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目的探讨肠道病毒71型(EV71)感染手足口病合并急性弛缓性麻痹(AFP)的起病及恢复期的脊髓MRI特点,并观察影像学和肌力变化之间的相互关系。资料与方法搜集2008年6至10月EV71感染手足口病合并AFP患儿8例,对其脊髓MRI表现及肌力进行2年随访观察。结果本组8例,单侧下肢无力4例,双侧下肢无力2例,单侧上肢无力和双侧上肢无力各1例,合并脑干脑炎4例。MRI病变特异性累及脊髓前角,上肢无力累及颈膨大,下肢无力累及腰膨大,T2WI高信号。单侧肢体无力5例,其中2例为单侧脊髓前角受累,3例表现为双侧受累,患侧病变范围大,信号强度高。双侧肢体无力3例,脊髓前角病变范围大的一侧肌力下降明显。2年后复查,8例均表现脊髓前角病变范围减小,肌力提高者10肢,肌力下降1肢,新出现肌力下降者1肢。T2WI呈高信号及稍高信号6例,肌力均达4级以上,呈脑脊液信号2例,肌力未达4级。结论脊髓MRI是诊断和随诊EV71感染手足口病合并AFP的最佳影像学检查方法。起病时病变累及脊髓前角区,单侧或双侧受累,以一侧为主多见。恢复期病变范围均有不同程度吸收,多数病变T2WI信号减低。起病时病变范围与肌力下降程度相一致,恢复期T2WI病变区仍呈脑脊液信号者肌力恢复较差。脊髓MRI对EV71感染手足口病合并AFP的临床预后评估具有一定的价值。
Objective To investigate the MRI features of spinal cord during the onset and recovery of enterovirus 71 (EV71) -containing HFMD complicated with acute flaccid paralysis (AFP), and to observe the correlation between the changes of imaging and muscle strength. Materials and Methods 8 cases of AFP-infected children with EV71 were enrolled in this study. The MRI findings and muscular strength of spinal cord were observed after 2 years follow-up. Results The group of 8 patients, unilateral lower limb weakness in 4 cases, bilateral lower limb weakness in 2 cases, unilateral upper limb weakness and bilateral upper limb weakness in 1 case, with brain stem encephalitis in 4 cases. MRI lesions involving the spinal cord anterior horn, upper extremity weakness involving the neck enlargement, lower extremity weakness involving lumbar enlargement, T2WI high signal. Unilateral limb weakness in 5 cases, 2 cases of unilateral spinal cord anterior horn involvement, 3 cases showed bilateral involvement, ipsilateral lesion range, high signal intensity. Bilateral limb weakness in 3 cases, spinal cord anterior horn lesions on a large side of the muscle strength decreased significantly. Two years after the review, 8 cases showed anterior horn angle lesion range, muscle strength increased 10 limbs, decreased muscle strength of 1 limbs, decreased muscle strength of 1 limbs. T2WI was high signal and slightly higher signal in 6 cases, muscle strength reached 4 above, was cerebrospinal fluid signal in 2 cases, muscular strength of less than 4. Conclusion Spinal cord MRI is the best imaging method for diagnosis and follow-up of EV71 infection with HFMD complicated with AFP. Incidence of lesions involving the anterior horn of the spinal cord area, unilateral or bilateral involvement, mainly to the side of the more common. Convalescent lesions have varying degrees of absorption, the majority of lesions T2WI signal decreased. The onset of lesion was consistent with the degree of decline in muscle strength, convalescent T2WI lesion area was still cerebrospinal fluid signal recovery of poor muscle strength. Spinal cord MRI EV71 infection in hand, foot and mouth disease combined with the clinical prognosis of AFP has some value.