Ishida Yu, Kawashima Hisashi, Morichi Shinichiro, Yamanaka Gaku, Okumura Akihisa, Nakagawa Satoshi, Morishima Tsuneo
Department of Pediatrics, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
Department of Pediatrics, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan.
Neuropediatrics. 2015 Feb;46(1):20-5. doi: 10.1055/s-0034-1393708. Epub 2014 Oct 7.
Pandemic influenza A (H1N1) 2009 has been shown to be associated more with neurological complications than the seasonal influenza virus. In this study, we focused on the clinical usefulness of magnetic resonance imaging (MRI) in the acute phase of influenza A (H1N1) 2009-associated encephalopathy. A questionnaire was distributed to pediatric and general hospitals in Japan that treat children with encephalopathy. We conducted a questionnaire-based study involving the collection of information regarding 207 patients with encephalopathy. Brain MRI was performed in 97 of these 207 patients in the age group of 9 months to 15 years (mean, 7.5 years) within 48 hours after the development of encephalopathy symptoms. Sixty-six patients (68%) showed normal imaging. Diffuse brain edema was visible in five patients and an abnormal signal in the deep gray matter in two patients which is consistent with acute necrotizing encephalopathy. Abnormal signals of the splenial lesion, subcortical white matter (bright tree appearance), and cortical area were observed in 15, 1, and 8 patients, respectively. From our findings based on the questionnaire results, we suggest that MRI is useful for determining fatal cases of pandemic influenza A (H1N1) 2009 infection when performed in the acute phase. However, MRI is not useful in predicting the development of sequelae.
2009年甲型H1N1流感大流行已被证明比季节性流感病毒更容易引发神经系统并发症。在本研究中，我们重点关注了磁共振成像（MRI）在2009年甲型H1N1流感相关脑病急性期的临床应用价值。我们向日本治疗脑病患儿的儿科和综合医院发放了调查问卷。我们开展了一项基于问卷调查的研究，收集了207例脑病患者的相关信息。在这207例年龄在9个月至15岁（平均7.5岁）的患者中，有97例在出现脑病症状后的48小时内进行了脑部MRI检查。66例患者（68%）影像显示正常。5例患者可见弥漫性脑水肿，2例患者深部灰质出现异常信号，这与急性坏死性脑病相符。分别有15例、1例和8例患者观察到胼胝体病变、皮质下白质（亮树征）和皮质区域的异常信号。根据问卷调查结果得出的研究发现，我们认为在急性期进行MRI检查有助于判定2009年甲型H1N1流感大流行感染的致死病例。然而，MRI对于预测后遗症的发生并无帮助。
