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MRI findings in osmotic myelinolysis
1Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Republic of Singapore. cgc99@hotmail.com
Objectives:
Osmotic myelinolysis is a distinctive clinical syndrome with characteristic CT and MR features. This study was undertaken to determine the MR appearance of these lesions on T1 and T2-weighted, and diffusion-weighted imaging (DWI) sequences with apparent diffusion coefficient (ADC) mapping.
Materials And Methods:
We describe six patients who presented with deranged serum sodium levels and subsequently developed osmotic myelinolysis. CT and MRI scans were retrospectively reviewed, including the advanced functional MR sequence of DWI with ADC mapping.
Results:
Both cerebral white matter and pontine lesions were typically hypo and hyper-intense on T1 and T2W sequences respectively. Lesions were mildly hyperintense on isotropic DWI images with elevation of the ADC.
Conclusion:
MRI is superior to CT in depicting lesions in osmotic myelinolysis. DWI with ADC mapping suggests that osmotic myelinolysis is not simply a demyelinating disorder but has similarities to multiple sclerosis.
Insights
Osmotic myelinolysis lesions are best visualized with MRI, particularly diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping. This advanced imaging suggests the condition shares similarities with multiple sclerosis.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Osmotic myelinolysis is a neurological syndrome characterized by specific CT and MR imaging findings.
- It is often associated with electrolyte imbalances, particularly rapid correction of hyponatremia.
Purpose of the Study:
- To evaluate the MR imaging appearance of osmotic myelinolysis lesions.
- To assess the utility of T1-weighted, T2-weighted, and diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping.
Main Methods:
- Retrospective review of CT and MRI scans from six patients with osmotic myelinolysis.
- Inclusion of advanced functional MR sequences: DWI with ADC mapping.
Main Results:
- Pontine and cerebral white matter lesions appeared hypo-intense on T1W and hyper-intense on T2W sequences.
- Lesions showed mild hyperintensity on isotropic DWI with elevated ADC values.
Conclusions:
- MRI significantly outperforms CT in visualizing osmotic myelinolysis lesions.
- DWI with ADC mapping indicates osmotic myelinolysis may share characteristics with multiple sclerosis, suggesting a complex pathophysiology beyond simple demyelination.