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Patterns in early diffusion-weighted MRI in children with haemolytic uraemic syndrome and CNS involvement
Frank Donnerstag1, Xiaoqi Ding, Lars Pape
1Institute of Diagnostic and Therapeutic Neuroradiology, Hannover Medical School, 30623 Hannover, Germany. donnerstag.frank@mh-hannover.de
Insights
Diffusion-weighted imaging (DWI) can detect early central nervous system (CNS) involvement in children with diarrhoea-associated haemolytic uraemic syndrome (D+HUS). However, early MRI findings do not predict the clinical course or outcome in these patients.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Nephrology
Background:
- Diarrhoea-associated haemolytic uraemic syndrome (D+HUS) can lead to severe neurological complications.
- Cerebral involvement in D+HUS is associated with significant morbidity and mortality.
- Early detection of central nervous system (CNS) involvement is crucial for management.
Purpose of the Study:
- To evaluate the utility of diffusion-weighted imaging (DWI) in detecting early cerebral involvement in children with D+HUS.
- To correlate DWI findings with clinical and laboratory parameters.
- To assess the predictive value of early MRI findings on neurological outcome.
Main Methods:
- Retrospective evaluation of DWI in children with D+HUS and neurological symptoms.
- DWI performed within 24 hours of neurological symptom onset.
- Apparent diffusion coefficient (ADC) measurement in grey/white matter and correlation with clinical data.
Main Results:
- DWI revealed abnormalities in all evaluated patients.
- Abnormal ADC was observed in the supratentorial white matter, cortex, basal ganglia, thalami, and cerebellum.
- ADC values showed varied changes (reduced, increased, or both), and findings did not correlate with neurological outcome.
Conclusions:
- Early DWI can detect CNS involvement in D+HUS, extending beyond the basal ganglia to include white matter and cortex.
- Pathogenetical mechanisms may involve thrombotic microangiopathy, shiga toxin effects, azotaemia, and hyponatremia/hypoosmolality.
- Early MRI findings in D+HUS do not reliably predict clinical course or patient outcome.
Objectives:
Diffusion-weighted imaging (DWI) in children with diarrhoea associated haemolytic uraemic syndrome (D+HUS) and cerebral involvement was evaluated retrospectively.
Methods:
DWI within 24 h of onset of neurological symptoms. The apparent diffusion coefficient (ADC) was measured in grey/white matter and correlated with clinical and laboratory findings.
Results:
DWI was abnormal in all. Abnormal ADC was detected in the supratentorial white matter (6/12) and cortex (1/12), the basal ganglia (5/12), the thalami (4/12), and the cerebellum (1/12). ADC was reduced in 5/12, increased in 4/12, and both in 3/12. Mean serum sodium was lower in patients with DWI abnormalities affecting the white matter (6/12), than in those with basal ganglia/thalamic involvement (6/12). Neurological outcome was normal in 4/11 and abnormal in 7/11, and 1 patient died, outcome did not correlate to either localisation or type of DWI abnormality.
Conclusions:
In D+HUS with neurological symptoms, early DWI may reveal abnormal ADC not only in the basal ganglia/thalami, but also in the white matter/cortex. Besides thrombotic microangiopathy, toxic effects of shiga toxin, azotaemia and hyponatraemia / hypoosmolality may be involved in cerebral involvement in children with D+HUS. Findings on early MRI seem not to predict clinical course or outcome.
Key Points:
• DWI MR imaging may detect early CNS involvement in haemolytic uraemic syndrome • Different pathogenetical mechanisms may contribute to the CNS disease in HUS • Early MRI findings do not seem to allow prediction of clinical outcome.
