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Published on: September 20, 2015
Diffusion MR imaging of hypoglycemic encephalopathy
1Department of Radiology, Wonkwang University Hospital, Chunbuk, Republic of Korea.
Background And Purpose:
MR imaging features of HE have not been fully established. The purpose of this study was to determine the topographic distribution and DWI findings of HE.
Materials And Methods:
We retrospectively evaluated HE MR imaging (n = 11). The topographic distribution of the lesions was evaluated on routine MR imaging, and DWI SI and ADC values were assessed. The ADC value of involved lesions was compared with the noninvolved subcortical WM area by use of the paired t test.
Results:
MR images demonstrated bilateral diffusion-restrictive lesions in the posterior limb of the IC (n = 6), cerebral cortex (n = 8), CR (n = 7), CS (n = 9), hippocampus (n = 4), and BG (n = 1). The mean ADC value of lesions was 448.82 +/- 92.34 x 10(-6) mm(2)/s compared with the mean ADC value of noninvolved lesions (837.72 +/- 62.14 x 10(-6) mm(2)/s); this difference was statistically significant (P < .000). The lesions showed complete resolution on follow-up DWI for 6 patients. Three patients with cortical involvement of > or = 2 lobes showed partial recovery or death, but most of the other patients with WM involvement or cortical involvement in only 1 lobe experienced complete recovery.
Conclusions:
The topographic localization of the lesions was the posterior limb of the IC, cerebral cortex, CR, CS, hippocampus, and BG. Most HE lesions probably correspond to areas of reversible cytotoxic edema as seen on DWI, which can predict the prognosis of HE according to the degree of lesion extent.
Insights
Hepatic encephalopathy (HE) lesions on MRI show specific patterns in the brain, particularly restricted diffusion on DWI. Lesion extent on diffusion-weighted imaging (DWI) can predict HE patient prognosis.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Magnetic Resonance (MR) imaging features of hepatic encephalopathy (HE) require further elucidation.
- Understanding the precise distribution and diffusion characteristics of HE lesions is crucial for diagnosis and prognosis.
Purpose of the Study:
- To determine the topographic distribution of HE lesions using MR imaging.
- To characterize the diffusion-weighted imaging (DWI) findings in patients with HE.
Main Methods:
- Retrospective analysis of MR imaging in 11 patients with HE.
- Evaluation of lesion distribution on routine MR imaging.
- Assessment of DWI signal intensity (SI) and apparent diffusion coefficient (ADC) values, with comparison to noninvolved white matter (WM).
Main Results:
- Bilateral diffusion-restrictive lesions were observed in the posterior limb of the internal capsule (IC), cerebral cortex, corona radiata (CR), corpus striatum (CS), hippocampus, and basal ganglia (BG).
- Mean ADC values of lesions were significantly lower (448.82 ± 92.34 x 10⁻⁶ mm²/s) compared to noninvolved subcortical WM (837.72 ± 62.14 x 10⁻⁶ mm²/s) (P < .000).
- Complete resolution on follow-up DWI was noted in 6 patients; prognosis varied based on lesion extent, with extensive cortical involvement correlating with poorer outcomes.
Conclusions:
- HE lesions commonly localize to the posterior limb of the IC, cerebral cortex, CR, CS, hippocampus, and BG.
- DWI findings suggest HE lesions represent reversible cytotoxic edema.
- The extent of lesion involvement on DWI can predict the prognosis of HE.
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