Advertisement

Japanese Journal of Radiology

, Volume 37, Issue 4, pp 277–282 | Cite as

Delayed appearance of transient hyperintensity foci on T1-weighted magnetic resonance imaging in acute disseminated encephalomyelitis

  • Yusuke KawanakaEmail author
  • Kumiko Ando
  • Reiichi Ishikura
  • Takayuki Katsuura
  • Yuki Wakata
  • Hiroshi Kodama
  • Haruyuki Takaki
  • Yoshihiro Takada
  • Junichiro Ono
  • Koichiro Yamakado
Original Article
  • 73 Downloads

Abstract

Purpose

To evaluate the frequency, characteristics, and clinical significance of transient hyperintensity foci on T1-weighted images (T1WI) in acute disseminated encephalomyelitis (ADEM).

Materials and methods

Patients diagnosed with ADEM underwent MR studies at the time of disease onset and every 3 months or more often thereafter. The frequency and appearance timing of abnormal signals including T1WI and their morphological characteristics were evaluated. Relations between patient symptoms and abnormal signals on MRI were also evaluated.

Results

Five ADEM patients were included in this study. Linear (n = 2) or nodular (n = 1) T1-hyperintensity foci appeared in 3 patients (60%, 3/5). Locations of T1-hyperintensity foci were both cortical/subcortical region and basal ganglia (n = 1), subcortical region alone (n = 1), and internal capsule (n = 1). Those T1-hyperintensity foci were located within the T2-weighted image (T2WI) and fluid-attenuated inversion recovery (FLAIR) hyperintensity foci on initial MRI. Some T1-hyperintensity foci also showed hyperintensity on diffusion-weighted image (DWI) and contrast enhancement. T1-hyperintensity appeared at 14–43 days (median, 28 days), and disappeared in 2 patients at 91 days and 627 days after disease onset. There were no neurological sequelae remained in any patients.

Conclusion

T1-hyperintensity foci is not a rare finding (60%) and it can be observed after improvement in symptoms in ADEM.

Keywords

Acute disseminated encephalomyelitis hyperintensity lesions T1-weighted images magnetic resonance imaging 

Notes

Compliance with ethical standards

Conflict of interest

No author has any conflict of interest to declare.

Ethical standards

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Ethical approval

This retrospective study was approved by our institutional review board.

References

  1. 1.
    Murthy SNK, Farden HS, Cohen ME, Bakshi R. Acute disseminated encephalomyelitis in children. Pediatrics. 2002;110:e21.CrossRefGoogle Scholar
  2. 2.
    Garg RK. Acute disseminated encephalomyelitis. Postgrad Med J. 2003;79:11–7.CrossRefGoogle Scholar
  3. 3.
    Krupp LB, Banwell B, Tenembaum S, International Pediatric MS Study Group. Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology. 2007;68:7–12.CrossRefGoogle Scholar
  4. 4.
    Tenembaum S, Chitnis T, Ness J, Hahn JS, International Pediatric MS Study Group. Acute disseminated encephalomyelitis. Neurology. 2007;68:23–36.CrossRefGoogle Scholar
  5. 5.
    Tenembaum S, Chamoles N, Fejerman N. Acute disseminated encephalomyelitis: a long-term follow-up study of 84 pediatric patients. Neurology. 2002;59:1224–31.CrossRefGoogle Scholar
  6. 6.
    Caldemeyer KS, Smith RR, Harris TM, Edwards MK. MRI in acute disseminated encephalomyelitis. Neuroradiology. 1994;36:216–20.CrossRefGoogle Scholar
  7. 7.
    Khong PL, Ho HK, Cheng PW, Wong VC, Goh W, Chan FL. Childood acute disseminated encephalomyelitis: The role of brain and spinal cord MRI. Pediatr Radiol. 2002;32:59–66.CrossRefGoogle Scholar
  8. 8.
    Marin SE, Callen DJ. The magnetic resonance imaging appearance of monophasic acute disseminated encephalomyelitis: an update post application of the 2007 consensus criteria. Neuroimaging Clin N Am. 2013;23:245–66.CrossRefGoogle Scholar
  9. 9.
    Krupp LB, Tardieu M, Amato MP, Banwell B, Chitnis T, Dale RC, International Pediatric Multiple Sclerosis Study Group, et al. International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. Mult Scler J. 2013;19:1261–7.CrossRefGoogle Scholar
  10. 10.
    Janardhan V, Suri S, Bakshi R. Multiple sclerosis: hyperintense lesions in the brain on nonenhanced T1-weighted MR images evidenced as areas of T1 shortening. Radiology. 2007;244:823–31.CrossRefGoogle Scholar
  11. 11.
    Khoury MN, Alsop DC, Agnihotri SP, Pfannl R, Wuthrich C, Ho ML, et al. Hyperintense cortical signal on magnetic resonance imaging reflects focal leukocortical encephalitis and seizure risk in progressive multifocal leukoencephalopathy. Ann Neurol. 2014;75:659–69.CrossRefGoogle Scholar
  12. 12.
    Powell T, Sussman JG, Davies-Jones GA. MR imaging in acute multiple sclerosis: ringlike appearance in plaques suggesting the presence of paramagnetic free radicals. AJNR. 1992;13:1544–6.Google Scholar
  13. 13.
    Habek M, Zarkovic K. Pathology of acute disseminated encephalomyelitis. Transl Neurosci. 2011;2:252–5.CrossRefGoogle Scholar
  14. 14.
    Kanda T, Ishii K, Kawaguchi H, Kitajima K, Takenaka D. High signal intensity in the dentate nucleus and globus pallidus in unenhanced T1-weighted MR images: relationship with increasing cumulative dose of a gadolinium-based contrast material. Radiology. 2014;270:834–41.CrossRefGoogle Scholar

Copyright information

© Japan Radiological Society 2019

Authors and Affiliations

  • Yusuke Kawanaka
    • 1
    Email author
  • Kumiko Ando
    • 1
  • Reiichi Ishikura
    • 1
  • Takayuki Katsuura
    • 1
  • Yuki Wakata
    • 1
  • Hiroshi Kodama
    • 1
  • Haruyuki Takaki
    • 1
  • Yoshihiro Takada
    • 2
  • Junichiro Ono
    • 3
  • Koichiro Yamakado
    • 1
  1. 1.Department of RadiologyHyogo College of MedicineNishinomiyaJapan
  2. 2.Department of RadiologyMeiwa HospitalNishinomiyaJapan
  3. 3.Department of PediatricsMeiwa HospitalNishinomiyaJapan

Personalised recommendations