Apparent Diffusion Coefficient Analysis of Encephalitis: A Comparative Study with Topographic Evaluation and Conventional MRI Findings

Overview

Journal Pak J Med Sci

Specialty General Medicine

Date 2016 Jul 5

PMID 27375722

Citations 2

Authors

Ahmet Katirag

Mehtap Beker-Acay

Ebru Unlu

Hayri Demirbas

Nese Demirturk

Affiliations

Soon will be listed here.

Abstract

Objective: Our purpose was to reveal the efficiency of diffusion weighted imaging (DWI) in the diagnosis of encephalitis, and to determine the relation between the apparent diffusion coefficient (ADC) values, the onset of the clinical symptoms, and the lesion extent.

Methods: Conventional magnetic resonance imaging (MRI) was performed in 17 patients with encephalitis diagnosed on the basis of laboratory, clinical and radiologic findings during 2009 and 2015. Based on the duration between the onset of the symptoms and the brain MRI findings, the patients were divided into three groups. ADC values of the encephalitis lesion, the lesions' topographic analysis score, deep gray matter involvement, patients' clinical situation and the duration of the arrival to the clinic was examined.

Results: Mean ADC values were 0,988±0,335 x10(-3) mm(2)/s in group I (0-2 days), 1,045±0,347 x10(-3) mm(2)/s in Group-II (3-7 days), 1,451±0,225 x10(-3) mm(2)/s in Group-III (8 days and over). The relation between the ADC values and the duration of the arrival, topographic analysis score, the relation between the patients' clinical situation and the deep gray matter involvement were found to be statistically significant. The deep gray matter involvement was demonstrated more clearly by FLAIR images when compared with DWI.

Conclusion: Conventional MRI sequences may be insufficient in showing the encephalitis lesion. DWI must be added to the imaging modalities immediately in the cases suspected of having encephalitis.

Citing Articles

Evaluation of children with acute central nervous system infections admitted to the pediatric intensive care unit and pediatric ward: a retrospective study.

Deniz M, Erat T, Feray Ari H, Kabar F, Tezer H, Senol H BMC Pediatr. 2024; 24(1):765.

PMID: 39587526 PMC: 11587708. DOI: 10.1186/s12887-024-05255-3.

Diagnostic accuracy of diffusion weighted MRI in differentiating malignant from benign liver lesions taking histopathology as gold standard.

Jia , Tabassum S, Haider S, Haania Pak J Med Sci. 2024; 40(4):669-673.

PMID: 38544996 PMC: 10963981. DOI: 10.12669/pjms.40.4.7738.

References

Tsuchiya K, Katase S, Yoshino A, Hachiya J . Diffusion-weighted MR imaging of encephalitis. AJR Am J Roentgenol. 1999; 173(4):1097-9. DOI: 10.2214/ajr.173.4.10511186. View

Mueller-Mang C, Mang T, Kalhs P, Thurnher M . Imaging characteristics of toxoplasmosis encephalitis after bone marrow transplantation: report of two cases and review of the literature. Neuroradiology. 2005; 48(2):84-9. DOI: 10.1007/s00234-005-0018-3. View

Sawlani V . Diffusion-weighted imaging and apparent diffusion coefficient evaluation of herpes simplex encephalitis and Japanese encephalitis. J Neurol Sci. 2009; 287(1-2):221-6. DOI: 10.1016/j.jns.2009.07.010. View

Sener R . Herpes simplex encephalitis: diffusion MR imaging findings. Comput Med Imaging Graph. 2001; 25(5):391-7. DOI: 10.1016/s0895-6111(01)00005-2. View

HEINER L, Demaerel P . Diffusion-weighted MR imaging findings in a patient with herpes simplex encephalitis. Eur J Radiol. 2003; 45(3):195-8. DOI: 10.1016/s0720-048x(02)00306-6. View

Okanishi T, Yamamoto H, Hosokawa T, Ando N, Nagayama Y, Hashimoto Y . Diffusion-weighted MRI for early diagnosis of neonatal herpes simplex encephalitis. Brain Dev. 2014; 37(4):423-31. DOI: 10.1016/j.braindev.2014.07.006. View

Skoldenberg B, Forsgren M, ALESTIG K, Bergstrom T, BURMAN L, Dahlqvist E . Acyclovir versus vidarabine in herpes simplex encephalitis. Randomised multicentre study in consecutive Swedish patients. Lancet. 1984; 2(8405):707-11. DOI: 10.1016/s0140-6736(84)92623-0. View

Tsuchiya K, Inaoka S, Mizutani Y, Hachiya J . Fast fluid-attenuated inversion-recovery MR of intracranial infections. AJNR Am J Neuroradiol. 1997; 18(5):909-13. PMC: 8338100. View

Whitley R . Viral encephalitis. N Engl J Med. 1990; 323(4):242-50. DOI: 10.1056/NEJM199007263230406. View

10.

Prakash M, Kumar S, Gupta R . Diffusion-weighted MR imaging in Japanese encephalitis. J Comput Assist Tomogr. 2004; 28(6):756-61. DOI: 10.1097/00004728-200411000-00005. View

11.

White M . Fluid attenuated inversion recovery (FLAIR) MRI of herpes encephalitis. J Comput Assist Tomogr. 1995; 19(3):501-2. DOI: 10.1097/00004728-199505000-00029. View

12.

Kiroglu Y, Calli C, Yunten N, Kitis O, Kocaman A, Karabulut N . Diffusion-weighted MR imaging of viral encephalitis. Neuroradiology. 2006; 48(12):875-80. DOI: 10.1007/s00234-006-0143-7. View

13.

Le Bihan D, Turner R, Douek P, Patronas N . Diffusion MR imaging: clinical applications. AJR Am J Roentgenol. 1992; 159(3):591-9. DOI: 10.2214/ajr.159.3.1503032. View

14.

Miyake M . THE PATHOLOGY OF JAPANESE ENCEPHALITIS. A REVIEW. Bull World Health Organ. 1964; 30:153-60. PMC: 2554796. View

15.

Sener R . Diffusion MRI in Rasmussen's encephalitis, herpes simplex encephalitis, and bacterial meningoencephalitis. Comput Med Imaging Graph. 2002; 26(5):327-32. DOI: 10.1016/s0895-6111(02)00028-9. View

16.

Kuker W, Nagele T, Schmidt F, Heckl S, Herrlinger U . Diffusion-weighted MRI in herpes simplex encephalitis: a report of three cases. Neuroradiology. 2004; 46(2):122-5. DOI: 10.1007/s00234-003-1145-3. View

17.

Renard D, Nerrant E, Lechiche C . DWI and FLAIR imaging in herpes simplex encephalitis: a comparative and topographical analysis. J Neurol. 2015; 262(9):2101-5. DOI: 10.1007/s00415-015-7818-0. View

18.

Chung S, You J, Lee H . Use of the diffusion-weighted magnetic resonance imaging for early diagnosis of herpes simplex encephalitis in the ED: a case report. Am J Emerg Med. 2007; 25(8):986.e5-6. DOI: 10.1016/j.ajem.2007.02.034. View

19.

Jorens P, Parizel P, Demey H, Smets K, Jadoul K, Verbeek M . Meningoencephalitis caused by Streptococcus pneumoniae: a diagnostic and therapeutic challenge. Diagnosis with diffusion-weighted MRI leading to treatment with corticosteroids. Neuroradiology. 2005; 47(10):758-64. DOI: 10.1007/s00234-005-1423-3. View