人神经李斯特菌病的影像学表现：71 例前瞻性研究。
Imaging of Human Neurolisteriosis: A Prospective Study of 71 Cases.
机构信息
Institut Pasteur, Biology of Infection Unit.
Institut national de la santé et de la recherche médicale (INSERM) U1117.
出版信息
Clin Infect Dis. 2018 Oct 15;67(9):1419-1426. doi: 10.1093/cid/ciy449.
BACKGROUND
Neurolisteriosis ranks among the most severe neurological infections. Its radiological features have not been thoroughly studied. We describe here the neuroradiological features of neurolisteriosis and assess their prognostic value.
METHODS
Patients with microbiologically proven neurolisteriosis were enrolled from November 2009 to October 2013 in MONALISA study. Magnetic resonance and computed tomography images were studied by 2 independent neuroradiologists. Predictors of 3-month mortality were determined using logistic regression.
RESULTS
Seventy-one patients were included; 42 were men (59%). Mean age was 64 years. Sixty patients (85%) reported signs of encephalitis, with clinical brainstem involvement in 16 (23%). Images were abnormal in 87% of cases (62/71). Main neuroradiological images were meningeal enhancement (25/71, 35%), abscess(es), or nodular image(s) evocative of abscess (10/71, 14%), hemorrhages (11/71, 15%), contrast-enhancing ventricles, or hydrocephalus (7/71, 10%). White-matter images (42/71, 59%), dilated Virchow-Robin spaces (22/71, 31%), and cerebral atrophy were also reported (34/71, 48%). Brainstem involvement (meningeal enhancement, abscess) was reported in only 7/71 cases (10%). Three-month survival was lower in patients with hydrocephalus or contrast-enhancing ventricles (1/7 [14%] than without [47/64, 73%], P = .005) and in patients with parenchymal images (abscess[es], nodule[s], or white matter images; 25/46 [54%] vs 23/25 without [92%], P = .004). Parenchymal images were associated with lower 3-month survival in the multivariable model (odds ratio 5.60, 95% confidence interval [1.42-29.6], P = .02).
CONCLUSIONS
Neurolisteriosis presents as a combination of neuroradiological images, none being specific. Radiological signs of rhombencephalitis are uncommon, whereas, unexpectedly, hemorrhagic images are frequent. The negative prognostic value of parenchymal neuroradiological images was evidenced.
CLINICAL TRIALS REGISTRATION
NCT01520597.
背景
神经李斯特菌病是最严重的神经感染之一。其放射学特征尚未得到充分研究。我们在此描述神经李斯特菌病的神经放射学特征，并评估其预后价值。
方法
我们从 2009 年 11 月至 2013 年 10 月 MONALISA 研究中招募了微生物学确诊的神经李斯特菌病患者。由 2 位独立的神经放射科医生对磁共振和计算机断层扫描图像进行研究。使用逻辑回归确定 3 个月死亡率的预测因素。
结果
共纳入 71 例患者，其中 42 例为男性（59%）。平均年龄为 64 岁。60 例（85%）患者有脑炎表现，16 例（23%）有临床脑干受累。87%的病例存在异常影像（62/71）。主要神经放射学表现为脑膜强化（25/71，35%）、脓肿或提示脓肿的结节状影像（10/71，14%）、出血（11/71，15%）、增强的脑室或脑积水（7/71，10%）。还报告了脑白质影像（42/71，59%）、扩大的 Virchow-Robin 空间（22/71，31%）和脑萎缩（34/71，48%）。仅 7/71 例（10%）报告了脑干受累（脑膜强化、脓肿）。有脑积水或增强脑室的患者 3 个月生存率低于无脑积水或增强脑室的患者（1/7 [14%] 比 47/64 [73%]，P =.005），且有实质影像（脓肿、结节或脑白质影像）的患者 3 个月生存率低于无脑实质影像的患者（25/46 [54%] 比 23/25 [92%]，P =.004）。多变量模型中，实质影像与较低的 3 个月生存率相关（比值比 5.60，95%置信区间 [1.42-29.6]，P =.02）。
结论
神经李斯特菌病表现为多种神经放射学影像的组合，没有任何一种影像具有特异性。脑桥炎的放射学征象不常见，而出乎意料的是，出血性影像很常见。实质神经放射学影像的预后不良具有提示作用。
临床试验注册
NCT01520597。
Zotero 插件