小儿重症手足口病并发脑炎的MRI表现

目的:探讨小儿重症手足口病(HFMD)并发脑炎的MRI表现.方法:回顾性分析24例小儿手足口病并发脑炎的MRI表现.结果:24例小儿脑部病变共69处病灶.病变多发13例,对称性分布10例,非对称性3例;多发病灶以脑白质病变为主,共37处病变;病变单发11例,其中累及丘脑2例,累及基底节区4例,累及脑干2例,累及颞叶1例...     

小儿重症手足口病并发脑炎或脑干脑炎的MRI分析

目的 探讨小儿重症手足口病并发脑炎或脑干脑炎的MRI表现.方法 分析本院2008-2009年27例重症手足口病并发脑炎或脑干脑炎的MRI表现.结果 27例患者中,15例累及脑干,其中3例同时累及颈髓,1例累及脊髓全长;累及枕叶8例,顶叶5例,额叶3例,丘脑2例.病变主要表现为T1WI稍低信号,T2WI稍高信号的斑片、斑点状影,边缘模糊,部分病灶在FLAIR T2WI序列上显示更为清楚.结论 小儿重症手足口病并发脑炎或脑干脑炎的磁共振表现有一定的特点,可成为与其他感染性脑病鉴别的重要依据.     

小儿手足口病脑炎的MRI表现特征

目的：探讨小儿手足口病脑炎的MRI表现特征,提高诊断水平。材料和方法：回顾性分析5例小儿手足口病脑炎的MRI表现。结果：3例病灶局限在脑桥和延脑交界部,1例病灶以脑桥和延脑交界为主向两侧延伸,1例病灶位于脑桥偏背侧。5例病变均呈略长T1、略长T2斑片状信号,边界不清,DWI图呈略高信号。结论：小儿手足口病脑炎MRI表现主要为位于脑桥和延脑交界区斑片状信号,MRI能真实地显示其脑炎脑部受损情况,对临床治疗提供可靠的影像学依据。     

小儿重症手足口病并发脑炎的MRI表现

目的：分析小儿重症手足口病（HFMD）并发脑炎的MRI平扫表现及特征。资料与方法回顾性分析85例经临床确诊为HFMD并发脑炎患儿的颅脑MRI资料。结果85例患儿头颅MRI平扫阴性28例,阳性57例,其中10例为斑点或片状病灶散在分布于大脑半球、胼胝体、丘脑及小脑蚓部,呈稍长或等T1、稍长或等T2信号,T2FLAIR、DWI多数呈高信号。47例病灶位于脑干,以桥脑被盖部及延髓为主,其中17例DWI见脑干被盖部呈对称斑片状高亮信号,T1WI呈低信号或等信号,T2WI及T2FLAIR呈高信号或等信号;30例表现为脑干背侧片状长T1、稍长T2信号,DWI呈等或略高信号,T2FLAIR呈高信号,9例病变对称性向四脑室周围延伸,其中1例累及两侧大脑脚。结论小儿HFMD并发脑炎的MRI表现有一定特征性,病变以脑干被盖部为主;DWI及T2FLAIR序列可提高病灶的检出率。     

儿童手足口病并发脑干脑炎的MRI表现

目的分析儿童手足口病(hand-foot-and-mouth disease,HFMD)并发脑干脑炎的MRI表现特征,探讨MRI对于早期诊断该并发症的临床价值。资料与方法回顾性分析18例经临床确诊为HFMD并发脑干脑炎的患儿的颅脑MRI资料,所有病例均行头颅MRI平扫及增强扫描。结果影像表现为单发或多灶性的、部分呈对称性分布的脑损害病灶,18例患儿共有病灶25个,其中脑桥-延髓交界处背侧8个,延髓背侧7个,脑桥背侧5个,中脑2个,丘脑1个,脑室旁白质区1个,小脑齿状核1个。MRI信号主要表现为以下几种:(1)T1WI呈低信号,T2WI呈高信号,边界清晰,液体衰减反转恢复序列(FLAIR)、扩散加权成像(DWI)正常或呈低信号,无强化;(2)T1WI呈稍低信号,T2WI呈稍高信号,边界模糊,FLAIR、DWI正常或呈高信号,部分病灶轻度强化;(3)平扫正常,增强扫描可见斑片状轻度强化。结论脑干脑炎为儿童HFMD的严重并发症之一,颅脑MRI对其诊断有较高敏感性和一定特异性,能明确病灶的部位和范围,可为临床诊治提供可靠的影像学依据。     

