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Similarities and differences of MR findings between Japanese encephalitis and Wilson's disease
Manash Saha1, Sunil Kumar, Ashish Das
1Department of Radiodiagnosis, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, India.
Abstract:
Although Japanese Encephalitis (JE) and Wilson's disease (WD) are different entities, MR findings in both these conditions are quite similar. The purpose of this retrospective study was to find out the similarities and differences between JE and WD on MR imaging. The study group comprised 25 proven cases of JE and 10 cases of WD. Spin echo (SE) TI- and T2-weighted imaging was performed on a 1.5-T MR system. Fourteen of these 35 cases (10 JE, 4 WD) were also examined using T1-weighted magnetization transfer (MT) SE sequence before and after contrast administration. Although both JE and WD showed similar topographical distribution of lesions, predominant involvement of the basal ganglia and thalami, there were some differences. Brain stem lesion was more frequent for WD than for JE, and posteromedial part of the thalami was spared in WD. The lesion characteristics were also different between both; in WD mixed intensity in the basal ganglia and hyperintense linear rim at the peripheral putamen was observed frequently, whereas hyperintense basal ganglia on T2-weighted images, subacute hemorrhage in the thalami and meningeal enhancement were seen only in the patients with JE. These characteristic lesion criteria may help in differentiation of JE from WD on MR imaging.
Insights
Magnetic Resonance (MR) imaging can differentiate Japanese Encephalitis (JE) from Wilson's disease (WD) despite similar lesion patterns. Key differences in brain stem, thalamic, and basal ganglia involvement aid in diagnosis.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Japanese Encephalitis (JE) and Wilson's disease (WD) are distinct neurological conditions.
- Both JE and WD can present with overlapping findings on Magnetic Resonance (MR) imaging, posing diagnostic challenges.
Purpose of the Study:
- To identify similarities and differences in MR imaging findings between JE and WD.
- To establish characteristic MR imaging criteria for differentiating JE from WD.
Main Methods:
- Retrospective study of 25 confirmed JE cases and 10 confirmed WD cases.
- Utilized Spin Echo (SE) T1- and T2-weighted imaging on a 1.5-T MR system.
- Included T1-weighted magnetization transfer (MT) SE sequences in a subset of patients before and after contrast administration.
Main Results:
- Both conditions showed predominant basal ganglia and thalamic involvement.
- WD cases more frequently exhibited brain stem lesions, with spared posteromedial thalami.
- JE cases showed hyperintense basal ganglia on T2-weighted images, thalamic hemorrhage, and meningeal enhancement; WD showed mixed basal ganglia intensity and peripheral putaminal rim enhancement.
Conclusions:
- Distinct MR imaging features can help differentiate JE from WD.
- Characteristic lesion patterns, including brain stem, thalamic, and basal ganglia appearances, are crucial for diagnosis.