的。最常见的慢性脑膜炎的原因是结节病（31%）和转移性腺癌（25%）。我们得出以下结论：1）磁共振成像是首选的成像技术; 2）增强区的活检最有可能诊断; 3）后颅窝或翼点入路的诊断率最高; 4）皮质活检虽然有助于保持上覆软脑膜的结构完整性，但可能是不必要的，应个体化。
MENINGEAL AND CORTICAL biopsies were evaluated in 37 patients (25 men and 12 women; mean age, 54 yr) who had chronic meningitis of an unknown cause between 1985 and 1993 (the era of magnetic resonance imaging). Magnetic resonance imaging with gadolinium contrast was the most useful diagnostic imaging technique, demonstrating meningeal enhancement in 15 of 32 patients (47%). Only 2 of 32 (6%) computed tomographic scans revealed enhancement. A definitive diagnosis was made in 16 of 41 biopsies (39%), but in cases where enhancement was present on either magnetic resonance imaging or computed tomography, a diagnosis was obtained in 80% (12 of 15 cases). Only 2 of 22 biopsies (9%) from nonenhancing regions were diagnostic. Although the locations of enhancement were distributed evenly, biopsies through suboccipital and pterional craniotomies gave the highest diagnostic yields (50%). Furthermore, if the biopsies were obtained from enhancing regions, the yield of these two approaches increased to 84 and 100%, respectively. Of 18 cases in which biopsy samples were taken from both the meninges and cortex only 1 had cortical involvement alone. The meninges were therefore diagnostic in 15 of the 16 definitive diagnostic cases (94%). Second biopsies were necessary in four cases, of which the three biopsies from enhancing regions were diagnostic. The most frequent causes of chronic meningitis were sarcoid (31%) and metastatic adenocarcinoma (25%). We made the following conclusions: 1) magnetic resonance imaging is the preferred imaging technique; 2) a biopsy of an enhancing region is most likely to be diagnostic; 3) posterior fossa or pterional approaches give the highest diagnostic yield; and 4) that a cortical biopsy, although helpful for preserving the structural integrity of the overlying leptomeninges, may be unnecessary and should be individualized.