儿童急性播散性脑脊髓炎的临床与影像学表现

Clinical and imaging features of acute disseminated encephalomyelitis in children

目的探讨急性播散性脑脊髓炎(ADEM)的临床与影像学表现特点。方法分析22例ADEM患儿的临床及影像学资料,并对ADEM的临床表现进行归类,观察ADEM患儿的脑MRI表现,包括病灶位置(皮层、皮层下白质、中央白质、脑室旁白质、深部灰质核团以及脑干和小脑)、大小、形态。结果 22例ADEM患儿的发病年龄平均(6.0±3.2)岁。前驱症状中以发热常见,占77.27%(17/22)。临床表现以脑病及抽搐最多见,各占45.45%(10/22);运动障碍次之,占36.36%(8/22)。影像学上,22例患儿中均可见中央白质病变;13例(13/22,59.09%)可见脑室旁病灶;9例(9/22,40.91%)可见皮层病灶;6例(6/22,27.27%)累及深部灰质核团。18例患儿急性期后1个月复查MRI,8例可见脑萎缩。结论儿童ADEM的MRI表现多样,可表现为中央白质病变,还可出现脑室旁病灶及灰质受累。影像学动态观察有助于了解疾病的变化。

Objective To investigate the clinical and imaging features of acute disseminated encephalomyelitis （ADEM） in children. Methods Totally 22 patients of ADEM were enrolled. The clinical data were analyzed and imaging data of cranial MRI were reviewed, including information on the location （subcortical, central and periventricular white matter, cortex, deep gray matter, brain stem, and cerebellum）, size and pattern of the lesions. Results The onset of ADEM was early, with the mean age of （6.0±3.2） years. Fever had a higher incidence （77.27 %[17/22]） in ADEM. Encephalopathy and seizure were common, with the incidence of 45.45% （10/22）. The incidence of movement impairment was 36.36 % （8/ 22）. Bilateral central white matter lesions were found in all patients. Periventrieular lesions occurred in 59.09 % （13/22）. Cortical lesions were detected in 9 patients （9/22, 40.91%）, and deep gray matter lesions appeared in 6 patients （6/22, 27.27%）. Eighteen patients underwent second MRI, which showed brain atrophy in 8 patients. Conclusion ADEM pres- ents various imaging findings in pediatric patients, including not only central white matter lesions, but also involvement of periventricular white matter and deep gray matter. Dynamic observation with MRI can be helpful to providing useful infor- mation for clinical diagnosis of ADEM.