16例儿童新型冠状病毒感染后合并不同类型脑病的MRI影像表现

MRI Imaging of 16 Children with Different Types of EncephalopathyAfter Novel Coronavirus Infection

目的 分析总结儿童新型冠状病毒感染后合并不同类型脑病的MRI影像表现,为临床及时、合理治疗提供影像信息。方法 回顾性分析16例经临床确诊为新型冠状病毒感染合并中枢神经系统受累患儿的临床及MRI影像资料,男9例,女7例,年龄13天~12岁。所有患儿均行MRI平扫及加扫扩散加权成像(DWI)序列。其中11例患儿于不同时期复查。结果 结合临床表现及实验室检查,8例患儿考虑为急性坏死性脑病,其中7例病变累及脑实质范围较广,MRI表现为双侧丘脑明显肿胀,呈对称性改变,T_(1)WI呈低信号,T_(2)WI及FLAIR呈高信号,DWI呈高信号,ADC呈“三色板征”,余双侧大脑半球内可见多发对称性斑片状DWI高信号;1例仅累及脑干,MRI表现为脑干明显肿胀,脑干内团片状异常信号,T_(1)WI呈低信号,T_(2)WI及FLAIR呈高信号,DWI呈高信号,ADC呈“三色板征”。2例患儿考虑为瑞氏综合征。MRI表现为双侧大脑半球皮层、基底节区弥漫性对称性T_(1)WI低信号,T_(2)WI高信号,FLAIR及DWI呈高信号,ADC减低。4例患儿考虑为急性脑病伴双向发作及后期扩散降低(AESD)。MRI表现为双侧额顶枕叶白质内对称性稍长T_(1)、长T_(2)信号,FLAIR呈高信号,DWI呈高信号,ADC减低,呈“亮树征”。2例患儿MRI表现为双侧大脑半球白质内分水岭区散在多发点片状T_(1)WI低、T_(2)WI高信号,FLAIR及DWI呈高信号,ADC减低,额顶叶片状T_(1)WI高信号,考虑为急性脑病合并血管病变。结论 儿童新型冠状病毒感染可合并急性坏死性脑病、瑞氏综合征、AESD及急性脑病并发脑血管病变,不同类型脑病MRI影像表现不同,总结其影像特征,提高诊断能力,为临床合理、及时治疗提供重要影像信息。

Objective To analyze and summarize the MRI findings of children with different types of encephalopathy after novel coronavirus infection,so as to providing image information for clinical timely and reasonable treatment.Methods Clinical and MRI imaging data of 16 clinically diagnosed children with novel coronavirus infection complicated with central nervous system involvement admitted were retrospectively analyzed,including 9 males and 7 females,aged 13 days to 12 years.All the patients underwent MRI plain scan and diffusion weighted imaging(DWI).Among them,11 cases were reexamined at different times.Results Combined with clinical findings and laboratory examination,8 cases were considered as acute necrotic encephalopathy,of which 7 cases involved a wide range of brain substance.MRI showed obvious bilateral thalamic swelling with symmetrical changes,low signal on T_(1)WI,high signal on T_(2)WI and FLAIR,high signal on DWI,and“trichromatic plate sign”on ADC.Multiple symmetrical patchy DWI high signals were seen in the remaining bilateral cerebral hemispheres,and only the brain stem was involved in 1 case.MRI showed obvious swelling of the brain stem,abnormal patchy signals in the brain stem,low signals on T_(1)WI,high signals on T_(2)WI and FLAIR,high signals on DWI,and“tricolor sign”on ADC.Reye's syndrome was considered in 2 cases.MRI showed diffuse symmetry of low T_(1)WI signal,high T_(2)WI signal,high FLAIR and DWI signal,and decreased ADC in both cerebral cortex and basal ganglia.Four patients were considered to have acute encephalopathy with biphasic seizures and late reduced diffusion(AESD).MRI showed slightly longer symmetrical T_(1) and T_(2) signals in the white matter of the frontal parietal occipital lobe,high FLAIR signal,high DWI signal,and reduced ADC,showing“bright tree sign”.In the two cases,MRI showed flaky T_(1)WI low T_(2)WI high signal scattered at multiple points in the intracranial white matter divide of both cerebral hemispheres,FLAIR and DWI showed high signal,ADC decreased,and fronto-parietal flaky T_(1)WI high signal,which was considered to be acute encephalopathy complicated with vascular disease.Conclusion Novel coronavirus infection in children can be complicated with acute necrotic encephalopathy,Reye's syndrome,AESD and acute encephalopathy complicated with cerebrovascular lesions.MRI findings of different types of encephalopathy are different.To summarize the imaging characteristics,improve the diagnostic ability,and provide important imaging information for clinical reasonable and timely treatment.