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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 6-month-old girl without significant neurologic sequelae.A. ADC map of diffusion imaging shows that the thalamic lesions have a concentric appearance. They have high-signal centers with low-signal rims (arrows), and the ADC values of their remaining portion are high.B. Initial proton MR spectrogram (STEAM 3000/30) of a lesion shows a small lactate peak (arrow). The N-acetyl aspartate peak is within the normal range.C. Follow-up proton MR spectrogram (STEAM 3000/30) obtained one week later shows no lactate peak (arrow). The N-acetyl aspartate peak shows no interval change and is still within the normal range.Note.-NAA=N-acetyl aspartate
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Figure 2: A 6-month-old girl without significant neurologic sequelae.A. ADC map of diffusion imaging shows that the thalamic lesions have a concentric appearance. They have high-signal centers with low-signal rims (arrows), and the ADC values of their remaining portion are high.B. Initial proton MR spectrogram (STEAM 3000/30) of a lesion shows a small lactate peak (arrow). The N-acetyl aspartate peak is within the normal range.C. Follow-up proton MR spectrogram (STEAM 3000/30) obtained one week later shows no lactate peak (arrow). The N-acetyl aspartate peak shows no interval change and is still within the normal range.Note.-NAA=N-acetyl aspartate

Mentions: Conventional brain MR imaging performed on the second day of hospitalization indicated that symmetric T1- and T2-prolonged areas were present in the thalami and external capsules. T2*-weighted gradient-echo images clearly showed that within the thalamic lesions, acute hemorrhage had occurred. After the intravenous administration of gadolinium-diethylene triamine penta-acetic acid, the lesions showed no abnormal enhancement and ADC mapping revealed areas of low signal intensity within them (Fig. 2A). Localized proton MR spectroscopy using a stimulated echo-acquisition mode sequence (TR/TE=3000/30, 96 acquisitions, volume of interest=7 mL) showed a small doublet at 1.33 ppm (Fig. 2B).


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 6-month-old girl without significant neurologic sequelae.A. ADC map of diffusion imaging shows that the thalamic lesions have a concentric appearance. They have high-signal centers with low-signal rims (arrows), and the ADC values of their remaining portion are high.B. Initial proton MR spectrogram (STEAM 3000/30) of a lesion shows a small lactate peak (arrow). The N-acetyl aspartate peak is within the normal range.C. Follow-up proton MR spectrogram (STEAM 3000/30) obtained one week later shows no lactate peak (arrow). The N-acetyl aspartate peak shows no interval change and is still within the normal range.Note.-NAA=N-acetyl aspartate
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698060&req=5

Figure 2: A 6-month-old girl without significant neurologic sequelae.A. ADC map of diffusion imaging shows that the thalamic lesions have a concentric appearance. They have high-signal centers with low-signal rims (arrows), and the ADC values of their remaining portion are high.B. Initial proton MR spectrogram (STEAM 3000/30) of a lesion shows a small lactate peak (arrow). The N-acetyl aspartate peak is within the normal range.C. Follow-up proton MR spectrogram (STEAM 3000/30) obtained one week later shows no lactate peak (arrow). The N-acetyl aspartate peak shows no interval change and is still within the normal range.Note.-NAA=N-acetyl aspartate
Mentions: Conventional brain MR imaging performed on the second day of hospitalization indicated that symmetric T1- and T2-prolonged areas were present in the thalami and external capsules. T2*-weighted gradient-echo images clearly showed that within the thalamic lesions, acute hemorrhage had occurred. After the intravenous administration of gadolinium-diethylene triamine penta-acetic acid, the lesions showed no abnormal enhancement and ADC mapping revealed areas of low signal intensity within them (Fig. 2A). Localized proton MR spectroscopy using a stimulated echo-acquisition mode sequence (TR/TE=3000/30, 96 acquisitions, volume of interest=7 mL) showed a small doublet at 1.33 ppm (Fig. 2B).

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