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目的探讨磁共振成像在中枢神经系统侵袭性真菌感染(IFI)致脑脓肿中的诊断价值。方法回顾性分析8例中枢神经系统IFI早产儿临床资料,8例患儿于住院期间和出院后接受了MRI T1WI、T2WI和DWI 3种序列头部检查。结果 8例IFI早产儿均为白色念珠菌感染。其中7例表现为脑脓肿,4例伴有脑膜炎。7例脑脓肿患儿MRI提示侵袭范围广泛,皮层下白质、深部脑室周围及半卵圆中心白质受累。其中4例MRI检查在感染后11 d内完成,表现为弥漫或多发粟粒样结节,DWI呈高信号,而T1WI和T2WI改变不明显,DWI信号3周后近消失;在感染的2～4周T1WI/T2WI信号改变最明显,结节可呈环形,T1WI周边为高信号,中央低信号,T2WI信号与之相反,严重者表现不同程度的融合,在T1WI可见明显强化效应。4周后病灶在T1WI也逐渐变少和变小,转为点或线样的高信号,T2WI明显低信号。2例MRI动态随访表现有髓鞘发育延迟,胼胝体变薄。结论 MRI-DWI和动态的MRI改变可为早产儿白色念珠菌感染脑脓肿的早期诊断及治疗转归评估提供客观依据。
Objective To investigate the diagnostic value of magnetic resonance imaging in brain abscess caused by invasive fungal infection (IFI) in the central nervous system. Methods The clinical data of 8 preterm infants with central nervous system IFI were retrospectively analyzed. Eight patients underwent MRI examinations during the hospitalization and after discharge from the hospital. All the patients underwent MRI examinations of T1WI, T2WI and DWI. Results Eight preterm infants with IFI were infected with Candida albicans. 7 cases showed brain abscess, 4 cases with meningitis. MRI in 7 children with brain abscess showed a wide range of invasion, white matter involvement in the subcortical white matter, deep periventricular and semi-oval centers. The MRI examination of 4 cases was completed within 11 days after infection, showing diffuse or multiple miliary nodules. DWI showed high signal, while T1WI and T2WI did not change obviously. DWI signal disappeared after 3 weeks. In 2 ~ 4 Week T1WI / T2WI signal changes the most obvious, nodules can be ring-shaped, T1WI peripheral high signal, the central low signal, T2WI signal in contrast, severe cases showed varying degrees of fusion in the T1WI visible significant enhancement effect. After 4 weeks, the lesion became smaller and smaller at T1WI, and turned to point or line-like hyperintensities with T2WI significantly lower signal. Two cases of MRI follow-up showed delayed myelination and thinning of the corpus callosum. Conclusion MRI-DWI and dynamic changes of MRI may provide an objective basis for the early diagnosis and treatment outcome of Candida albicans infection of brain abscess in preterm infants.