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

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

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MRI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。

Objective To investigate the characteristics of spinal MR images in acute flaccid paralysis（AFP） associated with enterovirns 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-footmouth 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 modality of choice for the detection of radiculomyelitis of AFP associated with EV71 infection.