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Diffusion-weighted imaging in acute demyelinating myelopathy
Chiara Zecca1, Carlo Cereda, Stephan Wetzel
1Servizio di Neurologia e Neuroradiologia, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, via Tesserete 46, 6903, Lugano, Switzerland. chiara.zecca@eoc.ch
Introduction:
Diffusion-weighted imaging (DWI) has become a reference MRI technique for the evaluation of neurological disorders. Few publications have investigated the application of DWI for inflammatory demyelinating lesions. The purpose of the study was to describe diffusion-weighted imaging characteristics of acute, spinal demyelinating lesions.
Methods:
Six consecutive patients (two males, four females; aged 28-64 years) with acute spinal cord demyelinating lesions were studied in a prospective case series design from June 2009 to October 2010. We performed magnetic resonance imaging studies from 2 to 14 days from symptom onset on the patients with relapsing remitting multiple sclerosis (n = 3) or clinically isolated syndrome (n = 3). Main outcome measures were diffusion-weighted imaging and apparent diffusion coefficient pattern (ADC) of acute spinal cord demyelinating lesions.
Results:
All spinal lesions showed a restricted diffusion pattern (DWI+/ADC-) with a 24% median ADC signal decrease. A good correlation between clinical presentation and lesion site was observed.
Conclusion:
Acute demyelinating spinal cord lesions show a uniform restricted diffusion pattern. Clinicians and neuro-radiologists should be aware that this pattern is not necessarily confirmatory for an ischaemic aetiology.
Insights
Diffusion-weighted imaging reveals a consistent restricted diffusion pattern in acute spinal cord demyelinating lesions. This finding is crucial for differentiating these lesions from ischemic conditions in clinical practice.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Diffusion-weighted imaging (DWI) is a key MRI technique for neurological disorders.
- Limited research exists on DWI for inflammatory demyelinating lesions.
- Spinal cord demyelination evaluation requires further investigation.
Purpose of the Study:
- To characterize the diffusion-weighted imaging features of acute spinal demyelinating lesions.
- To assess the utility of DWI in diagnosing spinal cord inflammatory conditions.
Main Methods:
- Prospective case series of six patients with acute spinal cord demyelinating lesions.
- MRI studies performed 2-14 days post-symptom onset.
- Analysis of diffusion-weighted imaging and apparent diffusion coefficient (ADC) patterns.
Main Results:
- All spinal lesions exhibited a restricted diffusion pattern (DWI+/ADC-).
- A median ADC signal decrease of 24% was observed.
- Correlation found between clinical presentation and lesion location.
Conclusions:
- Acute spinal demyelinating lesions demonstrate a uniform restricted diffusion pattern on DWI.
- This pattern can mimic ischemic lesions, requiring careful interpretation.
- Neuro-radiologists should consider inflammatory causes when observing restricted diffusion in spinal lesions.
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