腦包蟲病細(xì)粒棘球絳蟲感染MRI診斷.ppt

Cerebral hydatid disease-Echinococcus granulosus infection MRI diagnose 腦包蟲病-細(xì)粒棘球絳蟲感染MRI診斷,2012.2.27,概述,Hydatid disease is a worldwide zoonosis produced by the larval stage of the Echinococcus tapeworm.包蟲病是一種流行于全世界范圍的動(dòng)物源性寄生蟲病，主要是由棘球絳蟲幼蟲所引發(fā)。 The two main types of hydatid disease are caused by E granulosus and E multilocularis. E granulosus is the more common type .引發(fā)包蟲病的兩種主要的寄生蟲類型分別是細(xì)粒棘球絳蟲和多房棘球絳蟲，細(xì)粒棘球絳蟲更常見 。,whereas E multilocularis is less common but more invasive, mimicking a malignancy.多房棘球絳蟲少見但侵襲性更強(qiáng)，其表現(xiàn)類似于惡性病變。 It is commonly seen in the great grazing regions of the World, particularly the Mediterranean region, Africa, South America, the Middle East, Australia, and New Zealand.它常見于世界上的的牧區(qū)，特別是地中海區(qū)域、非洲、南美、東亞、澳大利亞和新西蘭。,Dogs or other carnivores are definitive hosts, whereas sheep or other ruminants are intermediate hosts.狗或其他的肉食動(dòng)物是終宿主，而羊或其他的反芻性動(dòng)物是中間宿主。 Humans are secondarily infected by the ingestion of food or water that has been contaminated by dog feces containing the eggs of the parasite.被包含有寄生蟲卵的狗糞所污染的食物或水被人類攝入從而引起繼發(fā)性感染。,Intracranial granulosus echinococcosis occurs in only approximately 2% of cases of hydatid disease.顱內(nèi)的細(xì)粒棘球絳蟲感染僅見于約2的包蟲病病例。 typically involving the cerebral parenchyma, especially the parietal lobes, corresponding to the middle cerebral artery watershed territory. Intracranial subarachnoid spaces are the second most common location of the disease in the CNS, although their occurrence is far less frequent. 通常累及大腦實(shí)質(zhì)，特別是頂葉，符合大腦中動(dòng)脈分水嶺區(qū)，顱內(nèi)的蛛網(wǎng)膜下腔是第二好發(fā)部位。,Cases of cerebral aqueduct cyst, gigantic cyst arising from the diploe of cranial bones with intracranial extension, and intradural spinal hydatid cysts have been reported. 發(fā)生于大腦導(dǎo)水管的囊腫、起源于顱骨板障并延伸至顱內(nèi)的巨大囊腫、以及椎管內(nèi)硬膜下囊腫都有報(bào)道。 Cysts are usually single and may be unilocular or multilocular.囊腫常常是單發(fā)的，可以是單房或多房。,Cerebral hydatid cyst is more common in children than in adults.兒童大腦包蟲囊腫比成人更常見。 At MRI, cerebral hydatid disease generally appears unilocular and is isointense relative to cerebrospinal fluid.大腦包蟲病通常表現(xiàn)為單房病變，信號(hào)與腦脊液相仿。,The lack of surrounding edema and the marked mass effect make it easy to distinguish cerebral hydatid disease from abscess and cystic tumor.無周邊水腫，明顯的占位效應(yīng)可以與膿腫和其他囊性腫瘤相鑒別。 The presence of a hypointense rim, especially on T2-weighted MR images, is characteristic of hydatid cyst of the brain.病變可以出現(xiàn)一個(gè)低信號(hào)環(huán)，尤其是在T2序列上，這是腦包蟲囊腫特征性病變。,Cerebral hydatid cyst is generally solitary but may be multiple when it ruptures spontaneously or due to trauma or surgery.腦包蟲囊腫通常是單囊的, 當(dāng)它自發(fā)破裂或由于外傷或手術(shù)而成為多囊。 Multivesicular cysts are rare in the brain. Calcification occurs in less than 1% of cases.顱內(nèi)的多囊狀病變是相當(dāng)少的，不超過1的病例可以出現(xiàn)鈣化。,T1 and T2 weighted MR images demonstrate two homogeneous cysts with signal intensity similar to cerebrospinal fluid and very thin-walls (yellow arrows). There is significant mass effect on the lateral ventricular system. T1和T2序列顯示兩個(gè)信號(hào)均勻的囊狀影，其內(nèi)信號(hào)類似于腦脊液，伴有非常薄的囊壁，囊腫對(duì)鄰近的側(cè)腦室有明顯的推移擠壓。,MRI表現(xiàn),Contrast enhanced MRI shows lack of enhancement of the cyst walls. 增強(qiáng)MRI囊壁無強(qiáng)化。,Intracranial granulosus echinococcosis occurs in only approximately 2% of cases of hydatid disease.顱內(nèi)的細(xì)粒棘球絳蟲感染僅見于約2的包蟲病病例。 E. granulosus infection of the brain presents with one or more homogeneous, thin-walled cysts. 顱腦細(xì)粒棘球絳蟲感染表現(xiàn)為一個(gè)或多個(gè)均勻的薄壁囊腫。,診斷要點(diǎn),Cyst signal is isointense relative to cerebrospinal fluid. 囊腫的信號(hào)與腦脊液信號(hào)相似。 The cyst wall typically lacks gadolinium enhancement. 囊壁通常無強(qiáng)化。 Usually there is no perilesional edema.通常沒有瘤周水腫。,Spinal fluid and blood, eosinophilic acid increased neutrophils, serum the complement of cerebrospinal fluid with the test positive .血與腦脊液中，嗜酸粒細(xì)胞增高，血清、腦脊液補(bǔ)體結(jié)合試驗(yàn)陽性 。 Hydatid capsule liquid antigen of intradermal, convection immune electrophoresis or indirect hemagglutination test positive.包蟲囊液抗原皮內(nèi)試驗(yàn)、對(duì)流免疫電泳或間接血凝試驗(yàn)陽性。,實(shí)驗(yàn)室檢查,X-ray, hydatid patients the liver, lungs, bones inspection, all can find calcification. X線檢查，包蟲患者肝、肺、骨骼檢查，均可發(fā)現(xiàn)鈣化。 DSA check, its special performance for lesions without blood vessels, the blood vessels of the capsule around hydatid extreme shift, straight, around into the spherical. DSA檢查，其特殊表現(xiàn)為病變區(qū)無血管、圍繞包蟲囊的血管極度移位、變直、環(huán)繞成球形。,其它影像學(xué)檢查,CT and MRI scans for brain echinococcosis highly characteristic, performance for cystic spherical and borders lesions . CT與MRI掃描對(duì)腦包蟲病具有高度特征性，表現(xiàn)為囊性球形病變，邊界清楚 ； Density and signal and cerebrospinal fluid is similar, no lesions edge edema, no enhancement and brain abscesses, cystic brain tumor or arachnoid cyst.密度與信號(hào)與腦脊液相似，無病灶邊緣水腫，無增強(qiáng)，可與腦膿腫、囊性腦瘤或蛛網(wǎng)膜囊腫等鑒別。,Complete removal cyst.完整摘除囊腫。 Bursa wall is thin, can spend part of liquid were first and