肠道病毒71型感染手足口病合并神经系统损害的MRI表现

MRI findings of neurologic complications in the enterovirus 71-infected hand-foot-mouth disease

目的 探讨肠道病毒71型（EV71）感染手足口病（HFMD）合并神经系统损害的MRI表现及特征.方法 回顾性分析海南省EV71感染流行期间25例伴有神经系统损害HFMD患儿临床、MRI表现,并结合文献分析其可能机制.结果 HFMD合并急性弛缓性麻痹（AFP）5例,典型MRI表现为矢状面脊髓内长条形长T1、长T2信号,横断面显示相应节段脊髓前角点状长T2信号,增强扫描部分前角、脊神经前根明显强化.HFMD合并脑干脑炎15例,MRI横断面显示桥脑、延髓、中脑后部长T1、长T2信号.HFMD合并无菌性脑膜炎5例,缺乏特异性MRI表现,若发现硬膜下腔增宽、脑膜强化及脑积水等征象则是无菌性脑膜炎的间接证据.结论 MRI是评价EV71型感染HFMD神经系统损害的有效方法,损害部位常位于脑干被盖部、脊髓前角,影像表现具有相对特异性.

Objective To explore the imaging characteristics of neurologic complications associated with the enterovirus 71 （ EV71 ） epidemic by analyzing 25 cases and reviewing the literature. Methods Twenty-five cases of hand-foot-mouth disease with neurologic complications during the recent EV71 outbreaks of Hainan province were studied for the clinical features and imaging findings, and literature were reviewed.Results In 5 cases, acute flaccid paralysis associated with EV71-infected hand-foot-mouth disease was related to the linear high signal in the spinal cord on sagittal images. Two cases showed symmetrical, welldefined hyperintense lesions in the spinal cord on T2WI transverse. Strong enhancement of the ventral horns and root was seen on the contrast-enhanced axial T1WI. In brainstem encephalitis, all lesions presented with significant hyperintensity on T2WI and hypointense on T1WI in the posterior portions of the medulla oblongata, midbrain, and pons. The manifestations of aseptic meningitis （AM） on MRI have no characteristics, but subdural effusion, meningeal enhancement and hydrocephalus can be the indirect signs of AM. Conclusions MRI is an effective method to investigate neurologic complications associated with the EV71 epidemic. Posterior portions of the medulla oblongata and pons, bilateral ventral horns of spinal involvement are characteristic findings of enteroviral encephalomyelitis.