儿童手足口病并发脑干脑炎的MRI表现

MRI Findings of Brainstem Encephalomyelitis as A Complication of Children’s Hand-Foot-Mouth Disease

目的分析儿童手足口病(hand-foot-and-mouth disease,HFMD)并发脑干脑炎的MRI表现特征,探讨MRI对于早期诊断该并发症的临床价值。资料与方法回顾性分析18例经临床确诊为HFMD并发脑干脑炎的患儿的颅脑MRI资料,所有病例均行头颅MRI平扫及增强扫描。结果影像表现为单发或多灶性的、部分呈对称性分布的脑损害病灶,18例患儿共有病灶25个,其中脑桥-延髓交界处背侧8个,延髓背侧7个,脑桥背侧5个,中脑2个,丘脑1个,脑室旁白质区1个,小脑齿状核1个。MRI信号主要表现为以下几种:(1)T1WI呈低信号,T2WI呈高信号,边界清晰,液体衰减反转恢复序列(FLAIR)、扩散加权成像(DWI)正常或呈低信号,无强化;(2)T1WI呈稍低信号,T2WI呈稍高信号,边界模糊,FLAIR、DWI正常或呈高信号,部分病灶轻度强化;(3)平扫正常,增强扫描可见斑片状轻度强化。结论脑干脑炎为儿童HFMD的严重并发症之一,颅脑MRI对其诊断有较高敏感性和一定特异性,能明确病灶的部位和范围,可为临床诊治提供可靠的影像学依据。

Objective To discuss the value of MRI in early diagnosis of brainstem encephalomyelitis as a complication of the children’s hand-foot-mouth disease.Materials and Methods The MRI features of 18 cases of children’s hand-foot-mouth disease with brainstem encephalomyelitis confirmed by clinical were retrospectively analyzed.All the cases received both plain and contrast MRI scanning.Results A total of 25 lesions were found,some of which were single and some were multiple,and some lesions were symmetrically located.8 lesions located in the dorsal part of the junction between pons and medulla oblongata,7 lesions located in the tegmentum of medulla,5 lesions located in the tegmentum of pons,2 lesions located in midbrain,and there was 1 lesion located in thalamus,periventricular leukomalacia and cerebellar dentate nucleus respectively.MRI features included：（1）The lesions were hypointensity signal on T1WI and hyperintensity signal on T2WI,hypointensity signal on FLAIR and DWI,no enhancement on contrast MRI;（2）The lesions were slightly hypointensity on T1WI and slightly hyperintensity on T2WI,normal or hyperintensity signal on FLAIR and DWI,and some of them were slightly enhanced;（3） The lesions demonstrated normally on plain MRI,but there were pathcy enhancement on contrast MRI.Conclusion Brainstem encephalomyelitis is one of the serious complications of children’s hand-foot-mouth disease.MRI has good sensitivity and a certain specificity for diagnosis,and can provide informations for treatment.