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1、Cerebral hydatid disease-Cerebral hydatid disease-Echinococcus granulosus Echinococcus granulosus infection MRI diagnoseinfection MRI diagnose脑包虫病脑包虫病- -细粒棘球绦虫感染细粒棘球绦虫感染MRIMRI诊断诊断 2012.2.272012.2.27概述概述n HydatiddiseaseisaworldwidezoonosisproducedbythelarvalstageoftheEchinococcustapeworm.包虫病是一种流行于全世界
2、范围的动物源性寄生虫病，主要是由棘球绦虫幼虫所引发。n 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。nwhereasEmultilocularisislesscommonbutmoreinvasive,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。nItiscommonlyseeninthegreatg
3、razingregionsoftheWorld,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。nIntracranialgranulosusechinococcosisoccursinonlyapproximately2%ofcasesofhydatiddisease.颅内的细粒棘球绦虫感染仅见于约2的包虫病病例。ntypicallyinvolvingthecerebralpar
4、enchyma,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。nCasesofcerebralaqueductcyst,giganticcystar
5、isingfromthediploeofcranialboneswithintracranialextension,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。nCystsareusuallysingleandmaybeunilocularormultilocular.囊肿常常是单发的，可以是单房或多房。nCerebral hydatid cyst is more common in children than in adults.儿童大脑包虫囊肿比成
6、人更常见。nAt MRI, cerebral hydatid disease generally appears unilocular and is isointense relative to cerebrospinal fluid.大脑包虫病通常表现为单房病变，信号与脑脊液相仿。nThelackofsurroundingedemaandthemarkedmasseffectmakeiteasytodistinguishcerebralhydatiddiseasefromabscessandcystictumor.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。nThepresen
7、ceofahypointenserim,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。nCerebralhydatidcystisgenerallysolitarybutmaybemultiplewhenitrupturesspontaneouslyorduetotraumaorsurgery.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。nMultivesicularcystsarerareinthebra
8、in.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。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序列显示
9、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Contrast enhanced MRI shows lack of enhancement of the cyst walls. 增强MRI囊壁无强化。nIntracranialgranulosusechinococcosisoccursinonlyapproximately2%ofcasesofhydatiddisease.颅内的细粒棘球绦虫感染仅见于约2的包虫病病例。nE.granulosusinfectionofthebrainpresentswithoneormorehomo
10、geneous,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nCystsignalisisointenserelativetocerebrospinalfluid.囊肿的信号与脑脊液信号相似。nThecystwalltypicallylacksgadoliniumenhancement.囊壁通常无强化。nUsuallythereisnoperilesionaledema.通常没有瘤周水肿。nSpinalfluidandblood,eosinophilicacidincreasedneutrophils,serumthecomplementofc
11、erebrospinalfluidwiththetestpositive.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。nHydatidcapsuleliquidantigenofintradermal,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nX-ray,hydatidpatientstheliver,lungs,bonesinspection,allcanfindcalcification.X线检查，包虫患者肝、肺
12、、骨骼检查，均可发现钙化。nDSAcheck,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nCTandMRIscansforbrainechinococcosishighlycharacteristic,performanceforcysticsphericalandbord
13、erslesions.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；nDensityandsignalandcerebrospinalfluidissimilar,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。nCompleteremovalcyst.完整摘除囊肿。nBursawallisthin,canspendpartofliquidwerefirstandthenremovebursawall.囊壁较薄者，可先抽出部分囊液，然后摘除囊壁。nSurgicalremovalofavoidbyallmeanswhendonotbreakthebursawall,lestcauseallergyortriggernewthylakoidsformation.手术摘除时切忌不可弄破囊壁，以免造成过敏或引发新的囊体形成。治疗
