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MR imaging with quantitative diffusion mapping of tacrolimus-induced neurotoxicity in organ transplant patients
Taro Shimono1, Yukio Miki, Hiroshi Toyoda
1Department of Nuclear Medicine and Radiology, Faculty of Medicine, Kyoto University, 54 Shogoinkawahara-cho Sakyo-ku, Kyoto 606-8507, Japan. shimono@kuhp.kyoto-u.ac.jp
Abstract:
Our objective was to investigate brain MR imaging findings and the utility of diffusion-weighted (DW) imaging in organ transplant patients who developed neurologic symptoms during tacrolimus therapy. Brain MR studies, including DW imaging, were prospectively performed in 14 organ transplant patients receiving tacrolimus who developed neurologic complications. In each patient who had abnormalities on the initial MR study, a follow-up MR study was performed 1 month later. Apparent diffusion coefficient (ADC) values on the initial MR study were correlated with reversibility of the lesions. Of the 14 patients, 5 (35.7%) had white matter abnormalities, 1 (7.1%) had putaminal hemorrhage, and 8 (57.1%) had normal findings on initial MR images. Among the 5 patients with white matter abnormalities, 4 patients (80.0%) showed higher than normal ADC values on initial MR images, and all showed complete resolution on follow-up images. The remaining 1 patient (20.0%) showed lower than normal ADC value and showed incomplete resolution with cortical laminar necrosis. Diffusion-weighted imaging may be useful in predicting the outcomes of the lesions of tacrolimus-induced neurotoxicity.
Insights
Diffusion-weighted imaging (DWI) helps predict outcomes for organ transplant patients experiencing neurologic symptoms from tacrolimus. Higher apparent diffusion coefficient (ADC) values on initial MRI scans indicate reversible white matter lesions.
Area of Science:
- Neurology
- Radiology
- Transplant Medicine
Background:
- Tacrolimus is an immunosuppressant used in organ transplant patients.
- Neurotoxicity is a potential complication of tacrolimus therapy.
- Brain MR imaging is crucial for diagnosing neurologic complications.
Purpose of the Study:
- To investigate brain MR imaging findings in organ transplant patients with neurologic symptoms during tacrolimus therapy.
- To evaluate the utility of diffusion-weighted (DW) imaging in assessing tacrolimus-induced neurotoxicity.
- To correlate apparent diffusion coefficient (ADC) values with lesion reversibility.
Main Methods:
- Prospective brain MR studies, including DW imaging, were performed in 14 organ transplant patients receiving tacrolimus.
- Follow-up MR studies were conducted 1 month later for patients with initial abnormalities.
- Apparent diffusion coefficient (ADC) values were measured and correlated with lesion outcomes.
Main Results:
- Five patients (35.7%) showed white matter abnormalities, one (7.1%) had putaminal hemorrhage, and eight (57.1%) had normal initial MR images.
- Of the five with white matter abnormalities, four (80.0%) had higher than normal ADC values and showed complete resolution.
- One patient (20.0%) with white matter abnormalities had lower than normal ADC values, incomplete resolution, and cortical laminar necrosis.
Conclusions:
- Diffusion-weighted imaging (DWI) shows promise in predicting the outcomes of tacrolimus-induced neurotoxicity lesions.
- Higher ADC values on initial MRIs may indicate reversible white matter lesions.
- DWI can aid in managing neurologic complications in organ transplant recipients on tacrolimus.