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Neuroradiology

, Volume 56, Issue 8, pp 679–684 | Cite as

Vasogenic edema characterizes pediatric acute disseminated encephalomyelitis

  • Giulio ZuccoliEmail author
  • Ashok Panigrahy
  • Gayathri Sreedher
  • Ariel Bailey
  • Ernest John LaneyIV
  • Luca La Colla
  • Gulay Alper
Paediatric Neuroradiology

Abstract

Introduction

MR imaging criteria for diagnosing acute disseminated encephalomyelitis (ADEM) have not been clearly established. Due to the wide spectrum of differential considerations, new imaging features allowing early and accurate diagnosis for ADEM are needed. We hypothesized that ADEM lesions would be characterized by vasogenic edema due to the potential reversibility of the disease.

Methods

Sixteen patients who met the diagnostic criteria for ADEM proposed by the International Pediatric Multiple Sclerosis Study Group (IPMSSG) and had complete MR imaging studies performed at our institution during the acute phase of the disease were identified retrospectively and evaluated by experienced pediatric neuroradiologists.

Results

Vasogenic edema was demonstrated on diffusion-weighted imaging (DWI) and corresponding apparent diffusion coefficient (ADC) maps in 12 out of 16 patients; cytotoxic edema was identified in two patients while the other two patients displayed no changes on DWI/ADC. ADC values for lesions and normal-appearing brain tissue were 1.39 ± 0.45 × 10−3 and 0.81 ± 0.09 × 10−3 mm/s2, respectively (p = 0.002). When considering a cutoff of 5 days between acute and subacute disease, no difference between ADC values in acute vs. subacute phase was depicted. However, we found a significant correlation and an inverse and significant relationship between time and ADC value.

Conclusion

We propose that vasogenic edema is a reliable diagnostic sign of acute neuroinflammation in ADEM.

Keywords

Acute disseminated encephalomyelitis ADEM Vasogenic edema DWI ADC 

Abbreviations

ADEM

Acute disseminated encephalomyelitis

IPMSSG

International Pediatric Multiple Sclerosis Study Group

Notes

Ethical standards and patient consent

We declare that all human and animal studies have been approved by the University of Pittsburgh IRB and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

We declare that we have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Giulio Zuccoli
    • 1
    Email author
  • Ashok Panigrahy
    • 1
  • Gayathri Sreedher
    • 1
  • Ariel Bailey
    • 1
  • Ernest John LaneyIV
    • 1
    • 2
  • Luca La Colla
    • 3
    • 4
  • Gulay Alper
    • 5
  1. 1.Department of Radiology, Section of NeuroradiologyChildren’s Hospital of Pittsburgh of UPMCPittsburghUSA
  2. 2.Department of Diagnostic RadiologyRush University Medical CenterChicagoUSA
  3. 3.Department of AnesthesiologyUniversity of ParmaParmaItaly
  4. 4.Department of Emergency MedicineUPMC Shadyside HospitalPittsburghUSA
  5. 5.Department of Pediatric Neurology, Neuroimmunology ClinicChildren’s Hospital of Pittsburgh of UPMCPittsburghUSA

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