小儿手足口病并发脑炎的头颅MRI表现  

MRI manifestations of pediatric hand-foot-mouth disease encephalitis

作　　者：李瑞利[1] 任美吉 赵大伟[1] 李宏军[1] Li Ruili Ren Meiji Zhao Dawei Li Hongjun.(Department of Radiology, Beijing You ＇an Hospital, Capital Medical University, Beijing 100069, China)

机构地区：[1]首都医科大学附属北京佑安医院放射科,100069

出　　处：《北京医学》2016年第12期1264-1267,共4页Beijing Medical Journal

基　　金：北京市医院管理局临床医学发展专项(ZYLX201511)

摘　　要：目的探讨小儿手足口病并发脑炎的头颅MRI表现特点,提高诊断水平。方法回顾性分析首都医科大学附属北京佑安医院2011年5月至2014年7月临床确诊的65例手足口病合并脑炎患儿的头颅MRI表现。结果65例MRI资料中,43例(66.2%)脑实质未见明确异常信号,22例(33.8%)信号有阳性表现:延髓背侧及脑桥被盖部模糊小片状分布5例,延髓背侧及脑桥被盖部对称斑点状分布4例,双侧侧脑室后角旁斑点、斑片状分布5例,中脑点状分布4例,左侧侧脑室后角后方局灶病变1例,左海马模糊小片状1例,中脑左侧及左丘脑1例,左侧大脑半球灰白质弥漫分布1例。T_1WI呈稍低信号,T_2WI、T_2-FLAIR、ADC(6例)及DWI呈稍高信号(9例,ADC呈低信号)。T_2WI病灶检出率(100.0%)分别与T_1WI(63.6%)、T_2-FLAIR(54.5%)、DWI(40.9%)、ADC(68.2%)序列相比,差异均有统计学意义(P均<0.05)。结论手足口病并发脑炎MRI平扫阳性率约为33.8%;损害部位具有特征性,常位于延髓背侧及脑桥被盖部;MRI信号特点无特异性,T_2WI序列对比度相对较高,对病变的检出有重要意义。Objective To summarize the MRI features of hand-foot-mouth disease（HFMD） encephalitis in children and to improve the level of diagnosis. Methods The plain MRI findings of 65 children whose diagnosis was confirmed by clinical examinations as HFMD combined with encephalitis from May 2011 to July 2014 were retrospectively analyzed. Results Among all the patients, 43（66.2%） did not show any abnormal signals, 22（33.8%） showed positive performance： fuzzy patchy in the dorsal of medulla oblongata and tegmentum of pons（5 cases）, symmetrical dot in the dorsal of medulla oblongata and tegmentum of pons（4 cases）, fuzzy patchy and pot around the posterior horn of bilateral lateral ventricle, pot in the subcortical of frontal and parietal lobes（5 cases）, pot in the midbrain（4 cases）, focal lesion in the back of left lateral ventricle posterior horn（1 case）, fuzzy patchy in the hippocampus（1 case）, patchy shadow in the midbrain and left thalamus（1 case）, diffuse abnormal signal in the left cerebral hemisphere（1 case）. MRI showed slightly low signal on T1 WI, slightly high signal on T2 WI, T2-FLAIR, ADC map（6 cases） and DWI（low signal on ADC map, 9 cases）. The differences of lesion detection were statistically significant between T2WI（100.0%） compared with T1WI（63.6%）, T2-FLAIR（54.5%）, DWI（40.9%）, ADC（68.2%）（all P〈0.05）. Conclusion The plain MRI positive rate of HFMD encephalitis is about 33.8%. Dorsal of medulla oblongata and tegmentum of pons involvement are characteristic findings of HFMD encephalitis. MRI signal characteristics are not specific. T2 WI sequence contrast is relatively high, and it plays an important role in lesion detection.

关 键 词：手足口病 脑炎 磁共振 

分 类 号：R725.1[医药卫生—儿科] R445.2[医药卫生—临床医学]