Tsubouchi Yoshiko, Itamura Shinji, Saito Yoshiaki, Yamashita Eijiro, Shinohara Yuki, Okazaki Tetsuya, Ohno Koyo, Nishimura Yoko, Oguri Masayoshi, Maegaki Yoshihiro
Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.
Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.
Brain Dev. 2018 Feb;40(2):116-125. doi: 10.1016/j.braindev.2017.07.012. Epub 2017 Aug 31.
To determine the use of high b value diffusion-weighted imaging (DWI) in the diagnosis and assessment of acute febrile encephalopathy/encephalitis in childhood.
We enrolled 22 children, for whom we examined DWI with b=1000s/mm, DWI with b=3000s/mm, and apparent diffusion coefficient (ADC) map with b=1000 during the acute phase of febrile encephalopathy/encephalitis. Clinical diagnoses included acute encephalopathy with biphasic seizures and late reduced diffusion (AESD; n=6), clinically mild encephalopathy/encephalitis with a reversible splenial lesion (MERS; n=6), and herpes simplex virus encephalitis (HSE; n=3), unclassified acute encephalopathy/acute encephalitis (n=2); acute encephalitis with refractory, repetitive partial seizures (AERRPS; n=1); other encephalopathy (n=1); infarction (n=1); head injury (n=1); or mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (n=1). The diagnostic quality of brain lesions was compared between b=1000 and b=3000 DWI images by visual inspection. In addition, we attempted a quantitative assessment using apparent diffusion coefficient (ADC) value and an index of signal intensity (SI) ratio, defined as the mean SI at the affected lesion divided by the mean SI at the pons.
High intensity lesions were either visible only on b=3000 DWI (n=5; 2 AESD, 1 MERS, 1 HSE, and 1 unclassifiable encephalopathy) or more effectively identified on b=3000 DWI than on b=1000 DWI (n=17). The outcome of the former five subjects was favorable, without motor or intellectual sequelae. The mean SI ratio of b=3000 was significantly greater than that of b=1000 in AESD and MERS subgroups as well as in all 22 subjects. Mean ADC values were lower in the AESD and MERS than that in the HSE subgroups.
We concluded that b=3000 DWI was superior to b=1000 DWI in detecting abnormal lesions in acute encephalopathy/encephalitis during childhood.
确定高b值扩散加权成像（DWI）在儿童急性发热性脑病/脑炎诊断及评估中的应用。
我们纳入了22名儿童，在发热性脑病/脑炎急性期对其进行b=1000s/mm的DWI、b=3000s/mm的DWI及b=1000的表观扩散系数（ADC）图检查。临床诊断包括伴有双相惊厥和晚期扩散受限的急性脑病（AESD；n=6）、伴有可逆性胼胝体病变的临床轻度脑病/脑炎（MERS；n=6）、单纯疱疹病毒性脑炎（HSE；n=3）、未分类的急性脑病/急性脑炎（n=2）；伴有难治性反复部分性发作的急性脑炎（AERRPS；n=1）；其他脑病（n=1）；梗死（n=1）；头部损伤（n=1）；或线粒体肌病、脑病、乳酸酸中毒和卒中样发作（n=1）。通过视觉检查比较b=1000和b=3000 DWI图像上脑病变的诊断质量。此外，我们尝试使用表观扩散系数（ADC）值和信号强度（SI）比指数进行定量评估，SI比指数定义为病变部位的平均SI除以脑桥的平均SI。
高强度病变要么仅在b=3000 DWI上可见（n=5；2例AESD、1例MERS、1例HSE和1例未分类脑病），要么在b=3000 DWI上比在b=1000 DWI上能更有效地识别（n=17）。前5名受试者预后良好，无运动或智力后遗症。在AESD和MERS亚组以及所有22名受试者中，b=3000的平均SI比显著高于b=1000。AESD和MERS组的平均ADC值低于HSE亚组。
我们得出结论，在检测儿童急性脑病/脑炎的异常病变方面，b=30
