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目的:探讨重症手足口病并发脑脊髓炎的MRI表现特征,以提高对本病MRI征象的认识。方法:对458例临床诊断为重症手足口病并发脑炎或脊髓炎的患儿进行头颅MRI检查,其中18例同时进行脊髓MRI检查,获得T1WI、T2WI及FLAIR图像,并分析脑部及脊髓MRI表现,重点分析病变的位置、形态及信号特点。结果:458例头颅MRI检查中402例脑实质或脊髓未见异常信号影;56例(12.2%)发现脑部和/或脊髓病灶,其中49例发现脑干异常信号影,11例累及脊髓,其中4例同时累及脑干与脊髓。脑炎病例T2WI均表现为脑干不同程度的高信号改变。脊髓炎病例均呈对称性纵行长条状T2WI高信号影,边缘清晰,横断位脊髓前角可见对称性类圆形病灶。结论:重症手足口病并发脑脊髓炎常累及脑干,易累及脊髓前角,MRI表现具有特征性,矢状面及横断面T2WI序列对脑部及脊髓病变的显示及病变范围评价起重要作用,可对临床治疗提供可靠的影像学依据。
Objective: To investigate the MRI features of severe hand-foot-mouth disease with encephalomyelitis to improve the understanding of MRI signs of this disease. Methods: A total of 458 children with severe HFMD complicated by encephalitis or myelitis were examined by cranial MRI. Among them, 18 patients underwent simultaneous MRI examination of the spinal cord to obtain T1WI, T2WI and FLAIR images, and MRI and brain MRI Performance, focusing on the analysis of lesion location, shape and signal characteristics. Results: There were no abnormal signals in 402 cases of parenchyma or spinal cord in 458 cases of craniocerebral lesions. Fifty-six cases (12.2%) had brain and / or spinal cord lesions. Among them, 49 cases had abnormal brainstem signals, 11 cases involved spinal cord, 4 cases involving both the brain stem and spinal cord. Encephalitis cases T2WI showed different levels of high signal changes in the brain stem. The cases of myelitis were symmetrical longitudinal stripe T2WI high signal intensity, clear edge, transverse anterior horn can be seen in the spinal cord symmetry class round lesions. Conclusions: Severe hand-foot-mouth disease complicated with encephalomyelitis often involves the brainstem, and it is easy to involve the anterior horn of the spinal cord. MRI features are characteristic. The T2WI sequences of sagittal plane and transverse plane play an important role in the display of brain and spinal cord lesions and the evaluation of the extent of lesions , Can provide a reliable imaging basis for clinical treatment.