Defres Sylviane, Keller Simon S, Das Kumar, Vidyasagar Rishma, Parkes Laura M, Burnside Girvan, Griffiths Michael, Kopelman Michael, Roberts Neil, Solomon Tom
Clinical Infection, microbiology and immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
Tropical and Infectious diseases Unit, Liverpool and Broadgreen University Hospital Trust, Liverpool, United Kingdom.
PLoS One. 2017 Jan 26;12(1):e0170215. doi: 10.1371/journal.pone.0170215. eCollection 2017.
To assess whether it is feasible to quantify acute change in temporal lobe volume and total oedema volumes in herpes simplex virus (HSV) encephalitis as a preliminary to a trial of corticosteroid therapy.
The study analysed serially acquired magnetic resonance images (MRI), of patients with acute HSV encephalitis who had neuroimaging repeated within four weeks of the first scan. We performed volumetric measurements of the left and right temporal lobes and of cerebral oedema visible on T2 weighted Fluid Attenuated Inversion Recovery (FLAIR) images using stereology in conjunction with point counting.
Temporal lobe volumes increased on average by 1.6% (standard deviation (SD 11%) in five patients who had not received corticosteroid therapy and decreased in two patients who had received corticosteroids by 8.5%. FLAIR hyperintensity volumes increased by 9% in patients not receiving treatment with corticosteroids and decreased by 29% in the two patients that had received corticosteroids.
This study has shown it is feasible to quantify acute change in temporal lobe and total oedema volumes in HSV encephalitis and suggests a potential resolution of swelling in response to corticosteroid therapy. These techniques could be used as part of a randomized control trial to investigate the efficacy of corticosteroids for treating HSV encephalitis in conjunction with assessing clinical outcomes and could be of potential value in helping to predict the clinical outcomes of patients with HSV encephalitis.
评估量化单纯疱疹病毒（HSV）脑炎患者颞叶体积和总水肿体积的急性变化，以此作为皮质类固醇治疗试验的前期准备是否可行。
本研究分析了急性HSV脑炎患者连续获取的磁共振成像（MRI），这些患者在首次扫描后的四周内进行了重复神经成像检查。我们使用体视学结合点计数法，对T2加权液体衰减反转恢复（FLAIR）图像上可见的左右颞叶及脑水肿进行了体积测量。
5例未接受皮质类固醇治疗的患者颞叶体积平均增加了1.6%（标准差（SD）为11%），2例接受皮质类固醇治疗的患者颞叶体积减少了8.5%。未接受皮质类固醇治疗的患者FLAIR高信号体积增加了9%，而2例接受皮质类固醇治疗的患者该体积减少了29%。
本研究表明，量化HSV脑炎患者颞叶和总水肿体积的急性变化是可行的，并提示皮质类固醇治疗可能会使肿胀消退。这些技术可作为随机对照试验的一部分，用于研究皮质类固醇治疗HSV脑炎的疗效，同时评估临床结局，可能有助于预测HSV脑炎患者的临床结局。
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