肠道病毒71型感染手足口病合并脑炎的MRI表现及特征

MR findings of hand-foot-mouth disease with encephalitis infected by enterovirus 71

目的探讨肠道病毒71型感染手足口病合并脑炎的MR表现及特征,为临床诊断及及时治疗提供帮助。方法回顾性分析2009年4月～2011年7月临床诊断为手足口病合并脑炎并行颅脑MR扫描的64例患儿的图像资料,所有病例均经病原学检查证实为肠道病毒71型感染。结果脑干病变共计32例,其中桥脑6例(主要位于桥脑背侧),延髓8例(6例表现为延髓背侧对称性小片状信号,2例为偏中心病灶),桥脑-延髓交界区8例,中脑10例(多位于双侧大脑脚,呈片状);小脑齿状核4例(双侧);丘脑4例(均为单侧丘脑,斑点状或小片状);右侧内囊后肢1例(呈条形);基底节区9例(多为斑点状信号);放射冠区、半卵圆中心及双侧额、顶叶皮质下区者共38例(病变多为多发斑点状信号);其中病灶位于单个部位者35例(35/64,54.69%),位于多个部位者29例(29/64,45.31%)。结论手足口病合并脑炎发病部位广泛,不只局限于脑干,基底节、内囊后肢、丘脑、小脑齿状核及双侧大脑白质区均可累及。总结其易发病部位,依次为脑干、脑白质、基底节、丘脑、小脑齿状核,MR颅脑扫描能真实、准确显示手足口病合并脑炎脑部受损情况,可为临床诊断及时治疗提供可靠的影像学依据。

Objective To investigate MR findings of hand-foot-mouth disease with encephalitis induced by enterovirus 71, for helping clinical diagnosis and timely treatment. Methods MR findings of 64 cases of HFMD with encephalitis and culture-proven EV71 infection were reviewed retrospectively. Results The brainstem involvement in 32 patients comprised pons in 6, medulla oblongata in 8, the junction of medulla oblongata and pons in 8, midbrain in 10, dentate body of cere- bellum in 4, thalamus in 4, right posterior limb of internal capsule in 1, basal ganglia in 9, and the area of alba in 38, of which 35 were individual and 29 were located at multiple site. Conclusion The incidence site of HFMD encephalitis not limited to the brainstem, basal ganglia, posterior limb of internal capsule, thalamus, dentate body of cerebellum and bilat- eral cerebral white matter area can be involved, followed by brainstem, cerebral white matter, basal ganglia, thalamus. MR images can reflect the damage of brain in HFMD with encephalitis. It can provide reliable radiology information for clinical diagnosis and timely treatment.