Radionuclide Brain Scintigraphy of Enterovirus Type 71-Induced Cerebral Ventriculitis

核子醫學腦部造影在腸病毒71型感染併發大腦腦室炎之應用

10.6440/TZUCMJ.200212.0389

王昱豐(Yuh-Feng Wang)；謝志強(Chin-Chiang Hsieh)；莊美華(Mei-Hua Chuang)；黃義盛(Yi-Shen Huang)

腸病毒71型 ； 中樞神經 ； 腦部造影 ； 病毒性腦炎 ； enterovirus type 71 ； central nervous system ； brain scan ； viral encephalopathy

慈濟醫學雜誌

14卷6期（2002 / 12 / 01）

389 - 393

英文

腸病毒71型主要以侵犯3歲以下的幼童為主；大部份的患者之臨床症狀均相當輕微，但若併發中樞神經症狀時，則可能有致命的危機。評估此類腦部炎症的情形中，磁振造影(MRI)是常用的方法，然若患者已因昏迷而至自主呼吸停止，而需仰賴呼吸器時，磁振造影便較難以進行。本研究中嘗試以傳統的核子醫學腦部造影配合單光子射出斷層造影(SPECT)技術，對腸病毒71型感染之患者進行腦病變之探討。有三位腸病毒71型感染之患者接受核子醫學的腦部造影檢其中有兩位有明顯的中樞神經影響症狀，並接受呼吸器協助呼吸，另一位則未呈現中樞神經影響症狀。腦部造影之步驟按美國梅約診所發行之標準操作流程進行，並針對平面影像沒有特別異常之兩位患者加作單光子射出斷層造影，以能更深入評估腦內的變化。對於呈現中樞神經影響的患者，腦部造影檢查可以作出相當有意義的評估，配合單光子射出斷層造影可大幅增加查的敏感度。對於並無出現中樞神經症狀的患者，則並未有確實的異常發現。對於無法以磁振造影進行檢查的病毒性腦炎的患者，以核子醫學的腦部造影檢查是相當安全、簡單且準確的替代性檢查。據此，我們可以更早期對於患者進行正確且有效的治療。

One of the most serious clinical problems of enterovirus type-71 (EV 71) infection is complications in the central nervous system (CNS) in children. Magnetic resonance imaging (MRI) is currently the preferred diagnostic modality for evaluating cerebral infection. However, in some special conditions, such as in patients with endotracheal intubation or ventilator-assisted respiration, MRI studies usually cannot be easily performed. In such cases, radionuclide brain scintigraphy, unlike MRI, is not affected by the instruments and can reflect the cerebral condition, making is a useful alternative tool for evaluation. The purpose of this study was to investigate the extent of cerebral invasion by EV 71 using radionuclide brain scintigraphy. Three cases of EV 71-infected children were examined. Two were in a comatose state and on a ventilator; one was relatively free from CNS symptoms. Radionuclide brain scintigraphy was performed according to the standard procedures as described by the Mayo Clinic in the US. In addition, both planar brain scintigraphy and single photon emission computed tomography (SPECT) studies were performed. Patients with clinical CNS manifestations showed uptake of radiopharmaceutical in invaded areas of the brain. SPECT studies improved the sensitivity of detection, especially when the result of planar imaging was equivocal. The patient who was relatively free from CNS symptoms showed negative results from the radionuclide brain scintigraphy. A brain scan may be a useful alternative tool for the evaluation of pediatric patients with viral encephalopathy. SPECT studies effectively improved the sensitivity of the brain scan. This is especially true when MRI is not applicable for patients with ventilator assistance.