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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 23:989-994, June-July 2002
© 2002 American Society of Neuroradiology

Case Report
BRAIN

Serial Diffusion-Weighted MR Imaging and Proton MR Spectroscopy of Acute Large Demyelinating Brain Lesions: Case Report

Alex Rovira^a, Imma Pericot^b, Juli Alonso^a, Jordi Rio^b, Elisenda Grivé^a and Xavier Montalban^b

^a Magnetic Resonance Unit, Department of Radiology, Hospital Universitari Vall d’Hebron, Barcelona. Spain
^b Unit of Clinical Neuroimmunology, Department of Neurology, Hospital Universitari Vall d’Hebron, Barcelona. Spain

Address reprint requests to A. Rovira-Cañellas, Magnetic Resonance Unit, Department of Radiology, Hospital Universitari Vall d’Hebron, Paseig Vall d’Hebron 119–129, 08035 Barcelona, Spain

Summary: We present the serial MR studies of two patients with symptomatic acute large demyelinating lesions that initially showed a drop in apparent diffusion coefficient values. Baseline proton MR spectroscopy showed a slight decrease in N-acetylaspartate and a normal choline level. An excess of lactate was observed at the first examinations and completely disappeared by the final examinations.

The time-course evolution of the lesions shown by MR imaging and proton MR spectroscopic examinations suggests that the initial drop in apparent coefficient diffusion may have been related to dense inflammatory cell infiltration and scant tissue destruction or to reversible reduced vascular supply due to the severity of the inflammatory process.

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