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Acute necrotizing encephalopathy: diffusion MR imaging and localized proton MR spectroscopic findings in two infants.

Goo HW, Choi CG, Yoon CH, Ko TS - Korean J Radiol (2003 Jan-Mar)

Bottom Line: In this report, we describe the findings of diffusion MR imaging and proton MR spectroscopy in two infants with acute necrotizing encephalopathy in which there was characteristic symmetrical involvement of the thalami.Diffusion MR images of the lesions showed that the observed apparent diffusion coefficient (ADC) decrease was more prominent in the first patient, who had more severe brain damage and a poorer clinical outcome, than in the second.Proton MR spectroscopy detected an increase in the glutamate/glutamine complex and mobile lipids in the first case but only a small increase of lactate in the second.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
In this report, we describe the findings of diffusion MR imaging and proton MR spectroscopy in two infants with acute necrotizing encephalopathy in which there was characteristic symmetrical involvement of the thalami. Diffusion MR images of the lesions showed that the observed apparent diffusion coefficient (ADC) decrease was more prominent in the first patient, who had more severe brain damage and a poorer clinical outcome, than in the second. Proton MR spectroscopy detected an increase in the glutamate/glutamine complex and mobile lipids in the first case but only a small increase of lactate in the second. Diffusion MR imaging and proton MR spectroscopy may provide useful information not only for diagnosis but also for estimating the severity and clinical outcome of acute necrotizing encephalopathy.

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Related in: MedlinePlus

A 10-month-old boy with sequelae of severe motor deficit.A. Axial fast spin-echo T2-weighted MR image (TR/TE=3500/120) shows symmetric high signal intensity in the bilateral thalami.B. Axial T2*-weighted gradient-echo MR image (TR/TE=800/30, flip angle = 20°) at the same level as A shows conspicuous low signal intensity within the thalamic lesions, possibly due to the presence there of acute petechial hemorrhage.C. Apparent diffusion coefficient (ADC) map of diffusion imaging reveals low ADC in the thalamic lesions (arrows), which may represent the presence of cytotoxic edema. In the central portion of the lesions, however, ADC is high, suggesting tissue necrosis.D. Short echo-time proton MR spectrogram (STEAM 3000/30) of a thalamic lesion shows increased glutamate/glutamine complex peak intensities at 2.0-2.5 ppm and lipid/lactate complex peak intensities at 0.8-1.5 ppm, as compared with an age-matched control subject (E). Broadening of the line-width may be caused by the occurrence of petechial hemorrhage within the lesion.E. Short echo-time proton MR spectrogram (STEAM 3000/30) of normal thalamus in a 9-month-old age-matched control subject.Note.-Ins=myoinositol, Cho=choline compound, tCr=creatine complex, Glx=glutamate/glutamine complex, NAA=N-acetyl aspartate
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Figure 1: A 10-month-old boy with sequelae of severe motor deficit.A. Axial fast spin-echo T2-weighted MR image (TR/TE=3500/120) shows symmetric high signal intensity in the bilateral thalami.B. Axial T2*-weighted gradient-echo MR image (TR/TE=800/30, flip angle = 20°) at the same level as A shows conspicuous low signal intensity within the thalamic lesions, possibly due to the presence there of acute petechial hemorrhage.C. Apparent diffusion coefficient (ADC) map of diffusion imaging reveals low ADC in the thalamic lesions (arrows), which may represent the presence of cytotoxic edema. In the central portion of the lesions, however, ADC is high, suggesting tissue necrosis.D. Short echo-time proton MR spectrogram (STEAM 3000/30) of a thalamic lesion shows increased glutamate/glutamine complex peak intensities at 2.0-2.5 ppm and lipid/lactate complex peak intensities at 0.8-1.5 ppm, as compared with an age-matched control subject (E). Broadening of the line-width may be caused by the occurrence of petechial hemorrhage within the lesion.E. Short echo-time proton MR spectrogram (STEAM 3000/30) of normal thalamus in a 9-month-old age-matched control subject.Note.-Ins=myoinositol, Cho=choline compound, tCr=creatine complex, Glx=glutamate/glutamine complex, NAA=N-acetyl aspartate

Mentions: Conventional brain MR images obtained using a 1.5-T system on the second day of hospitalization depicted symmetric distribution of T1- and T2-prolonged areas in the thalami (Fig. 1A), tegmentum of the pons, and periventricular white matter. T2*-weighted gradient-echo images (TR/TE = 800/30, flip angle = 20°) demonstrated low signal intensities within the thalamic lesions, suggesting acute hemorrhage (Fig. 1B). After the intravenous administration of gadolinium-diethylene triamine penta-acetic acid, the lesions showed no abnormal enhancement. Diffusion-weighted MR imaging (b value=1000 sec/mm2) demonstrated high signal intensity in all the lesions, though this was absent in the central portion of thalamic lesions, and other than in this same area, apparent diffusion coefficient (ADC) mapping revealed low signal intensity (Fig. 1C). Localized proton MR spectroscopy of the thalami using a stimulated echo-acquisition mode sequence (TR/TE=3000/30, 96 acquisitions, volume of interest=7 mL) showed that compared with an age-matched control subject, peak intensities were higher, occurring at 2.0-2.5 and 0.8-1.5 ppm (Figs. 1D, E).