小儿手足口病合并脑干脑炎的MRI特征与临床预后评估

目的:探讨MRI对小儿手足口病合并脑干脑炎的诊断、预后评估价值及临床指导意义。方法:回顾性分析42例小儿手足口病合并脑干脑炎的临床及影像资料,对比分析其入院及出院时的MRI表现及临床治疗效果。结果:根据入院时MRI表现,将患儿分为2组:31例病灶边界模糊型和11例病灶边界清晰型。边界模糊型病灶MRI表现为脑干背侧不同厚度T1WI呈等或稍低信号,T2WI稍高信号;出院时复查MRI均表现正常,30例临床完全康复,1例遗留眼球运动障碍。边界清晰型MRI表现为脑干内斑片状或对称性斑点状、条状T1WI低信号,T2WI高信号;出院复查MRI,7例表现正常,6例临床完全康复,4例遗留不同程度后遗症,其中,2例遗留桥脑延髓交界区病灶,1例遗留延髓病灶,1例遗留脊髓前角病灶,1例死亡。结论:小儿手足口病边界模糊型明显比边界清晰型预后好,以MRI表现进行分型有助于临床预后判断。     

小儿手足口病合并脑干脑炎、脊髓炎的MRI表现

目的 探讨小儿手足口病(hand-foot-mouth disease,HFMD)合并脑干脑炎、脊髓炎MRI表现特征,以提高对本病的认识.资料与方法回顾性分析7例有阳性影像学表现的小儿HFMD合并脑干脑炎、脊髓炎患者的MRI特征性表现.结果 4例病灶以桥脑、延脑交界部为主,1例位于桥脑,呈略长T1、长T2斑片状信号.2例病灶在横断位上表现为对称性小斑片状信号.2例病灶均位于脊髓圆锥,呈长条形略长T1、长T2信号,病灶在横断位上表现为对称性小斑片状信号.结论 HFMD合并脑干脑炎、脊髓炎MRI表现有一定特征性.MRI能真实地显示HFMD脑干脑炎、脊髓炎脑部、脊髓受损情况,可对临床治疗提供可靠的影像学依据.     

手足口病并发脑炎的临床及头颅MRI分析

目的 探讨儿童手足口病并发脑炎的临床特点及头颅MRI影像特征.方法 对71例临床诊断为手足口病并发脑炎的患儿进行头颅MRI检查,获得T1WI、T2WI图像并分析脑部MRI表现.结果 25例累及脑干,其中23例(92%)累及脑桥被盖,21例(84%)累及延髓,19例(76%)累及相邻小脑中脚,8例(32%)累及小脑齿状核.表现为不同范围的T2WI高信号病变,T1WI多呈等信号,少数(12%)呈低信号.结论 手足口病并发脑炎常累及脑干,MRI表现具有特征性.     

病毒性脑炎的MRI诊断及临床意义

目的：研究病毒性脑炎的MRI表现特点，探讨MRI对病毒性脑炎的诊断价值。材料和方法：搜集55例经临床诊断为病毒性脑炎的病例，其中男31例。回顾分析其脑部MRI表现。结果：55例中共54例脑部MRI有异常表现。病灶单发或多发，可见于大脑半球、小脑及脑干。大部分病灶不对称分布，少数累及基底节、丘脑病例可对称分布，病灶呈不规则片状或斑片状、点状，可局限于脑皮质或白质，亦可皮髓质同时累及，T1WI呈等、低信号，TWI呈高信号，大部病灶FLAIR呈高信号，部分病程较长者可见软化灶，FLAIR呈低信号。27例增强扫描见8例病灶无强化，19例增强病灶呈不规则片状、环形、结节状及半环形强化。结论：MRI是诊断病毒性脑炎重要的辅助检查方法，具有敏感、准确的优点，结合临床可提高病毒性脑炎的诊断准确率。     

