European Radiology

, Volume 22, Issue 3, pp 506–513

Patterns in early diffusion-weighted MRI in children with haemolytic uraemic syndrome and CNS involvement

  • Frank Donnerstag
  • Xiaoqi Ding
  • Lars Pape
  • Eva Bültmann
  • Thomas Lücke
  • Jan Zajaczek
  • Ludwig Hoy
  • Anibh Martin Das
  • Heinrich Lanfermann
  • Jochen Ehrich
  • Hans Hartmann
Neuro

DOI: 10.1007/s00330-011-2286-0

Cite this article as:
Donnerstag, F., Ding, X., Pape, L. et al. Eur Radiol (2012) 22: 506. doi:10.1007/s00330-011-2286-0

Abstract

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

Keywords

Haemolytic uraemic syndrome Neurological disorders Diffusion weighted MRI Children Outcome 

Supplementary material

330_2011_2286_MOESM1_ESM.pdf (13 kb)
Supplementary 1(PDF 13.1 KB)
330_2011_2286_Fig2_ESM.tif (3.5 mb)
Supplementary Fig 1(TIFF 3.46 MB)
330_2011_2286_Fig3_ESM.tif (4 mb)
Supplementary Fig 2(TIFF 3.97 MB)

Copyright information

© European Society of Radiology 2011

Authors and Affiliations

  • Frank Donnerstag
    • 1
  • Xiaoqi Ding
    • 1
  • Lars Pape
    • 2
  • Eva Bültmann
    • 1
  • Thomas Lücke
    • 2
    • 3
  • Jan Zajaczek
    • 1
  • Ludwig Hoy
    • 4
  • Anibh Martin Das
    • 2
  • Heinrich Lanfermann
    • 1
  • Jochen Ehrich
    • 2
  • Hans Hartmann
    • 2
  1. 1.Institute of Diagnostic and Therapeutic NeuroradiologyHannover Medical SchoolHannoverGermany
  2. 2.Clinic for Pediatric Kidney, Liver and Metabolic DiseasesHannover Medical SchoolHannoverGermany
  3. 3.Department of Neuropediatrics, Pediatric HospitalUniversity of BochumBochumGermany
  4. 4.Institute of BiometricsHannover Medical SchoolHannoverGermany

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