Neuro-Magnetic Resonance Imaging in Hand, Foot, and Mouth Disease: Finding in 412 Patients and Prognostic Features

Abstract

Purpose: The aims of this study were to describe the neuroimaging findings in hand, foot, and mouth disease and determine those who may provide prognosis.

Material and methods: Magnetic resonance imaging scans in 412 severe hand, foot, and mouth disease between 2009 and 2014 were retrospectively evaluated. The patients who had the neurological signs were followed for 6 months to 1 year. According to the good or poor prognosis, 2 groups were categorized. The incidence of lesions in different sites between the 2 groups was compared, and multivariate analysis was used to look for risk factors.

Results: The major sites of involvement for all patients with percentages were the medulla oblongata (16.1%), spinal anterior nerve roots (12.4%), thoracic segments (11.1%), brain or spinal meninges (8.3%), and so on. There were 347 patients (84.2%) with good prognosis and 65 (15.8%) with poor prognosis in the follow-up. There was a significantly higher rate of lesions involving the cerebral white substance, thalamus, medulla oblongata, pons, midbrain, and spinal cord in the group with poor prognosis. Multivariate analysis showed 2 independent risk factors associated with poor prognosis: lesions located in the medulla oblongata (P < 0.015) and spinal cord (P < 0.001) on magnetic resonance imaging; the latter was the most significant prognostic factor (odds ratio, 29.11; P < 0.001).

Conclusions: We found that the distribution patterns for all patients mainly involved the medulla oblongata, spinal anterior nerve roots, thoracic segments, and brain or spinal meninges. Our findings suggested that patients with lesions located in the medulla oblongata and spinal cord may be closely monitored for early intervention and meticulous management. For children with the symptom of nervous system, they are strongly recommended for magnetic resonance examination.

FIGURE 1

Cases involving different sites on MRI.

FIGURE 2

A 23-month-old girl having EV71 with poor prognosis. A, T1WI shows remarkable bilateral hypointense signal on the posterior portion of medulla oblongata (arrows). B, T2WI demonstrates high signal intensity (arrows). The lesions were obscure on FLAIR (C) and showed slight enhancement on contrast-enhanced T1WI (D).

FIGURE 3

A 26-month-old boy having EV71 with good prognosis. Initial FLAIR (A) reveals symmetrical hyperintense signal on the midbrain (arrows); after 6-month follow-up, the lesions had disappeared (B).

FIGURE 4

A 16-month-old boy having EV71 with poor prognosis. He manifested decreased muscle strength in his bilateral lower limbs in the follow-up. A, Sagittal T2WI reveals high signal intensity in the inferior thoracic segments (arrows). B, T1WI demonstrates slightly low signal intensity (arrows). Axial images showed hyperintense symmetrical lesions in the anterior horn regions on T2WI (C) and T1WI (D).

FIGURE 5

A 19-month-old boy having EV71 with good prognosis. He manifested bilateral lower limb weakness during hospitalization. Initial image (A) showed bilateral spinal anterior nerve roots enhancement (arrows); after 8-month follow-up, the lesions had disappeared (B), and the symptom also disappeared.

FIGURE 6

A 2-year-old boy having EV71. There are extensive lesions in the occipital cortex and the subcortical white matter on T2WI (A), which were difficult to identify on T1WI (B) and FLAIR (C), and contrast-enhanced transverse T1WI showed no enhancement (D).