病毒性脑炎的MRI诊断

目的探讨病毒性脑炎MR I表现特点及与急性播散性脑脊髓炎(ADEM)鉴别的可能性。方法分析56例病毒性脑炎及50例ADEM的脑部MR I表现,重点分析病毒性脑炎的脑部MR I表现。结果病毒性脑炎脑内有多发或单发的对称或不对称大片状病灶,主要位于皮层、皮层下及基底节-丘脑区,MR I呈长T1长T2信号,增强扫描27例,显示病灶强化者17例,其中呈大片状或脑回状强化者10例。ADEM则脑内有多发不对称斑点、斑片状病灶,主要位于双侧脑室周围及额颞顶枕叶脑白质区,MR I呈长T1长T2信号,增强扫描20例,显示病灶强化者15例,均为环形或斑点状强化。结论MR I是诊断病毒性脑炎重要的辅助检查方法,可在一定程度上为临床的早期诊断及鉴别诊断提供依据。     

Rasmussen脑炎的MRI诊断

目的 总结Rasmussen脑炎的MRI特点,提高对本病影像表现的认识.方法 回顾性分析10例Rasmussen脑炎患者的MR图像,男7例、女3例,平均年龄(11±4)岁.常规行横断面、矢状面及垂直于海马长轴的斜冠状面扫描,获得T1WI、T2WI及液体衰减反转恢复(FLAIR)序列图像.评估Rasmussen脑炎患者术前MR检查中脑萎缩和信号情况,以及上述改变在随访时MR的表现.结果 Rasmussen脑炎的影像特点为:(1)脑萎缩性改变:患侧侧脑室体部扩大(8/10),颞角扩大(9/10),外侧裂增宽(9/10),局部脑沟增宽和脑回变小(7/10),尾状核和壳核萎缩(6/10).病变晚期皮层萎缩多为半球性或累及2个以上脑叶.(2)信号改变:皮层或皮层下长T2信号(9/10),多累及2个以上脑叶.(3)病变进展性:8例接受随访MR的患者均可见病变侧半球的萎缩性改变加重,范围加大,由局部向半球性发展;皮层信号改变较大.结论 Rasmussen脑炎好发于儿童,表现为一侧大脑半球进展性萎缩改变,脑室扩大,外侧裂和脑沟增宽,脑回变小,伴有相应部位的皮层萎缩和皮层T2高信号,深部灰质核团也可受累.     

支原体脑炎的磁共振诊断价值

目的:探讨磁共振成像对支原体脑炎的影像学特点及临床诊断价值。方法:对21例支原体脑炎患者行颅脑MRI检查,12例增强扫描。结果:MRI表现异常16例,正常5例。①病变形态及分布:脑白质多发、散在的点状或/及斑片状异常信号8例;两侧大脑半球弥漫性异常信号3例;脑室扩大,侧脑室后角周围异常信号3例;皮层灰质内脑回状异常信号2例;②病变信号:所有病例T2WI及FLAIR序列呈略高或高信号,T1WI呈等或低信号,在DWI(b=1000)像上均呈异常高信号;③增强扫描:12例行增强扫描中,4例呈点状或/及斑片状强化,8例无异常强化。结论:MRI表现具有一定特征性,且有助于诊断支原体脑炎,并可显示支原体脑炎脑实质受累范围和程度,为临床治疗及判定预后提供可靠依据。     

