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AJNR - American Journal of Neuroradiology

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Delayed MR Imaging Changes in Acute Disseminated Encephalomyelitis

Jari Honkaniemi^a, Prasun Dastidar^a, Veikko Kähärä^a and Hannu Haapasalo^a

^a From the Departments of Neurology and Rehabilitation (J.H.), Diagnostic Radiology (P.D., V.K.), and Neuropathology (H.H.), Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland.

View larger version (65K): [in a new window]   FIG 1. Hematoxylin-eosin (A) and luxol fast blue (B) staining of the lesion seen in the cerebellum of case 2. Hematoxylin-eosin staining shows intact gray matter and some degenerative changes of the white matter. Luxol fast blue staining of myelin (blue) shows a restricted, focal area of demyelination (arrows)

View larger version (101K): [in a new window]   FIG 2. PD (3000/40/1 [TR/TE/TI]) (first image) and non-contrast FLAIR (9002/200/2200/2 [TR/TE/TI/excitations]) MR images of case 1 at indicated times after admission to the hospital. The first scan, performed at 2 days, does not reveal any intraparenchymal lesions. In the second scan done 1 week after admission, when the patient was unconscious and connected to a respirator, only two weakly high-signal areas are located in the basal ganglia, which by 3 weeks have grown (arrows). Despite significant recovery, several new lesions are seen in the periventricular white matter 1 month after admission (arrows). By 2 months, almost all the lesions are resolved

View larger version (155K): [in a new window]   FIG 3. Non-contrast FLAIR (9002/200/2200/2) MR images of case 2 at 3 and 6 weeks after admission. MR imaging performed at 3 weeks does not show any focal lesions, whereas the last MR scan shows a few high-density lesions located in the deep periventricular white matter (arrows) in addition to a subcortical infarct in the left frontoparietal lobe (arrowhead). A large, high-density lesion is located in the right cerebellar hemisphere

View larger version (72K): [in a new window]   FIG 4. T2-weighted (4000/115/1 [TR/TE/excitation]) MR images of case 3. The first MR scan taken 2 days after admission shows a large lesion in the right centrum semiovale (arrows), as well as in the periventricular white matter and basal ganglia (arrowheads). By 2 weeks, these lesions have grown despite steroid treatment and slight improvement in the patient's condition. By 1 month, some petecchial hemorrhage is seen in the lesions (arrows). On the last MR scan, performed 4 months after admission to the hospital, the lesions are somewhat decreased in size. Note the mild cortical pseudoatrophy likely caused by the steroid treatment

View larger version (129K): [in a new window]   FIG 5. Non-contrast FLAIR (9002/200/2200/2) images of case 4. The first MR scan shows a few focal ischemic white matter lesions located in the right frontal and left occipital lobes. The second scan, performed 2 months after admission, reveals several new lesions located in the deep periventricular white matter. These lesions do not show any major resolution in the follow-up scans performed at 4 and 8 months