儿童MOG抗体病MR影像特征及临床特点  

Magnetic Resonance Imaging Features and Clinical Characteristics of Myelin Oligodendrocyte Glycoprotein Antibody Associated Disorders in Children

作　　者：王冬[1] 郝跃文 杨乐[2] 陈超[1] 侯欣 张鹏 白慧萍[1] 胡文 WANG Dong;HAO Yuewen;YANG Le(Department of Radiology,Xi’an Children’s Hospital,Xi’an,Shaanxi Province 710003,P.R.China)

机构地区：[1]西安市儿童医院放射科,710003 [2]西安市儿童医院神经内科,710003

出　　处：《临床放射学杂志》2022年第8期1520-1524,共5页Journal of Clinical Radiology

摘　　要：目的探讨儿童髓鞘少突胶质细胞糖蛋白(MOG)抗体病首次发作的MRI特征及临床特点。方法回顾性分析2018年12月至2021年3月西安市儿童医院神经内科28例MOG抗体病患儿MRI特征及临床特点,其中男14例,女14例,年龄0.6~12.2岁,中位年龄5.6岁。由两名放射医师对MR图像进行评价,包括病灶的位置、边界、大小、强化及转归,由一名儿科神经诊断医师对临床资料进行总结。结果28例患儿MR表现为多部位受累的T_(2)WI高信号病灶,主要包括:幕上病灶:双侧发病25例(89.3%),大脑皮层下22例(78.6%),深部白质15例(53.6%),基底节13例(46.4%),丘脑9例(32.1%)。幕下病灶:中脑13例(46.4%),脑桥9例(32.1%),小脑中脚10例(35.7%)。脊髓病灶7例(25%),3例>3个节段。视神经2例(7.1%)。颅脑增强扫描呈短线状或结节样强化3例。病灶边界模糊23例(82.2%),病灶边界清楚9例(32.1%)。病灶直径0.3~2 cm 21例(95%),病灶直径>2 cm 12例(42.9%)。2例呈“脑白质营养不良样”改变。主要首发症状包括:发热13例(46.4%),意识障碍7例(25.0%),头痛4例(14.3%)。12例(42.9%)脑脊液白细胞计数升高,中位数34×10^(6)/L(24×10^(6)/L~68×10^(6)/L)。结论儿童MOG抗体病首发症状以发热最常见,脑脊液以白细胞轻度升高多见,MR主要表现为广泛、多发T_(2)WI高信号病灶,幕上以双侧大脑皮层下、深部白质、深部灰质受累为主,幕下以中脑、小脑中脚受累为主,病灶多边界模糊,少数病例呈“脑白质营养不良样”改变。Objective To explore the magnetic resonance imaging(MRI)features and clinical characteristics of children with first attack of myelin oligodendrocyte glycoprotein(MOG)antibody associated disorders.Mehtods The MRI features and clinical characteristics of MOG antibody associated disorders in 28 children hospitalized from December 2018 to March 2021 were retrospectively analyzed by two radiologists and one pediatric neurologist.In 28 children(14 boys and 14 girls)with a onset age of 0.6-12.2 years,the median age was 5.6 years.Result MRI of the 28 children showed hyperintense on T_(2)WI involvement of multiple anatomical regions mainly including the following:supratentorial lesions:bilateral brain lesions(89.3%),subcortical lesions(78.6%),deep white matter(53.6%),basal ganglia(46.4%),thalamus(32.1%);infratentorial lesions:mesencephalon(46.4%),pons(32.1%),middle cerebellar peduncles(35.7%);spinal cord lesions(25%);optic neuritis(7.1%),with nodular or linear enhancement in brain(3/9),poorly demarcated lesions(82.2%),well-demarcated lesions(32.1%).Lesion diameter 0.3-2 cm(95%),lesion diameter>2 cm(42.9%).2 cases presented with“Leukodystrophy-like”MRI patterns.The main initial symptoms included fever in 13 cases(46.4%),disturbance of consciousness in 7 cases(25.0%),headache in 4 cases(14.3%).12 cases(42.9%)had elevated leukocytes in CSF,with a median of 34×10^(6)/L(24×10^(6)/L-68×10^(6)/L).Conclusion In children with MOG antibody associated disorders,fever was the most common initial symptom,mild increase of white blood cells was more common in cerebrospinal fluid.MRI predominantly shows bilateral poorly demarcated lesions mostly affecting the subcortical and deep white matter,deep grey matter,mesencephalon and middle cerebellar peduncles.A few cases present with“Leukodystrophy-like”MRI patterns.

关 键 词：髓鞘少突胶质细胞糖蛋白抗体 磁共振成像 儿童 

分 类 号：R445.2[医药卫生—影像医学与核医学] R744.5[医药卫生—诊断学]