儿童脑型肺吸虫病活动期的MRI表现

MRI findings of children cerebral paragonimiasis in early active stage

目的 研究早期活动性脑型肺吸虫病的MRI表现 ,提高对该病的早期诊断及治疗。方法 经酶联免疫吸附试验 (ELISA)阳性的 4例患儿 ,均经MRI常规SE序列扫描 ,1例行MR血管造影。回顾分析其MRI表现特点。结果 4例MRI均发现多发、不规则、大小不等的出血灶 ,部分围绕与出血灶不相称的水肿信号 ,即较小的出血灶伴有较大的水肿带 ,病灶随机分布 ,并呈聚集或迁移状 ,1例可见“隧道”征 ,早期表现为自中脑大脑脚上行至右侧丘脑的条状出血信号 ,出血吸收后形成长T1的隧道样表现。结论 MRI可清晰显示肺吸虫迁移引起的脑实质多发出血、炎性病变、水肿及特征性隧道形成 ,对肺吸虫脑病的活动期诊断具有重要价值。

Objective MRI findings of cerebral paragonimiasis in early stage is important to improve the diagnosis and therapy of this disease. Accordingly, this study was undertaken to evaluate the MRI features of early cerebral paragonimiasis. Methods MRI features in 4 cases between 6 and 13 years old with cerebral paragonimiasis in the early stage were retrospectively reviewed. The diagnosis was based on a positive antibody test by enzyme linked immunosorbent assay(ELISA) for paragonimiasis in serum and effective therapy. Conventional MRI was performed by using spin echo (SE) pulse sequences in 4 cases and MRA was performed in one case. Results The common findings were multiple irregular hemorrhage, part of them surrounded with edema signals which often showed large unsuitable edematous area centered with small hemorrhagic lesion. Lesions of two cases were just localized in cerebral lobes and the other two cases could be found in cerebrum, cerebellum and brain stem which showed the lesions distributed in random ways. Most lesions showed the shapes of assembling and migrating. The characteristic appearance was 'tunnel sign' which showed the migrating track of adult worm. 'Tunnel sign' on T 1WI showed tunnel like high signal in early stage and low signal in later stage. Conclusion MRI findings of multiple irregular hemorrhage, unsuitable surrounding edema, assembling and migrating lesions and 'tunnel sign' are suggestive of early active cerebral paragonimiasis.