1、Cerebral hydatid disease-Echinococcus granulosus infection MRI diagnose 脑包虫病-细粒棘球绦虫感染MRI诊断,2012.2.27,概述,Hydatid disease is a worldwide zoonosis produced by the larval stage of the Echinococcus tapeworm.包虫病是一种流行于全世界范围的动物源性寄生虫病，主要是由棘球绦虫幼虫所引发。 The two main types of hydatid disease are caused by E granu
2、losus and E multilocularis. E granulosus is the more common type .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 。,whereas E multilocularis is less common but more invasive, mimicking a malignancy.多房棘球绦虫少见但侵袭性更强，其表现类似于恶性病变。 It is commonly seen in the great grazing regions of the World, particularly the
3、Mediterranean region, Africa, South America, the Middle East, Australia, and New Zealand.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。,Dogs or other carnivores are definitive hosts, whereas sheep or other ruminants are intermediate hosts.狗或其他的肉食动物是终宿主，而羊或其他的反刍性动物是中间宿主。 Humans are secondarily infected by t
4、he ingestion of food or water that has been contaminated by dog feces containing the eggs of the parasite.被包含有寄生虫卵的狗粪所污染的食物或水被人类摄入从而引起继发性感染。,Intracranial granulosus echinococcosis occurs in only approximately 2% of cases of hydatid disease.颅内的细粒棘球绦虫感染仅见于约2的包虫病病例。 typically involving the cerebral par
5、enchyma, 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。,Cases o
6、f cerebral aqueduct cyst, gigantic cyst arising from the diploe of cranial bones with intracranial extension, and intradural spinal hydatid cysts have been reported. 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。Cysts are usually single and may be unilocular or multilocular.囊肿常常是单发的，可以是单房或多房。,Cerebr
7、al hydatid cyst is more common in children than in adults.儿童大脑包虫囊肿比成人更常见。 At 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。,The lack of surrounding edema and the marked mass effect make it easy to distinguish cere
8、bral hydatid disease from abscess and cystic tumor.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。 The presence of a hypointense rim, especially on T2-weighted MR images, is characteristic of hydatid cyst of the brain.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。,Cerebral hydatid cyst is generally solitary but may be multiple
9、 when it ruptures spontaneously or due to trauma or surgery.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。 Multivesicular cysts are rare in the brain. Calcification occurs in less than 1% of cases.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 si
10、milar 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。,Intracranial granulosu
11、s echinococcosis occurs in only approximately 2% of cases of hydatid disease.颅内的细粒棘球绦虫感染仅见于约2的包虫病病例。E. granulosus infection of the brain presents with one or more homogeneous, thin-walled cysts. 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,Cyst signal is isointense relative to cerebrospinal fluid. 囊肿的信号与脑脊液信号相似。
12、 The cyst wall typically lacks gadolinium enhancement. 囊壁通常无强化。 Usually there is no perilesional edema.通常没有瘤周水肿。,Spinal fluid and blood, eosinophilic acid increased neutrophils, serum the complement of cerebrospinal fluid with the test positive .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 。 Hydatid capsule liquid
13、 antigen of intradermal, convection immune electrophoresis or indirect hemagglutination test positive.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,X-ray, hydatid patients the liver, lungs, bones inspection, all can find calcification. X线检查，包虫患者肝、肺、骨骼检查，均可发现钙化。 DSA check, its special performance for lesions wit
14、hout blood vessels, the blood vessels of the capsule around hydatid extreme shift, straight, around into the spherical. 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,CT and MRI scans for brain echinococcosis highly characteristic, performance for cystic spherical and borders lesions . CT与MRI扫描对脑
15、包虫病具有高度特征性，表现为囊性球形病变，边界清楚 ； 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。,Complete removal cyst.完整摘除囊肿。 Bursa wall is thin, can spend part of liquid were first and then remove bursa wall .囊壁较薄者，可先抽出部分囊液，然后摘除囊壁。 Surgical removal of avoid by all means when do not break the bursa wall, lest cause allergy or trigger new thylakoids formation .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,Thanks for you attention!,
