EV71型手足口病中枢神经系统并发症急性期影像表现分析

目的分析EV71型手足口病中枢神经系统(CNS)并发症急性期MR表现,探讨其影像学特点及诊断价值。资料与方法回顾分析经实验室检测确诊为EV71型手足口病,临床诊断其伴CNS并发症的62例患儿的临床资料和影像资料,所有患儿均行头颅和/或脊髓MRI平扫及增强。结果 11例临床诊断脑膜炎者MRI均阴性;10例临床诊断为脑炎者仅1例MRI阳性,主要表现为右顶叶皮质下长T1长T2信号,伴轻度强化。41例脑干脑炎有30例MRI阳性,主要为脑桥延髓交界处长T1长T2信号;11例轻-中度强化,其中5例平扫阴性。17例脊髓炎者11例MRI阳性,9例为脊髓中央灰质长T1长T2信号、未见明显强化,(颈、胸和腰分别为4、3、2例),另2例表现为颈髓横贯性脊髓炎,均同时合并脑干。结论 EV71型手足口病CNS并发症MRI检查阳性主要是脑干脑炎,表现为稍长T1和稍长T2信号,增强MRI可发现平扫为阴性病灶,脑干脑炎可同时累及多个部位,合并颈髓横贯性脊髓炎是病情危重的征象。

Analysis of Neuroimaging features of Enterovirus 71 Related Hand-Foot-Mouth Disease in Acute Stage

Purpose To analyze the neuroimaging features of Enterovius 71 （EV71） related Hand-Foot-Mouth Disease （HFMD） in acute stage, and explore the neuroimage features and diagnostic value. Material and method Clinical and neuroimaging data of 62 cases with lab confirmed EV71 related HFMD in acute stage in 2010 were retrospectively analyzed. All patients underwent crania and/or spine pre and post-contrast MRI. Result 11 cases with aseptic meningitis had normal MRI. only one of the 10 cases with encephalitis had positive MRI result, demonstrating prolonged TI and T2 signals in right parietal lobe with mild enhancement. 30 of the 41 cases with brainstem encephalitis had positive MRI findings, the main lesion located at the junction region between pons and medullar oblongata, presenting as prolonged TI and T2 signal, 11 cases had mild to moderate enhancement, 5 of this 1 I cases presenting as normal in plain MRI scan. 11 of 17clinical myelitis cases had positive MR findings, 9 of these 11 cases demonstrated prolonged TI and T2 signal in central gray matter without enhancement （4, 3 and 2 in cervical, thoracic and lumbar spinal cord respectively）, other 2 cases demonstrated as transverse cervical myelitis with brainstem involved simultaneous. Conclusion The predominant neurological complication of EV71 related HFMD is brainstem encephalitis, demonstrating prolonged T1 and T2 signal, post contrast enhanced MRI can reveal the lesion missed in plain scan. Brain stem encephalitis might involve several portions simultaneously; with transverse cervical myelitis would be an important indication for critical case.