Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) An erratum has been published Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Chen, C.L. Articles by Fang, H.C. Search for Related Content PubMed PubMed Citation Articles by Chen, C.L. Articles by Fang, H.C.

American Journal of Neuroradiology 28:68-71, January 2007
© 2007 American Society of Neuroradiology

BRAIN

A Preliminary Report of Brain Edema in Patients with Uremia at First Hemodialysis: Evaluation by Diffusion-Weighted MR Imaging

C.L. Chen^a, P.H. Lai^b, K.J. Chou^a,c, P.T. Lee^a,c,d, H.M. Chung^a,c and H.C. Fang^a,C

^a Division of Nephrology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
^b Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
^c Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
^d Institute of Clinical Medicine, National Cheng Kung University School of Medicine, Tainan, Taiwan

Please address correspondence to Hua-Chang Fang, MD, 386 Ta-Chung 1st Rd, Kaohsiung 813, Taiwan, ROC; e-mail: hcfang{at}isca.vghks.gov.tw

BACKGROUND AND PURPOSE: The dynamics of brain-water content associated with hemodialysis in patients with severe azotemia remains obscure. To investigate whether either interstitial or cytotoxic edema is responsible for dialysis disequilibrium syndrome (DDS), we used diffusion-weighted MR imaging (DWI) to measure the apparent diffusion coefficient (ADC), which is sensitive for detecting tissue water dynamics.

METHODS: Eight consecutive patients with end stage renal disease (ESRD) and blood urea nitrogen level of more than 100 mg/dL (160.9 ± 53.1 mg/dL) were recruited. Conventional MR images, DWI, and clinical manifestations were obtained before and after the 1st hemodialysis. The ADC values were determined for regions of normal-appearing gray and white matter and for regions of hyperintensity of white matter on T2-weighted MR imaging.

RESULTS: Foci of bright areas of white matter were found in all patients on T2-weighted images. The ADC values of the patients with ESRD, in white matter and gray matter before and after hemodialysis, were greater than those of the healthy controls (P < .005). Regarding the impact of hemodialysis, the ADC of frontal lobe white matter increased significantly after hemodialysis (1.09 ± 0.11 versus 1.03 ± 0.11, P = .036). We did not find the specific area of brain edema reported in posterior leukoencephalopathy and the osmotic demyelination syndrome.

CONCLUSIONS: These results suggest that severe azotemia in end stage renal disease leads to interstitial brain edema reflected as increased ADC, and the further increased ADC reflects that edema associated with 1st hemodialysis is interstitial rather than cytotoxic in nature.

This article has been cited by other articles:

				M. Liu, Y. Liang, S. Chigurupati, J. D. Lathia, M. Pletnikov, Z. Sun, M. Crow, C. A. Ross, M. P. Mattson, and H. Rabb Acute Kidney Injury Leads to Inflammation and Functional Changes in the Brain J. Am. Soc. Nephrol., July 1, 2008; 19(7): 1360 - 1370. [Abstract] [Full Text] [PDF]