Acute necrotizing encephalopathy: diffusion MR imaging and localized proton MR spectroscopic findings in two infants.

Goo HW, Choi CG, Yoon CH, Ko TS - Korean J Radiol (2003 Jan-Mar)

A 10-month-old boy with sequelae of severe motor deficit.A. Axial fast spin-echo T2-weighted MR image (TR/TE=3500/120) shows symmetric high signal intensity in the bilateral thalami.B. Axial T2*-weighted gradient-echo MR image (TR/TE=800/30, flip angle = 20°) at the same level as A shows conspicuous low signal intensity within the thalamic lesions, possibly due to the presence there of acute petechial hemorrhage.C. Apparent diffusion coefficient (ADC) map of diffusion imaging reveals low ADC in the thalamic lesions (arrows), which may represent the presence of cytotoxic edema. In the central portion of the lesions, however, ADC is high, suggesting tissue necrosis.D. Short echo-time proton MR spectrogram (STEAM 3000/30) of a thalamic lesion shows increased glutamate/glutamine complex peak intensities at 2.0-2.5 ppm and lipid/lactate complex peak intensities at 0.8-1.5 ppm, as compared with an age-matched control subject (E). Broadening of the line-width may be caused by the occurrence of petechial hemorrhage within the lesion.E. Short echo-time proton MR spectrogram (STEAM 3000/30) of normal thalamus in a 9-month-old age-matched control subject.Note.-Ins=myoinositol, Cho=choline compound, tCr=creatine complex, Glx=glutamate/glutamine complex, NAA=N-acetyl aspartate
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Figure 1: A 10-month-old boy with sequelae of severe motor deficit.A. Axial fast spin-echo T2-weighted MR image (TR/TE=3500/120) shows symmetric high signal intensity in the bilateral thalami.B. Axial T2*-weighted gradient-echo MR image (TR/TE=800/30, flip angle = 20°) at the same level as A shows conspicuous low signal intensity within the thalamic lesions, possibly due to the presence there of acute petechial hemorrhage.C. Apparent diffusion coefficient (ADC) map of diffusion imaging reveals low ADC in the thalamic lesions (arrows), which may represent the presence of cytotoxic edema. In the central portion of the lesions, however, ADC is high, suggesting tissue necrosis.D. Short echo-time proton MR spectrogram (STEAM 3000/30) of a thalamic lesion shows increased glutamate/glutamine complex peak intensities at 2.0-2.5 ppm and lipid/lactate complex peak intensities at 0.8-1.5 ppm, as compared with an age-matched control subject (E). Broadening of the line-width may be caused by the occurrence of petechial hemorrhage within the lesion.E. Short echo-time proton MR spectrogram (STEAM 3000/30) of normal thalamus in a 9-month-old age-matched control subject.Note.-Ins=myoinositol, Cho=choline compound, tCr=creatine complex, Glx=glutamate/glutamine complex, NAA=N-acetyl aspartate
Mentions: Conventional brain MR images obtained using a 1.5-T system on the second day of hospitalization depicted symmetric distribution of T1- and T2-prolonged areas in the thalami (Fig. 1A), tegmentum of the pons, and periventricular white matter. T2*-weighted gradient-echo images (TR/TE = 800/30, flip angle = 20°) demonstrated low signal intensities within the thalamic lesions, suggesting acute hemorrhage (Fig. 1B). After the intravenous administration of gadolinium-diethylene triamine penta-acetic acid, the lesions showed no abnormal enhancement. Diffusion-weighted MR imaging (b value=1000 sec/mm2) demonstrated high signal intensity in all the lesions, though this was absent in the central portion of thalamic lesions, and other than in this same area, apparent diffusion coefficient (ADC) mapping revealed low signal intensity (Fig. 1C). Localized proton MR spectroscopy of the thalami using a stimulated echo-acquisition mode sequence (TR/TE=3000/30, 96 acquisitions, volume of interest=7 mL) showed that compared with an age-matched control subject, peak intensities were higher, occurring at 2.0-2.5 and 0.8-1.5 ppm (Figs. 1D, E).

Bottom Line: In this report, we describe the findings of diffusion MR imaging and proton MR spectroscopy in two infants with acute necrotizing encephalopathy in which there was characteristic symmetrical involvement of the thalami.Diffusion MR images of the lesions showed that the observed apparent diffusion coefficient (ADC) decrease was more prominent in the first patient, who had more severe brain damage and a poorer clinical outcome, than in the second.Proton MR spectroscopy detected an increase in the glutamate/glutamine complex and mobile lipids in the first case but only a small increase of lactate in the second.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
In this report, we describe the findings of diffusion MR imaging and proton MR spectroscopy in two infants with acute necrotizing encephalopathy in which there was characteristic symmetrical involvement of the thalami. Diffusion MR images of the lesions showed that the observed apparent diffusion coefficient (ADC) decrease was more prominent in the first patient, who had more severe brain damage and a poorer clinical outcome, than in the second. Proton MR spectroscopy detected an increase in the glutamate/glutamine complex and mobile lipids in the first case but only a small increase of lactate in the second. Diffusion MR imaging and proton MR spectroscopy may provide useful information not only for diagnosis but also for estimating the severity and clinical outcome of acute necrotizing encephalopathy.

Show MeSH
Related in: MedlinePlus