MRI in Japanese encephalitis

We document the MRI features in seven patients with Japanese encephalitis. MRI was carried out on a 1.5 T system within 10–60 days of onset. In all the patients MRI revealed bilateral thalamic lesions, haemorrhagic in five. Signal changes were present in the cerebrum in four patients, the midbrain and cerebellum in three each, the pons in two and the basal ganglia in one. The lesions were haemorrhagic in three of the four patients with lesions in the cortex, two of the three with lesions in the midbrain and cerebellum, but the pontine lesions were haemorrhagic in both patients. Spinal cord involvement was seen in one of the three patients who underwent MRI. In two patients MRI was repeated 3 years after the onset, showing marked reduction in abnormal signal; and all the lesions gave low signal on both T1- and T2-weighted images. Bilateral thalamic involvement, especially haemorrhagic, may be considered characteristic of Japanese encephalitis, especially in endemic areas. Received: 2 January 1996 Accepted: 2 February 1996     

MRI of encephalitis in children: comparison of CT and MRI in the acute stage with long-term follow-up

We examined 14 children aged 28 days to 12.7 years with encephalitis by CT or MRI. Of the patients examined by CT 58% had a normal first scan, whereas all MRI investigations demonstrated abnormalities. The clinical features correlated with several MRI investigations. On MRI herpes (HSV) encephalitis started in the medial temporal lobe and encephalomalacia developed within a few weeks. All patients had a follow-up examination 0.5 to 6.5 years after the acute phase. MRI revealed abnormalities in 13 of the 14 children; one boy, with lesions in only the white matter, had a normal follow-up MRI. Even with immediate, optimal therapy the children demonstrated severe parenchymal abnormalities. Signal abnormalities seen in the acute phase of the disease were likely to persist. In children with HSV encephalitis atypical lesions in different areas were seen.     

MRI of herpes simplex encephalitis

Summary The magnetic resonance imaging (MRI) findings in eight patients with herpes simplex meningoencephalitis were reviewed: 14 examinations were analysed. The most striking finding was high signal intensity in the temporal lobe(s) with the typical configuration known from CT. Meningeal enhancement after Gd-DTPA administration was clearly seen in four patients. Haemorrhagic changes are much better seen on MRI than on CT. When adequate motion control can be achieved, MRI becomes the examination of choice in the diagnosis and follow-up of herpes simplex encephalitis. Localized¹H MR spectroscopy also proved promising in the study of neuronal loss.     

MRI and proton spectroscopy in a child with Rasmussen's encephalitis. Case report

The greater sensitivity of magnetic resonance spectroscopy (MRS) compared with MRI to brain abnormalities in Rasmussen's encephalitis was demonstrated in a 3-year-old boy. The patient, with symptoms, signs and morphological findings consistent with Rasmussen's encephalitis, was followed with MRI and MRS over 30 months. That metabolic changes can be disclosed by MRS before the development of symptoms or signs was demonstrated as pathological spectra were found not only in the diseased left hemisphere but also in the morphologically normal right hemisphere before any neurological disturbance of that side. Received: 21 December 1998 Accepted: 16 April 1999     

磁共振成像技术在病毒性脑炎诊断中的应用进展

病毒性脑炎指病毒侵犯脑实质,引起急、慢性炎症性疾病。引起病毒性脑炎的病毒种类众多,临床表现差异明显。病毒性脑炎的诊断仍依赖于实验室检查。MRI具有良好的组织对比分辨力,能清晰的显示病变本身及其周围的软组织变化情况,对于病毒性脑炎的诊断具有非常重要的作用,随着MRI技术不断发展,新的成像技术可以更好的显示病变,对病毒性脑炎诊断和治疗计划的制定具有很大帮助。本文综述了MRI技术在病毒性脑炎诊断中的应用。     

MRI in tick-borne encephalitis

The tick-borne encephalitis (TBE) virus gives rise to epidemic encephalitis. Mild forms usually manifest as influenza-like episodes or are clinically silent. MRI is usually normal in TBE. We describe severe TBE in a patient who presented with fever and altered mental status after a tick bite and a specific antibody response to TBE. MRI revealed pronounced signal abnormalities in the basal ganglia and thalamus, without contrast enhancement. These findings coincide well with neuropathological studies of severe nerve cell degeneration with inflammatory cell infiltrates, neuronophagia and reactive astrocytosis in the deep grey matter. We review the literature and discuss the relevant differential diagnosis. Received: 10 November 1999/Accepted: 4 February 2000