Radionuclide Brain Scintigraphy of Enterovirus Type 71-Induced Cerebral Ventriculitis

Abstract

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.