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Acute necrotizing encephalopathy: diffusion MR imaging and localized proton MR spectroscopic findings in two infants
Hyun Woo Goo1, Choong-Gon Choi, Chong Hyun Yoon
1Department 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.
Insights
Diffusion MRI and proton MR spectroscopy reveal key differences in brain damage severity for infants with acute necrotizing encephalopathy. These imaging techniques may help predict patient outcomes.
Area of Science:
- Neurology
- Radiology
- Pediatric Imaging
Background:
- Acute necrotizing encephalopathy (ANE) is a rare but severe neurological disorder affecting infants.
- Characteristic symmetrical thalamic involvement is often observed in ANE.
- Understanding the neuroimaging features of ANE is crucial for diagnosis and prognosis.
Observation:
- Two infants with ANE presented with symmetrical thalamic lesions.
- Diffusion MR imaging (dMRI) revealed apparent diffusion coefficient (ADC) decreases in the affected thalami.
- Proton MR spectroscopy (MRS) was used to analyze biochemical changes in the brain.
Findings:
- The first patient, with more severe brain damage and poorer outcome, showed a more prominent ADC decrease on dMRI compared to the second patient.
- Proton MRS detected elevated glutamate/glutamine complex and mobile lipids in the first patient.
- The second patient exhibited only a minor increase in lactate on proton MRS.
Implications:
- Diffusion MR imaging and proton MR spectroscopy can aid in diagnosing ANE.
- These advanced neuroimaging techniques may help assess the severity of brain damage in ANE.
- The findings suggest that dMRI and MRS can be valuable tools for predicting clinical outcomes in infants with ANE.