肠道病毒71型感染手足口病合并急性弛缓性麻痹的脊髓MRI特征

目的 探讨肠道病毒71型(EV71)感染手足口病合并急性弛缓性麻痹(AFP)的脊髓MRI特点.方法 回顾性分析8例EV71感染手足口病合并AFP患儿临床及影像资料,总结其脊髓MRJ特点.结果 8例患儿中,单侧下肢无力4例,四肢无力2例,单侧上肢无力和双侧下肢无力各1例,合并脑干脑炎2例.MRI表现为脊髓前角T2WI高信号,T1WI低信号,其中C3～7水平1例,T10至圆锥、T11至圆锥水平5例,两处均受累2例.单侧肢体无力5例,其中2例为单侧脊髓前角受累,3例表现为双侧受累,且患侧病变范围大,信号强度高.1例行增强扫描,表现为受累脊髓前角轻度强化,同侧前根明显强化.双侧肢体无力3例,均表现为双侧脊髓前角受累.结论 MR平扫及增强检查是诊断EV71相关AFP所致的脊髓神经根病变的首选的影像检查方法.

MRI findings of spine: acute flaccid paralysis associated with enterovirus 71 infected hand-foot-mouth disease

Objective To investigate the characteristics of spinal MR images in acute flaccid paralysis(AFP) associated with enterevirus 71 infected hand-foot-mouth disease.Methods The spinal MR images of eight infants with AFP and positive EV71 cultures were analyzed during an outbreak of hand-foot-mouth disease in China in 2008.Results Acute paralysis was observed in one lower limb in 4 of the 8 patients,in four limbs in 2 patients,in one upper limb and both lower limbs in 1 patient,2 of the 8 patients also had brain stem encephalitis.Lesions were identified in anterior horn regions of spinal cord with hyperintensity on T2-weighted images and hypointensity on T1-weighted images.Location of the lesions included C3 to C7(1 case),T10 extending to conus medullaris(5 cases)and a combination of the above (2 cases).Five of the 8 patients presented with unilateral paralysis.Two of the 5 cases showed unilateral hyperintense lesions in anterior horn regions and the remaining 3 cases showed bilateral hyperintense lesions in anterior horn regions with a unilateral predominance.One of the 3 patients with bilateral lesions showed slight enhancement of anterior horn with prominent enhancement of ventral roots after intravenous injections of contrast medium.Three of the 8 patients with bilateral paralysis showed bilateral hyperintensity in both anterior horn regions.Conclusion MR is the imaging medality of choice for the detection of radiculomyelitis of AFP associated with EV71 infection.