Bonawitz C, Castillo M, Mukherji S K
Department of Radiology, University of North Carolina School of Medicine, Chapel Hill 27599, USA.
AJNR Am J Neuroradiol. 1997 Mar;18(3):459-64.
To compare neuroimaging findings and clinical features in patients with Rocky Mountain spotted fever and to determine the impact of imaging studies in the treatment of these patients.
We reviewed the brain CT scans (n = 44), MR images (n = 6), or both (n = 4), and one MR spinal study in 34 patients with Rocky Mountain spotted fever, proved by definitive serologic criteria. Records were reviewed with attention to clinical symptoms and therapeutic modifications based on neuroimaging; outcomes were compared with imaging findings.
Abnormalities, consisting of infarctions, cerebral edema, meningeal enhancement, and prominent perivascular spaces, were found on four of 44 CT scans and on four of six MR studies. The spinal MR study showed abnormal enhancement of the lower spinal cord and cauda equina. Nonspecific clinical symptoms were present in all patients in whom neuroimaging findings were abnormal and in 80% of patients whose CT and/or MR findings were normal. After treatment, return to baseline clinical status was documented in 67% of patients with abnormal imaging findings and in 93% with normal findings. Death occurred in 17% of patients with abnormal neuroimaging results and in none of those with normal results.
Abnormalities on neuroimaging studies were not common in patients with Rocky Mountain spotted fever. When present, they were subtle. Symptoms at presentation and unfavorable outcomes were more prevalent when CT or MR findings were abnormal. Abnormalities identified on neuroimaging studies did not alter clinical treatment in any patient.
比较落基山斑疹热患者的神经影像学表现和临床特征，并确定影像学检查对这些患者治疗的影响。
我们回顾了34例经明确血清学标准确诊的落基山斑疹热患者的脑部CT扫描（n = 44）、磁共振成像（MR）（n = 6）或两者（n = 4），以及一项MR脊髓检查。回顾记录时关注临床症状以及基于神经影像学的治疗调整；将结果与影像学表现进行比较。
在44例CT扫描中的4例以及6例MR检查中的4例发现了异常，包括梗死、脑水肿、脑膜强化和明显的血管周围间隙。脊髓MR检查显示脊髓下部和马尾神经异常强化。神经影像学表现异常的所有患者以及CT和/或MR表现正常的患者中的80%均出现非特异性临床症状。治疗后，影像学表现异常的患者中有67%恢复至基线临床状态，表现正常的患者中有93%恢复至基线临床状态。神经影像学结果异常的患者中有17%死亡，结果正常的患者中无死亡病例。
落基山斑疹热患者神经影像学检查异常并不常见。若存在异常，也较为轻微。CT或MR表现异常时，就诊时的症状及不良结局更为普遍。神经影像学检查发现的异常未改变任何患者的临床治疗。
