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Diagnoses in Pediatric Patients With Magnetic Resonance Imaging (MRI) Lesions Suspicious for Demyelination
Michael L Sweeney1, Marcia Kukreja2, Paul S Horn3
1Department of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA Michael.Sweeney@cchmc.org.
Insights
Pediatric brain MRI may show white matter lesions concerning for demyelinating disease. Specific lesion locations and patient race can help predict diagnosis in children with acute neurological issues.
Area of Science:
- Neurology
- Pediatric Radiology
- Neuroimaging
Background:
- Brain Magnetic Resonance Imaging (MRI) in children often reveals white matter lesions.
- These lesions can be concerning for primary central nervous system demyelinating diseases.
- Accurate diagnosis is crucial for appropriate management.
Purpose of the Study:
- To determine the proportion of pediatric patients with MRI lesions suggestive of demyelinating disease who are ultimately diagnosed with such a condition.
- To identify clinical and imaging factors associated with a confirmed diagnosis of demyelinating disease.
Main Methods:
- Retrospective chart review of brain MRI reports from a tertiary pediatric hospital.
- Analysis of 299 pediatric patient records.
- Identification of lesion characteristics and patient demographics.
Main Results:
- In patients with acute neurologic complaints (n=192), diagnosis of a treatable disease was associated with ≥ 5 lesions, African American race, and lesions in the brain stem, thalamus, cerebellum, or optic nerves.
- In patients with other MRI indications (n=107), corpus callosum or cerebellar lesions were associated with a diagnosed disease requiring treatment.
Conclusions:
- Specific MRI findings and patient demographics can aid in diagnosing demyelinating diseases in pediatric patients.
- Early identification of concerning lesions assists in timely and appropriate medical intervention.
Abstract:
Magnetic resonance imaging (MRI) studies of the brain in pediatric patients frequently show abnormal white matter lesions, which may be concerning for demyelinating disease. This study aimed to determine the proportion of pediatric patients who have MRI lesions concerning for demyelinating disease at presentation and ultimately are diagnosed with a primary central nervous system demyelinating disease. A retrospective chart review was performed on MRI reports of patients who underwent imaging evaluation at a single tertiary pediatric hospital. Of 299 patients identified, 192 presented with acute neurologic complaints. In this group, ≥ 5 discrete lesions, African American race, and having brain stem, thalamic, cerebellar, or optic nerve lesions was associated with the patient being diagnosed with a disease that required further treatment. The other 107 patients underwent MRI for other indications. Among these subjects, having lesions within the corpus callosum or cerebellum was associated with being diagnosed with a disease requiring further treatment.
