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Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
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Change in mean transit time, apparent diffusion coefficient, and cerebral blood volume during pediatric diabetic

Monica S Vavilala1, Ken I Marro, Todd L Richards

  • 1Department of Anesthesiology, University of Washington, Seattle, WA, USA. Vavilala@u.washington.edu

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|April 26, 2011
PubMed

Insights

Cerebral edema in children with diabetic ketoacidosis may involve vasogenic changes. Mean transit time decreased and apparent diffusion coefficient increased during treatment, suggesting altered brain blood flow and water movement.

Area of Science:

  • Pediatric neurology
  • Neuroimaging
  • Endocrinology

Background:

  • Diabetic ketoacidosis (DKA) is a serious complication in children with diabetes.
  • Cerebral edema is a life-threatening consequence of DKA, necessitating better understanding of its pathophysiology.
  • Current understanding of brain changes during DKA treatment is limited.

Purpose of the Study:

  • To investigate potential causes of whole brain and regional brain edema in children undergoing DKA treatment.
  • To analyze changes in mean transit time (MTT), apparent diffusion coefficient (ADC), and relative cerebral blood volume (rCBV) during DKA management.

Main Methods:

  • Prospective observational study conducted at a regional children's hospital.
  • Serial contrast-enhanced and diffusion magnetic resonance imaging (MRI) scans were performed on children with DKA.
  • Measurements of MTT, ADC, and rCBV were taken at two time points (12-24 hrs and 36-72 hrs) after initiating insulin therapy.

Main Results:

  • Thirteen children with DKA were included in the study.
  • Whole brain and regional mean transit time (MTT) significantly decreased by 51% (p = .01) between scans.
  • Whole brain apparent diffusion coefficient (ADC) significantly increased by 4.7% (p = .001).
  • No significant changes were observed in relative cerebral blood volume (rCBV).

Conclusions:

  • The observed decrease in MTT and increase in ADC suggest a vasogenic process during DKA treatment.
  • These findings may indicate changes in brain blood flow and water diffusion related to DKA management.
  • Further research is needed to elucidate the precise mechanisms of cerebral edema in pediatric DKA.
Abstract

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