| 石玉铸,杨洋,袁新宇.儿童血液病异基因造血干细胞移植后中枢神经系统感染MRI特征[J].中国医学影像技术,2021,37(6):820~824 |
| 儿童血液病异基因造血干细胞移植后中枢神经系统感染MRI特征 |
| MRI features of central nervous system infections after allogeneic hematopoietic stem cell transplantation in children with hematologic diseases |
| 投稿时间：2020-02-24 修订日期：2020-05-20 |
| DOI：10.13929/j.issn.1003-3289.2021.06.005 |
| 中文关键词: 儿童 造血干细胞移植 中枢神经系统感染 磁共振成像 |
| 英文关键词:child hematopoietic stem cell transplantation central nervous system infections magnetic resonance imaging |
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| 中文摘要: |
| 目的 观察儿童血液病异基因造血干细胞移植（allo-HSCT）后中枢神经系统（CNS）感染的MRI特征。方法 回顾2 240例因血液病接受HSCT患儿，分析其中13例经手术、穿刺活检、实验室检查确诊的不同病原CNS感染的MRI表现。结果 血液病allo-HSCT后CNS感染率为0.58%（13/2 240），死亡率为38.46%（5/13），发病时间为移植后24~271天，中位数79天；主要临床表现为头痛、抽搐、凝视及颈强直。7例真菌感染（7/13，53.85%），MRI见幕上、幕下与基底节受累，病灶呈多发或单发结节状、类圆形团块状及脑回样异常信号伴环形强化；细菌感染2例（2/13，15.38%）， MRI显示幕上受累，病灶呈单发或多发脑回样、斑片状异常信号；结核感染2例（2/13，15.38%），MRI显示幕上受累，病灶呈多发团块状、脑回样及小结节状异常信号，伴簇状环形强化；EB病毒感染2例（2/13，15.38%），MRI显示幕上、下均受累，病灶呈多发斑片状、类圆形团块状及脑回样异常信号，部分对称分布，伴脑回样、花环样强化。结论 血液病患儿allo-HSCT后CNS感染类型多样，MRI表现各有不同，但具有一定特征性，与临床症状、体征及实验室检查相结合有助于早诊断、早治疗。 |
| 英文摘要: |
| Objective To explore MRI features of infectious diseases of the central nervous system (CNS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children with hematological diseases. Methods Data of 2 240 children with hematologic diseases who underwent HSCT were retrospectively reviewed, among them 13 children with CNS infection confirmed by surgery, puncture biopsy and laboratory examinations were analyzed, and MRI manifestations of different pathogens were observed. Results The incidence of CNS infection after allo-HSCT was 0.58% (13/2 240), and the mortality rate was 38.46% (5/13). The onset time was 24-271 (median 79) days after allo-HSCT, and the main clinical symptoms included headache, convulsions, gaze and neck stiffness. Fungal infection occurred in 7 cases (7/13, 53.85%), among them 3 children died; MRI showed supratentorial, infratentorial and basal ganglia involvements present as multiple or single nodular, round-like masses with gyrus-like abnormal signals and ring-like enhancements. Bacterial infection occurred in 2 cases (2/13, 15.38%), and 1 child died; MRI showed only supratentorial involvements with single or multiple gyrus-like and patchy abnormal signals. Tuberculosis infection was found in 2 cases (2/13, 15.38%); MRI showed only supratentorial involvements with multiple masses, gyrus-like and small nodular abnormal signals accompanied by cluster-like ring enhancements. Epstein-Barr (EB) viral infection occurred in 2 cases (2/13, 15.38%), and 1 case died; MRI showed involvements in both supratentorial and subtentorial areas present as multiple patchy, round-like masses and abnormal gyrus-like signals, some were symmetrical, with gyrus-like and rosette-like enhancements. Conclusion MRI manifestations of CNS in children with hematological diseases after allo-HSCT were various, showing some characteristics of different pathogens. Combining with clinical symptoms, signs and laboratory findings could assist early diagnosis and treatment. |
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