Comparison and Correlation of Magnetic Resonance Imaging and Clinical Severity in Nonhuman Immunodeficiency Virus Patients with Cryptococcal Infection of Central Nervous System

The incidence of cryptococcal meningitis among immunocompetent patients increases, especially in China and imaging plays an important role. The current study was to find the correlation between magnetic resonance imaging (MRI) manifestation and clinical severity in nonhuman immunodeficiency virus patients with cryptococcal infection of central nervous system (CNS).A total of 65 patients with CNS cryptococcal infection from August 2014 to October 2016 were retrospectively included in this study. All the patients had MRI data and clinical data. The patients were divided into two groups according to whether the patients were confirmed with identifiable underlying disease. Comparison and correlation of MRI and clinical data in both groups were investigated using independent sample t- test, Chi-square test, Mann-Whitney test and Spearman rank correlation analysis.In all 65 patients, 41 cases (41/65, 63.1%; Group 1) had normal immunity and 24 cases (24/65, 36.9%; Group 2) had at least one identifiable underlying disease. Fever, higher percentage of neutrophil (NEUT) in white blood cell (WBC), and increased cell number of cerebral spinal fluid (CSF) were much common in patients with underlying disease (Group 1 vs. Group 2: Fever: 21/41 vs. 21/24, χ2 = 8.715, P = 0.003; NEUT in WBC: 73.15% vs. 79.60%, Z = -2.370, P = 0.018; cell number of CSF: 19 vs. 200, Z = -4.298, P < 0.001; respectively). Compared to the patients with normal immunity, the lesions are more common in the basal ganglia among patients with identifiable underlying disease (Group 1 vs. Group 2: 20/41 vs. 20/24, χ2 = 7.636, P = 0.006). The number of the involved brain areas in patients with identifiable underlying disease were well correlated with the number of cells and pressure of CSF (r = -0.472, P = 0.031; r = 0.779, P = 0.039; respectively).With the increased number of the involved brain areas in patients with identifiable underlying disease, the body has lower immunity against the organism which might result in higher intracranial pressure and more severe clinical status.中枢神经系统隐球菌感染的非HIV患者磁共振成像与临床严重程度的比较及相关性摘要背景：隐球菌性脑膜炎在免疫功能正常的患者中的发病率增加，尤其是在中国。影像学在其中发挥着重要作用。本研究旨在寻找中枢神经系统隐球菌感染的非人类免疫缺陷病毒（HIV）患者中MR影像表现与临床严重程度之间的相关性。 方法：回顾性分析并纳入2014年8月至2016年10月共65例CNS隐球菌感染患者。 所有患者均具有MR成像数据和临床资料。 根据患者是否确诊患有可识别的潜在疾病，将患者分为两组。 采用独立样本t检验，卡方检验，Mann-Whitney检验和Spearman相关分析，研究两组MR成像与临床资料的差异及相关性。 结果：65例患者中，41例（41/65,63.1％；第1组）具有正常免疫力，24例（24/65,36.9％；第2组）至少有一种潜在疾病。 发热，中性粒细胞在白细胞计数（WBC）中高百分比，脑脊液（CSF）细胞数增加在具有基础疾病的患者中更为常见（正常免疫力患者组和具有基础疾病的患者组: 第1组 vs. 第2组； 发热:21/41 vs 21/24, χ2=8.715,p=0.003; 中性粒细胞: 73.15% vs. 79.60%, Z=-2.370, p=0.018; 脑脊液细胞数: 19 vs. 200, Z=-4.298, p<0.001）。 与免疫正常的患者相比，具有潜在疾病患者的基底神经节中的病变更为常见第1组 vs. 第2组: 20/41 vs. 20/24, χ2=7.636,p=0.006）。 具有潜在疾病的患者中颅内病灶的数量与细胞数量和脑脊液压力密切相关（r=-0.472, p=0.031; r=0.779, p=0.039）。 结论：在具有潜在疾病的患者中，随着颅内病灶的数量增加，机体的免疫力下降，可能导致更高的颅内压和更严重的临床状态。.