目的 分析结核性脑膜炎(TBM)的 多层螺旋CT与MRI影像特点及诊断价值。 方法 选取我院2013年5月至2016年5月期 间我院神经内科和急诊科收治的42例TBM 患者为研究对象，均行头颅CT和头颅 MRI 影像学检查，分析其影像学表现。结果 多层螺旋CT与MRI影像学异常征象主要包 括脑膜增厚、脑梗死灶、不同程度脑积 水、基底池或鞍池或脑实质内异常密度 等，MRI诊断阳性率83.33%明显高于多层 螺旋CT64.29%(P＜0.05)。多数患者CT平 扫显示脑积水、脑梗死、单发或多发结核 瘤等异常改变，呈现等密度或稍高密度影 改变，部分伴有钙化；增强扫描时多数呈 环状或结节状强化，少数可不强化。MRI 表现在脑底部脑池形态变窄或消失，T1加 权像显示等信号或稍高信号，T2加权像显 示等信号，脑膜增厚，增强扫描显示多数 受累脑膜呈线条状、点状、斑片状等强 化，少数可不强化；且粟粒样结核病灶 MRI表现为T1加权像为等信号或低信号， 病变中心为高信号，强化后呈多发性小 灶性强化。结论 MRI检查诊断TBM阳性率 较高，结合CT检查可为TBM患者的病变部 位、累及范围、病理类型提供准确的定位 及定性诊断,提高临床诊断准确率。

Objective To study image features and diagnostic value of multi-slice spiral CT and MRI in tuberculous meningitis (TMB). Methods 42 TMB patients treated in department of neurology and emergency department of our hospital from May 2013 to May 2016 were selected as the research objects, all patients underwent skull CT and skull MRI imaging examination, imaging performances were analyzed. Results Abnormal signs of multi-slice spiral CT and MRI imaging included meningeal thicking, cerebral infracted area, various degrees of hydrocephalus, abnormal density in basal cistern or suprasellar cistern or brain parenchyma and others, MRI diagnosis positive rate was 83.33%, which was significantly higher than multi-slice spiral CT (64.29%) (P<0.05). CT scan of most patients showed that there were hydrocephalus, cerebral infarction, solitary or multiple tuberculoma, anfractuosity or subarachnoid cistern narrowed down, cerebral hemorrhage, cistern narrow and occlusion and other abnormal changes, showed equidensity or slightly higher density shadow changes, some were accompanied by calcification; enhanced scan showed that most were cyclic annular or nodositas strengthen, few could not strengthen. MRI performance were shape of brain cisterns narrowed down or disappeared at the base of brain, T1 weighted image displayed equal signal or slightly higher signal, T2 weighted image displayed equal signal, meningeal thicking, enhancement scan showed that majority were involved in linear, punctiform, patchy, cyclic annular or nodositas strengthen, few could not strengthen; MRI performance of miliary tuberculose focus were T1-weighted images equal signal or low signal, center of lesions were high signal, they were multiple focal enhancement after strengthening. Conclusion Positive rate of MRI examination in the diagnosis of TBM is high, its combination with CT examination can provide accurate positioning and qualitative diagnosis of diseased region, implicative range, pathological types of TBM patients, improve clinical diagnostic accuracy.