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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 22:1125-1130 (6 2001)
© 2001 American Society of Neuroradiology

ARTICLE

Quantitative Proton MR Spectroscopic Imaging in Acute Disseminated Encephalomyelitis

Alberto Bizzi^a, Aziz M. Ulu^a, Thomas O. Crawford^a, Ted Passe^a, Marianna Bugiani^a, R. Nick Bryan^a and Peter B. Barker^a

^a From the Russell C. Morgan Department of Radiology and Radiological Science (A.B., A.M.U., T.P., R.N.B., P.B.B.) and the Departments of Neurology and Pediatrics (T.O.C), The Johns Hopkins University, Baltimore, Maryland; and the Department of Child Neurology (A.B., M.B.), National Neurological Institute "C. Besta", Milan, Italy.

Summary: Serial MR imaging and quantitative proton MR spectroscopic imaging (MRSI) findings of a 4-year-old boy with acute disseminated encephalomyelitis (ADEM) are reported. Over a 2-month period characterized by an initial illness and two relapses, each with full recovery, MR imaging exhibited the appearance and disappearance of multifocal lesions throughout the CNS that correlated only partly with the neurologic impairment. During one relapse, MRSI revealed low levels of N-acetylaspartate (NAA) within the regions of prolonged T2 signal intensity. All other metabolites were normal. At follow-up, the MR imaging and MRSI abnormalities had fully resolved. MRSI might play an important role in the diagnosis of ADEM, as well as in the elucidation of underlying pathophysiologic processes in this poorly defined disorder of children. This case demonstrates that reduced levels of NAA are not always associated with neuronal loss, irreversible tissue damage, or poor neurologic outcome.

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