| Objective:Intracranial tuberculosis is a serious central system infection,and the current conventional imaging methods cannot immediately assess their cerebral hemodynamics state of intracranial arterial blood flow.In this study,we try to explored the hemodynamic characteristics of cerebral arteries of intracranial tuberculosis divided into different MR(magnetic resonance)subtypes by using transcranial doppler(TCD),to evaluate the diagnostic value of TCD cerebral hemodynamics in intracranial tuberculosis.Materials and Methods:Fifty-two patients with intracranial tuberculosis were included from December 2015 to December 2016.After admission to hospital,MR scan was performed before relevant treatment and the patients were grouped according to their imaging manifestations.TCD was performed on the same day to obtain cerebral hemodynamic parameters.In this study,we mainly detect and collect datas such as the peak systolic velocity(Vs),the mean blood flow velocity(Vm)5 end-diastolic velocity(Vd)and pulsation index(PI)of the main arteries of anterior cerebral circulation(including the both sides of middle cerebral arteries(MCA),anterior cerebral arteries(ACA))and posterior circulation(including basic artery(BA),both sides of vertebral arteries(VA)and posterior cerebral arteries(posterior cerebral artery(PCA)).At the same time,32 healthy adults were collected as the control group to obtain TCD cerebral hemodynamic parameters.Lumbar puncture was performed to determine the intracranial pressure level in the tuberculous intracranial group the next day.Before the lumbar puncture no cranial pressure reduction therapy was performed.SPSS20 was used to analyze all the obtained cerebral hemodynamic data and intracranial pressure values,and P<0.05 was considered statistically significantResults:A total of 52 patients underwent MR routine and enhanced scanning for 52 times,which were divided into 26 cases of meningeal tuberculosis,20 cases of cerebral parenchymal tuberculosis,and 6 cases of mixed type according to the literature.Among the 26 cases of meningeal tuberculous type,17 cases of meningeal thickening were located in the ependymal membrane,quadrisomal cistern,circumferential cistern,choroid plexus,lateral fissure cistern,and 9 cases of fusion nodules with the meninges were distributed in the basal cistern meninges and the pia mater.There were 57 tuberculous tumors of cerebral parenchymal tuberculous type,with diameter of>5mm and the largest of 12mm.There were 6 cases of mixed tuberculosis,most of which focused on meningeal lesion and accompanied by edema.In the anterior cerebral circulation,the velocity of the right middle cerebral artery and the anterior cerebral artery of the three subtypes was lower than that of the control group.The velocity of left middle cerebral artery and anterior cerebral artery(except Vs of meningotypes)was higher than that of the control group.PI values of bilateral middle cerebral artery of meningia type and tuberculoma type were higher than those of control group,while those of mixed type were lower than those of control group.PI values of bilateral anterior cerebral arteries of the three subtypes were higher than those of the control group.Among the parameters of the right middle cerebral artery,the mixed flow rate was the lowest,with a peak velocity of 79.70±19.00cm/s,and the tuberculous tumor type PI was the highest,with a value of 1.0760±0.2857.Among the parameters of the left middle cerebral artery,the tuberculous flow rate and PI value were the highest,with the peak velocity of 94.58±33.26cm/s and the PI value of 1.0890±0.3137.Among the parameters of the right anterior cerebral artery,meningotype velocity was the lowest,with a peak velocity of 66.58±36.93cm/s,and tuberculous tumor type PI was the highest,with a value of 1.13500±0.3499.Among the parameters of the left anterior cerebral artery,meningia-type flow rate was the highest,with a peak velocity of 83.00±30.42cm/s,and tuberculoma type PI was the highest,with a value of 1.0590± 0.2201.In the intracranial tuberculosis group,Vd and PI values of the right anterior cerebral artery were correlated(P=0.018,p=0.011),especially meningotype and tuberculoma type.Vd of the left anterior cerebral artery was correlated with PI(p=0.035,p=0.008).In the posterior circulation of the brain,all blood vessel velocities of the three subtypes were lower than those of the normal control group,and PI values were higher than those of the normal control group.Among the parameters of the basilar artery and bilateral vertebral artery,the meningeal velocity was the lowest,and the PI value was the highest,with the peak velocity of 44.36±19.02cm/s(basilar artery),40.64±13.00cm/s(right vertebral artery),45.85±12.23cm/s(left vertebral artery),and the PI values were 1.0038±0.2640(basal artery),1.038±0.2712(right vertebral artery),0.9946±0.2697(left vertebral artery),respectively.Among the parameters of the right posterior cerebral artery,the mixed flow rate was the lowest,with a peak velocity of 36.60±17.24cm/s,and the meningeal PI value was the highest,with a value of 0.9392±0.2778.Among the parameters of the left posterior cerebral artery,the mixed flow rate was the lowest,with a peak value of 40.97±14.83 cm/s,and the meningotype PI was the highest,with a value of 0.9931±0.2196.All flow rates of basilar artery,bilateral vertebral artery and right posterior cerebral artery in the intracranial tuberculosis group were statistically din?eerent from those in the normal control group(p<0.05).There was no statistically significant difference in all flow rates between the left posterior cerebral artery and the normal control group(p>0.05).There was no statistical difference in TCD cerebral hemodynamic parameters between MR subtypes of intracranial tuberculosis(p>0.05).There was no significant difference in the correlation between the cerebral hemodynamic parameters PI of TCD and intracranial pressure(p>0.05)Conclusion:MR manifestations of the three subtypes of intracranial tuberculosis have their own characteristic changes,and the accurate classification of intracranial tuberculosis patients depends on MR imagingIntracranial tuberculosis abnormal changes in intracranial blood vessels affect the anterior and posterior circulatory systems of the brain.Transcranial doppler(TCD)examination is an effective supplement method to the diagnosis of intracranial tuberculosis.In this study,there was no significant difference in the correlation analysis between PI values of all measured arteries and intracranial pressure in the intracranial tuberculosis group.Therefore,the accurate determination of intracranial pressure level in patients with intracranial tuberculosis still depends on traditional methods. |
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