Uremic Encephalopathy: MR Imaging Findings and Clinical Correlation

Area of Science:

• Nephrology
• Neurology
• Radiology

Background:

• Uremic encephalopathy is a metabolic disorder associated with renal failure.
• It presents with characteristic neurological symptoms due to the accumulation of uremic toxins.

Purpose of the Study:

• To describe the magnetic resonance (MR) imaging findings in patients with uremic encephalopathy.
• To identify imaging biomarkers for early diagnosis and monitoring of the condition.

Main Methods:

• Retrospective review of MR imaging in 10 patients with clinically diagnosed uremic encephalopathy.
• Evaluation of lesion location, signal intensity on various MR sequences (T1WI, T2WI, FLAIR, DWI, ADC), and diffusion characteristics.
• Assessment of lesion reversibility on follow-up imaging after treatment.

Main Results:

• MR imaging abnormalities were observed in all 10 patients with elevated serum creatinine.
• Expansile bilateral basal ganglia lesions with high signal intensity on T2WI (lentiform fork sign) were noted in 9 patients.
• Cortical lesions were seen in 1 patient with acute renal failure; all lesions showed high signal intensity on T2WI and some exhibited restricted diffusion.
• Complete resolution of lesions was observed in 4 patients after hemodialysis.

Conclusions:

• The lentiform fork sign on T2WI is a reliable indicator for the early diagnosis of uremic encephalopathy.
• MR imaging findings, including cytotoxic and/or vasogenic edema on DWI/ADC maps, may be associated with uremic encephalopathy.
• Reversibility of MR imaging abnormalities after hemodialysis suggests the potential for therapeutic intervention.