脑包虫病细粒棘球绦虫感染mri诊断2012课件

Cerebralhydatiddisease EchinococcusgranulosusinfectionMRIdiagnose脑包虫病 细粒棘球绦虫感染MRI诊断 2012 2 27 概述 HydatiddiseaseisaworldwidezoonosisproducedbythelarvalstageoftheEchinococcustapeworm 包虫病是一种流行于全世界范围的动物源性寄生虫病 主要是由棘球绦虫幼虫所引发 ThetwomaintypesofhydatiddiseasearecausedbyEgranulosusandEmultilocularis Egranulosusisthemorecommontype 引发包虫病的两种主要的寄生虫类型分别是细粒棘球绦虫和多房棘球绦虫 细粒棘球绦虫更常见 whereasEmultilocularisislesscommonbutmoreinvasive mimickingamalignancy 多房棘球绦虫少见但侵袭性更强 其表现类似于恶性病变 ItiscommonlyseeninthegreatgrazingregionsoftheWorld particularlytheMediterraneanregion Africa SouthAmerica theMiddleEast Australia andNewZealand 它常见于世界上的的牧区 特别是地中海区域 非洲 南美 东亚 澳大利亚和新西兰 Dogsorothercarnivoresaredefinitivehosts whereassheeporotherruminantsareintermediatehosts 狗或其他的肉食动物是终宿主 而羊或其他的反刍性动物是中间宿主 Humansaresecondarilyinfectedbytheingestionoffoodorwaterthathasbeencontaminatedbydogfecescontainingtheeggsoftheparasite 被包含有寄生虫卵的狗粪所污染的食物或水被人类摄入从而引起继发性感染 Intracranialgranulosusechinococcosisoccursinonlyapproximately2 ofcasesofhydatiddisease 颅内的细粒棘球绦虫感染仅见于约2 的包虫病病例 typicallyinvolvingthecerebralparenchyma especiallytheparietallobes correspondingtothemiddlecerebralarterywatershedterritory IntracranialsubarachnoidspacesarethesecondmostcommonlocationofthediseaseintheCNS althoughtheiroccurrenceisfarlessfrequent 通常累及大脑实质 特别是顶叶 符合大脑中动脉分水岭区 颅内的蛛网膜下腔是第二好发部位 Casesofcerebralaqueductcyst giganticcystarisingfromthediploeofcranialboneswithintracranialextension andintraduralspinalhydatidcystshavebeenreported 发生于大脑导水管的囊肿 起源于颅骨板障并延伸至颅内的巨大囊肿 以及椎管内硬膜下囊肿都有报道 Cystsareusuallysingleandmaybeunilocularormultilocular 囊肿常常是单发的 可以是单房或多房 Cerebralhydatidcystismorecommoninchildrenthaninadults 儿童大脑包虫囊肿比成人更常见 AtMRI cerebralhydatiddiseasegenerallyappearsunilocularandisisointenserelativetocerebrospinalfluid 大脑包虫病通常表现为单房病变 信号与脑脊液相仿 Thelackofsurroundingedemaandthemarkedmasseffectmakeiteasytodistinguishcerebralhydatiddiseasefromabscessandcystictumor 无周边水肿 明显的占位效应可以与脓肿和其他囊性肿瘤相鉴别 Thepresenceofahypointenserim especiallyonT2 weightedMRimages ischaracteristicofhydatidcystofthebrain 病变可以出现一个低信号环 尤其是在T2序列上 这是脑包虫囊肿特征性病变 Cerebralhydatidcystisgenerallysolitarybutmaybemultiplewhenitrupturesspontaneouslyorduetotraumaorsurgery 脑包虫囊肿通常是单囊的 当它自发破裂或由于外伤或手术而成为多囊 Multivesicularcystsarerareinthebrain Calcificationoccursinlessthan1 ofcases 颅内的多囊状病变是相当少的 不超过1 的病例可以出现钙化 T1andT2weightedMRimagesdemonstratetwohomogeneouscystswithsignalintensitysimilartocerebrospinalfluidandverythin walls yellowarrows Thereissignificantmasseffectonthelateralventricularsystem T1和T2序列显示两个信号均匀的囊状影 其内信号类似于脑脊液 伴有非常薄的囊壁 囊肿对邻近的侧脑室有明显的推移挤压 MRI表现 ContrastenhancedMRIshowslackofenhancementofthecystwalls 增强MRI囊壁无强化 Intracranialgranulosusechinococcosisoccursinonlyapproximately2 ofcasesofhydatiddisease 颅内的细粒棘球绦虫感染仅见于约2 的包虫病病例 E granulosusinfectionofthebrainpresentswithoneormorehomogeneous thin walledcysts 颅脑细粒棘球绦虫感染表现为一个或多个均匀的薄壁囊肿 诊断要点 Cystsignalisisointenserelativetocerebrospinalfluid 囊肿的信号与脑脊液信号相似 Thecystwalltypicallylacksgadoliniumenhancement 囊壁通常无强化 Usuallythereisnoperilesionaledema 通常没有瘤周水肿 Spinalfluidandblood eosinophilicacidincreasedneutrophils serumthecomplementofcerebrospinalfluidwiththetestpositive 血与脑脊液中 嗜酸粒细胞增高 血清 脑脊液补体结合试验阳性 Hydatidcapsuleliquidantigenofintradermal convectionimmuneelectrophoresisorindirecthemagglutinationtestpositive 包虫囊液抗原皮内试验 对流免疫电泳或间接血凝试验阳性 实验室检查 X ray hydatidpatientstheliver lungs bonesinspection allcanfindcalcification X线检查 包虫患者肝 肺 骨骼检查 均可发现钙化 DSAcheck itsspecialperformanceforlesionswithoutbloodvessels thebloodvesselsofthecapsulearoundhydatidextremeshift straight aroundintothespherical DSA检查 其特殊表现为病变区无血管 围绕包虫囊的血管极度移位 变直 环绕成球形 其它影像学检查 CTandMRIscansforbrainechinococcosishighlycharacteristic performanceforcysticsphericalandborderslesions CT与MRI扫描对脑包虫病具有高度特征性 表现为囊性球形病变 边界清楚 Densityandsignalandcerebrospinalfluidissimilar nolesionsedgeedema noenhancementandbrainabscesses cysticbraintumororarachnoidcyst 密度与信号与脑脊液相似 无病灶边缘水肿 无增强 可与脑脓肿 囊性脑瘤或蛛网膜囊肿等鉴别 Completeremovalcyst 完整摘除囊肿 Bursawallisthin canspendpartofliquidwerefir