The Application Value Of Susceptibility-weighted Imaging For The Diagnosis And Treatment Of Tuberculosis Within Brain

objective: To analysis the representations of brain tuberculoma on susceptibility weighted imaging Minimum-Intensity Projection(SWI m IP), and to discuss the advantages of SWI in detection of focal cerebral tuberculoma and the clinical application value of SWI in the follow-up of cerebral tuberculomas patients who were on anti-tuberculosis treatment.Methods : 17 patients who were clinically definite for cerebral tuberculosis and eligibility were studied retrospectively.Eight of them were male and nine were female,their mean age was 34.31 士 19.89.All the patients suffered from cerebral tuberculomas,14 patients accompaied extra-cerebral tuberculosis(11 patients suffered from pulmonary tuberculosis,2 patients suffered from spinal tuberculosis,1 patient suffered from tuberculous peritonitis),they all had taken pre-contrast MRI(including axial T1flair、T2WI、coronal T2flair、SWI)、contrast enhanced MRI(including axial、coronal and sagittal T1WI).There were 4 aspects in this study. Firstly, 23 brain lobes there were at least three lesions of the 17 patients who were suffering from cerebral tuberculosis were selected, the performance of T1flair、T2WI、enhanced-MRI and SWI m IP of the same lobe was judged, the recognition capabilities of each different sequences to the tuberculomas in the brain were compared.Secondly, the acreage of seventy one focuses which were ring-enhancement on the enhanced-MRI and were hypoinstense on SWI m IP of the 17 patients were measured,when measuring, every focuses were enlarged in three times and were measured three times,then averaged the measured value,compared the discrepancies of the focuses which were feeble enhanced on the enhanced-MRI and were hypoinstense on SWI Mip.Thirdly, the imaging findings on different sequences of the 17 patients with cerebral tuberculosis were analysed.Forthly,12 patients with brain tuberculosis who were treated with standardized anti-tuberculosis chemotherapy for six months or more were followed, the performances and changes on T1 WI 、 T2 WI 、 enhanced-MRI and SWI m IP pretherapy and post-treatment were compared, and the sensibility and outcome of the anti-tuberculosis chemotherapy to the different tuberculomas were analysed.Results:1.T1flair、T2WI、enhanced-MRI and SWI m IP were different on the showing of each focus,There was no significant difference between T1 flair and T2 WI,P=0.216(P>0.05);there was significant difference between T1 flair and SWI m IP(P=0.000)、T2WI and enhanced-MRI(P=0.000)、T2WI and SWI m IP(P=0.000),there was no significant difference between enhanced MRI and SWI m IP. 2.There was no significant difference between the acreage of the feeble center in the 71 ring-enhanced focuses and the hypointense in SWI m IP(t=-0.701,P=0.485).3.Based on the MRI performance of brain tuberculoma,they can be sorted to three kinds;Ⅰ:being porphyritic,with slightly low signal shadow on T1 flair and slightly high signal shadow on T2 WI or T2 flair, which were ring-enhanced on enhanced-MRI,and were mixed signals or porphyritic hypointense with hyperintense ring on SWI m IP. Ⅱ:being miliary or dot,with equisignal on T1 flair,and slightly high signal shadow on T2 WI or T2 flair,which were miliary enhanced on enhanced-MRI,and were military hypointense being accompanied or not hyperintense ring on SWI m IP;Ⅲ:being miliary or dot,with slightly low signal on T1 flair and homogeneous high signal on T2 WI or T2 flair,which were military homogeneous enhanced on enhanced-MRI,and were disappeared on SWI m IP. 4.There were inordinately changes on amounts and rangs of the MRI imaging findings which were executed pretherapy and post-treatment after six months or more of the 12 patients,the level of encephaledem which was around the lesions alleviated,the degree of brain swelling was alleviated too.Conclusions: 1. The detectability of SWI mIP to brain tuberculomas in cerebral tuberculosis patients was higher than other sequences,it can detect lesions those were in different course,including lesions those did not have peripheral edema.2.The acreages of the feeble enhanced center in the ring-enhanced focuses and the hypointense in SWI m IP were consistent. 3.There were different MRI performance of brain tuberculomas,it may be relate to the treatment outcome. 4.There were certain values to integrate the SWI m IP with enhanced-MRI on assessing the therapeutic effect of brain tuberculosis patients who were treated with standardized anti-tuberculosis chemotherapy,can manifest the outcome and offer the secondly therapeutic schemes for clinician.