Arterial spin-labeling perfusion imaging of childhood encephalitis: correlation with seizure and clinical outcome
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Magnetic Resonance Imaging Quantification of Pulmonary Perfusion using Calibrated Arterial Spin Labeling
Published on: May 30, 2011
Alex Mun-Ching Wong1, Chih-Hua Yeh2, Jainn-Jim Lin3
1Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung/Linkou, and Chang Gung University, 5 Fu-Hsing Street, Taoyuan, 333, Taiwan. alexmcwchop@yahoo.com.
Purpose:
In childhood encephalitis, perfusion abnormalities have been infrequently reported to associate with clinical status. We investigated whether perfusion abnormalities correlated with seizure and clinical outcome in encephalitis.
Methods:
We retrospectively analyzed the MR studies of 77 pediatric patients with encephalitis. Pseudo-continuous arterial spin-labeling (ASL) imaging was performed on a 3-T scanner. The patients were divided into five groups according to ASL perfusion imaging pattern: normal perfusion (NP), focal hypoperfusion (Lf), extreme global hypoperfusion (LE), focal hyperperfusion (Hf), and extreme global hyperperfusion (HE). Clinical outcome at 3 weeks was dichotomized to unfavorable or favorable outcome according to the Glasgow outcome scale. Multivariate logistic regression was conducted to predict unfavorable outcome and presence of seizure separately, based on explanatory variables including age, sex, and ASL pattern.
Results:
Twenty-seven (35%) patients were designated as in group Hf, five (7%) in group Lf, 11 (14%) in group LE, none in group HE, and 34 (44%) in group NP. Multivariate logistic regression analysis showed that ASL pattern was significantly associated with unfavorable outcome (P = 0.005) and with presence of seizure (P = 0.005). For ASL pattern, group LE was 17.31 times as likely to have an unfavorable outcome as group NP (odds ratio confidence interval [CI] 3.084, 97.105; P = 0.001). Group Hf was 6.383 times as likely to have seizure as group NP (CI 1.765, 23.083; P = 0.005).
Conclusions:
In childhood encephalitis, patients with extreme global hypoperfusion had poor neurological outcome and those with focal hypoperfusion were more likely to have seizure.
Insights
In childhood encephalitis, extreme global hypoperfusion indicates poor neurological outcome. Focal hypoperfusion in pediatric patients is linked to a higher likelihood of seizures, impacting overall prognosis.
Area of Science:
- Pediatric neurology
- Neuroimaging
- Medical diagnostics
Background:
- Childhood encephalitis can present with varied clinical outcomes.
- Perfusion abnormalities on imaging are infrequently linked to clinical status in pediatric encephalitis.
- Understanding these correlations is crucial for prognosis and management.
Purpose of the Study:
- To investigate the correlation between perfusion abnormalities and seizure occurrence in pediatric encephalitis.
- To determine if perfusion abnormalities predict clinical outcomes in children with encephalitis.
Main Methods:
- Retrospective analysis of 77 pediatric encephalitis patients' MR studies.
- Pseudo-continuous arterial spin-labeling (ASL) imaging used to assess cerebral blood flow.
- Patients categorized into five groups based on ASL patterns: normal perfusion (NP), focal hypoperfusion (Lf), extreme global hypoperfusion (LE), focal hyperperfusion (Hf), and extreme global hyperperfusion (HE).
- Clinical outcomes assessed at 3 weeks using the Glasgow Outcome Scale; multivariate logistic regression used to analyze associations with ASL patterns, age, and sex.
Main Results:
- 35% of patients showed focal hyperperfusion (Hf), 7% focal hypoperfusion (Lf), 14% extreme global hypoperfusion (LE), and 44% normal perfusion (NP). No patients had extreme global hyperperfusion (HE).
- ASL patterns significantly correlated with unfavorable outcomes (P=0.005) and seizure presence (P=0.005).
- Extreme global hypoperfusion (LE) was associated with a 17.31-fold increased likelihood of unfavorable outcome compared to normal perfusion (P=0.001). Focal hyperperfusion (Hf) showed a 6.38-fold increased likelihood of seizure compared to normal perfusion (P=0.005).
Conclusions:
- Extreme global hypoperfusion in pediatric encephalitis is a strong predictor of poor neurological outcomes.
- Focal hypoperfusion patterns in childhood encephalitis are significantly associated with an increased likelihood of seizures.
- ASL imaging provides valuable prognostic information in pediatric encephalitis, aiding in risk stratification.
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