磁共振成像在成人流行性乙型脑炎临床分期和分型中的应用研究

Application of MRI for clinical staging and classification of Japanese encephalitis in adult patients

目的探讨磁共振成像(MRI)特征在成人流行性乙型脑炎临床分期与分型中的应用价值。方法回顾性分析2018年8至9月在宁夏医科大学总医院行颅脑MRI检查的35例成人乙型脑炎患者的临床资料,分析不同临床分期和分型中乙型脑炎患者的MRI影像学特征,分析丘脑病灶的表观扩散系数(ADC值)在不同分期乙型脑炎患者的差异。采用SPSS 23.0统计软件对数据进行分析。结果35例成人乙型脑炎患者中,6例普通型患者病灶均累及丘脑,颅内病灶数目均<2个;11例重型患者病灶分别累及丘脑8例、海马5例,颅内病灶数目<2个3例、2~4个3例、>4个5例;18例极重型患者病灶分别累及丘脑14例、海马14例、大脑皮层14例、大脑脚9例、基底节区6例、脑干2例,颅内病灶数目<2个2例、2~4个6例、>4个10例。11例初期患者病灶扩散加权成像(DWI)高信号9例,T2液体衰减反转恢复序列(FLAIR)稍高信号2例;19例极期患者病灶DWI高信号16例,FLAIR稍高信号11例,T1加权成像(T1WI)高信号3例及T2加权成像(T2WI)高信号6例;5例恢复期患者病灶DWI稍高信号1例,FLAIR高信号5例,T2WI高信号1例。恢复期和极期患者的丘脑病灶ADC值均高于初期(q=3.931和4.012,P<0.05)。恢复期患者的丘脑病灶ADC值高于极期(q=3.372,P<0.05)。结论成人乙型脑炎病灶数目越多,累及范围越广。DWI序列易于早期发现病灶,FLAIR序列显示病变时间跨度长。DWI和FLAIR序列对成人乙型脑炎患者进行早期临床分期和分型具有重要意义,同时ADC值随着病程进展呈现由低到高的趋势,可作为成人乙型脑炎患者临床分期的有效补充。

Objective To investigate the application of magnetic resonance imaging(MRI)in clinical staging and classification of adult Japanese encephalitis.Methods The clinical data and craniocerebral MRI findings of 35 adult patients with Japanese encephalitis admitted in General Hospital of Ningxia Medical University from August to September 2018 were analyzed retrospectively.The MRI imaging characteristics were compared among patients with different stages and types,the apparent diffusion coefficient(ADC value)of thalamic lesions in patients of different stages was analyzed.SPSS 23.0 software was used to analyze the data.Results Six moderate cases all had lesions involving the thalamus,and the number of intracranial lesions was<2.In 11 severe cases,8 had lesions involving thalamus and 5 had lesions involving hippocampus;the number of intracranial lesions was<2 in 3 cases,the number of intracranial lesions was 2-4 in 3 cases,and the number of intracranial lesions was>4 in 5 cases.In 18 cases critical cases,the lesions involved thalamic in 14 cases,hippocampus in 14 cases,cerebral cortex in 14 cases,cerebral feet in 9 cases,basal ganglia area in 6 cases,and brain stem in 2 cases,respectively;2 cases had the intracranial lesions<2,6 cases had intracranial lesions 2-4,10 cases had intracranial lesions>4.In 11 preliminary stage patients,9 cases had DWI high signal and 2 had FLAIR slightly high signal;in 19 extreme stage patients,16 cases had DWI high signal,11 cases had FLAIR slightly high signal,3 cases had T1WI high signal and 6 cases had T2WI high signal.In 5 recovery stage patients,1 case had DWI slightly high signal,5 cases had FLAIR high signal,and 1 case had T2WI high signal.The ADC values of thalamic lesions in recovery and extreme patients were higher than those in the preliminary stage(q=3.931 and 4.012,P<0.05).The ADC value of thalamic lesions in the recovery period was higher than that in the extreme period(q=3.372,P<0.05).Conclusions The number of lesions and the range of involvement are associated with disease severity in adult Japanese encephalitis.The DWI sequence is easy to detect at early stage,and the FLAIR sequence shows a long time span of lesions;and the DWI and FLAIR sequences are of great significance for the early clinical staging and classification of adult encephalitis patients.At the same time,the ADC value shows a trend of disease progresses,which can be used as a supplement for the clinical staging in adult encephalitis patients.