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。

Prognostic evaluation and MRI findings of children with hand-foot-mouth disease combined with brainstem encephalitis

Objective： To investigate the value of MRI in diagnosis,prognosis and clinical guiding of children with hand-foot- mouth disease （HFMD） combined with brainstem encephalitis. Methods： Retrospective comparative analysis of the MRI findings and the clinical effect on admission and at discharge of 42 children with HFMD combined with hrainstem encephalitis. Resuits：According to the MRI findings on admission,42 cases were divided into fuzzy boundary type group （31 cases） and clear boundary type group （11 cases）. The fuzzy boundary type lesions appeared as different thickness isoor slight hypointensity on T1 and slight hyperintensity on T2 of the dorsal brainstem. Of the 31 cases, the MRI showed all normal at discharge, of which 30 cases fully recovered, 1 case remaind eyeball movement disorders. The clear boundary type lesions appeared as flake or symmetry spots, strip hypointensity on T1 and hyperintensity on T2 in the brainstem. Of the 11 cases, 7 cases MRI showed normal at discharge, 2 cases showed lesion in the junction of pons and the medulla oblongata, 1 case in medulla oblongata,1 case in anterior horn of spinal cord; in clinical, 6 cases fully recovered, 4 cases got improved with sequelae, 1 case died. Conclusions： The fuzzy boundary type has a better prognosis than clear boundary type . The MRI based classification may be helpful in making a better estimation of prognosis.