Magnetic Resonance Imaging to Predict Neurological Outcome in Children with Acute Encephalitis
GCY Chan, TW Yeung, YC Wong
Hong Kong J Radiol 2018;21:34-9
DOI: 10.12809/hkjr1616415
Objective: To identify magnetic resonance imaging (MRI) variables that are predictive of neurological outcome in children with acute encephalitis.
Methods: We retrospectively reviewed all consecutive patients younger than 18 years who presented to the Tuen Mun Hospital, Hong Kong, between January 2006 and July 2014 with the diagnosis of acute encephalitis. The location and extent of hyperintense lesions on T2-weighted or fluid-attenuated inversion recovery images and the presence of restricted diffusion were assessed. The extent of lesions was quantified using a scoring system ranging 0 to 9. Clinical outcome was assessed at 1 year using the Pediatric Cerebral Performance Category Scale (PCPCS). Neurological outcome was dichotomised to good (PCPCS score of 1) or adverse (PCPCS score of 2 to 6). Multiple logistic regression analysis was used to determine the association between neurological outcome and lesion location or restricted diffusion. Spearman's rank correlation test was used to evaluate the association between lesion extent score and the PCPCS score.
Results: Of 46 patients, 12 were excluded and the remaining 15 male and 19 female patients aged 2 months to 17 years were included. The mean time from admission to MRI was 7 days (median, 4 days; range, 1-40 days); only two patients underwent MRI after 3 weeks. At 1 year, 24 patients achieved good outcomes with no neurological sequelae (PCPCS score of 1), six patients had mild to moderate (n = 4) or severe (n = 2) residual neurological deficits (PCPCS score of 2 to 5), and four patients died (PCPCS score of 6). All patients with adverse outcomes had T2-weighted or fluid-attenuated inversion recovery images that showed hyperintense parenchymal lesions. Adverse neurological outcome was associated with involvement of basal ganglia and/or thalami (odds ratio [OR] = 12.7; p = 0.004) and involvement of the brainstem (OR = 8.8; p = 0.023). Lesion extent score was moderately correlated with PCPCS score (r2 = 0.35; p = 0.01). Restricted diffusion was a predictor of adverse neurological outcome (OR = 5.7; p = 0.033).
Conclusion: Restricted diffusion and involvement of the deep grey nuclei and brainstem are predictive of adverse neurological outcome. Patients with a greater extent of lesions tend to have worse neurological outcomes.
中文摘要
用磁共振成像預測兒童急性腦炎的神經結果
陳頌恩、楊子慧、王耀忠
目的：確定能預測兒童急性腦炎神經結果的磁共振成像（MRI）變數。
方法：回顧分析於2006年1月至2014年7月期間入院的18歲以下連續急性腦炎兒童患者。 評估T2加權 / 流體衰減反恢復（FLAIR）高信號病變的位置和範圍以及有否限制性擴散。病變範圍 被量化為0到9分。一年臨床結果用小兒腦性能量表（PCPCS）評估。神經結果分為良好（PCPCS分 數為1）或不良（PCPCS分數為2至6）。用多重邏輯回歸分析來確定神經結果與病變位置或限制性 擴散之間的關聯。用Spearman等級相關評估病變範圍與PCPCS之間的相關性。
結果：46例患者中，12例被排除，其餘15例男性和19例女性患者年齡介於2個月至17歲之間。入院 至接受MRI檢查的平均時間為7天（中位數4天，範圍：1-40天）；只有兩名患者在3週後接受MRI檢 查。一年後，24例患者無神經功能障礙（PCPCS分數為1）、6例患者有輕度至中度（n = 4）或嚴重 （n = 2）殘留神經功能缺損（PCPCS分數為2至5）、4例患者死亡（PCPCS分數為6）。所有預後不 良的患者均有T2加權或FLAIR高信號實質病變。不良神經結果與基底神經節和/或丘腦病變（比值 比[OR] = 12.7；p = 0.004）和腦幹病變（OR = 8.8；p = 0.023）相關。病變範圍與PCPCS中度相關 （r2 = 0.35；p = 0.01）。限制性擴散是不良神經結果的預測因子（OR = 5.7；p = 0.033）。
結論：限制性擴散和深灰色核和腦幹病變能預示不良的神經結果。病變範圍較大的患者傾向有較差 的神經結果。