Abstract
Introduction
Acute disseminated encephalomyelitis (ADEM) is usually a monophasic illness characterized by multiple lesions involving gray and white matter. Quantitative MR techniques were used to characterize and stage these lesions.
Methods
Eight patients (seven males and one female; mean age 19 years, range 5 to 36 years) were studied using conventional MRI (T2- and T1-weighted and FLAIR sequences), diffusion-weighted imaging (DWI) and proton magnetic resonance spectroscopy (MRS). Apparent diffusion coefficient (ADC) values and MRS ratios were calculated for the lesion and for normal-appearing white matter (NAWM). Three patients were imaged in the acute stage (within 7 days of the onset of neurological symptoms) and five in the subacute stage (after 7 days from the onset of symptoms).
Results
ADC values in NAWM were in the range 0.7–1.24×10−3 mm/s2 (mean 0.937 ± 0.17 mm/s2). ADC values of ADEM lesions in the acute stage were in the range 0.37–0.68×10−3 mm/s2 (mean 0.56 ± 0.16 mm/s2) and 1.01–1.31×10−3 mm/s2 (mean 1.24 ± 0.13 mm/s2) in the subacute stage. MRS ratios were obtained for all patients. NAA/Cho ratios were in the range 1.1–3.5 (mean 1.93 ± 0.86) in the NAWM. NAA/Cho ratios within ADEM lesions in the acute stage were in the range 0.63–1.48 (mean 1.18 ± 0.48) and 0.29–0.84 (mean 0.49 ± 0.22) in the subacute stage. The ADC values, NAA/Cho and Cho/Cr ratios were significantly different between lesions in the acute and subacute stages (P < 0.001, P < 0.027, P < 0.047, respectively). ADC values were significantly different between lesions in the acute (P < 0.009) and subacute stages (P < 0.005) with NAWM. In addition, NAA/Cho and Cho/Cr ratios were significantly different between lesions in the subacute stage and NAWM (P < 0.006, P < 0.007, respectively).
Conclusion
ADEM lesions were characterized in the acute stage by restricted diffusion and in the subacute stage by free diffusion and a decrease in NAA/Cho ratios. Restricted diffusion and progressive decrease in NAA/Cho ratios may help in staging the disease.
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Acknowledgements
The authors wish to acknowledge Dr. D.K. Thennarasu, Associate Professor, Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Balasubramanya, K.S., Kovoor, J.M.E., Jayakumar, P.N. et al. Diffusion-weighted imaging and proton MR spectroscopy in the characterization of acute disseminated encephalomyelitis. Neuroradiology 49, 177–183 (2007). https://doi.org/10.1007/s00234-006-0164-2
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DOI: https://doi.org/10.1007/s00234-006-0164-2