小儿重症手足口病并发脑炎的MRI表现

MRI Features of Encephalitis in Children with Severe Hand-foot-mouth Disease

目的分析小儿重症手足口病(HFMD)并发脑炎的MRI平扫表现及特征。资料与方法回顾性分析85例经临床确诊为HFMD并发脑炎患儿的颅脑MRI资料。结果 85例患儿头颅MRI平扫阴性28例,阳性57例,其中10例为斑点或片状病灶散在分布于大脑半球、胼胝体、丘脑及小脑蚓部,呈稍长或等T1、稍长或等T2信号,T2FLAIR、DWI多数呈高信号。47例病灶位于脑干,以桥脑被盖部及延髓为主,其中17例DWI见脑干被盖部呈对称斑片状高亮信号,T1WI呈低信号或等信号,T2WI及T2FLAIR呈高信号或等信号;30例表现为脑干背侧片状长T1、稍长T2信号,DWI呈等或略高信号,T2FLAIR呈高信号,9例病变对称性向四脑室周围延伸,其中1例累及两侧大脑脚。结论小儿HFMD并发脑炎的MRI表现有一定特征性,病变以脑干被盖部为主;DWI及T2FLAIR序列可提高病灶的检出率。

Purpose To investigate MRI features of encephalitis in children with severe hand- foot-mouth disease （HFMD）. Materials and Methods The MR images of 85 cases of clinically diagnosed encephalitis in severe HFMD patients were retrospectively reviewed. Results In 85 patients, plain MRI was negative in 28; 57 cases were positive including 10 cases showing punctate or patchy lesions in cerebral hemisphere, callosum, thalamus and cerebellar vermis with isointensity or slightly hypointensity on TI WI, isointensity or slightly hyperintensity on T2WI, and hyperintensity on T2FLAIR and DW1. In 47 cases, the lesions were located in the brainstem, tegmentum of pons and medulla oblongata. MRI features included symmetric high signal on DW1 in posterior portions of brainstem, hypointensity or isointensity on TIWI and hyperintensity or isointensity on T2WI and T2FLAIR （n=17）; patchy long T I, long T2 signal in posterior portions of brainstem, normal or mild hyperintensity on DWI, hyperintensity on T2FLAIR （n=30）; lesion extending around the fourth ventricle in 9 patients, one of which involved bilateral cerebral peduncles. Conclusion Encephalitis in children with severe HFMD has characteristic MRI features. The lesions are mostly located in the posterior portion of the brainstem. DWI and T2FLAIR can better detection lesions.