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

Alex Roviraa, Imma Pericotb, Juli Alonsoa, Jordi Riob, Elisenda Grivéa and Xavier Montalbanb

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



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  		FIG 1. Patient 1, a 22-year-old woman who was admitted to the hospital for sudden dysarthria and numbness of the right hand and ensuing right hemiparesis.

A, Fast fluid-attenuated inversion recovery image (9000/110/2 [TR/TE/NEX]; inversion time, 2200 ms) obtained 1 day after symptom onset.

B, Fast fluid-attenuated inversion recovery image (9000/110/2; inversion time, 2200 ms) obtained 10 days after symptom onset. Left deep white matter lesion shows slight increase in size between initial images and those obtained 10 days after symptom onset.

C, Fast fluid-attenuated inversion recovery image (9000/110/2; inversion time, 2200 ms) obtained 20 days after symptom onset.

D, Fast fluid-attenuated inversion recovery image (9000/110//2; inversion time, 2200 ms) obtained 90 days after symptom onset. Significant size reduction can be seen on final images.

E, ADC map obtained 1 day after symptom onset shows signal drop within the lesion.

F, ADC map obtained 10 days after symptom onset shows signal drop within the lesion.

G, ADC map obtained 20 days after symptom onset shows an almost isointense signal.

H, ADC map obtained 90 days after symptom onset shows an increased signal intensity.

I, Initial proton spectrum obtained from lesion (spin-echo, 1600/135/256). Baseline examination shows slight decrease in NAA and a peak attributed to lactate (Lac). Cho, choline.

J, Final proton spectrum obtained from lesion (spin-echo, 1600/135/256). Final examination shows increase in choline (Cho), and lactate peak is not present.



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  		FIG 2. Patient 2, a 22-year-old woman who was admitted to the hospital for sudden left pyramidal weakness and paresthesia.

A, Fast fluid-attenuated inversion recovery image (9000/110/2 [TR/TE/NEX]; inversion time, 2200 ms) obtained 24 hr after symptom onset. Symptomatic high-signal-intensity lesion is identified in right deep white matter.

B, Contrast-enhanced T1-weighted image (600/15/2) obtained 24 hr after symptom onset. Symptomatic high-signal-intensity lesion shows slight peripheral enhancement.

C, ADC map obtained 24 hr after symptom onset. Symptomatic high-signal-intensity lesion shows marked signal drop compared with contralateral normal appearing white matter.

D, Initial proton spectrum (spin-echo, 1600/135). Lesion shows slight NAA decrease and excess of lactate (Lac). Cho indicates choline.

E, Fast fluid-attenuated inversion recovery image obtained 90 days after symptom onset. Symptomatic right lesion is slightly smaller as compared with initial examination. In addition, a new lesion appeared on the left parietal white matter.

F, Contrast-enhanced T1-weighted image obtained 90 days after symptom onset. Contrast material uptake is observed only in the new lesion.

G, ADC map obtained 90 days after symptom onset. Initial lesion is hyperintense compared with contralateral normal appearing white matter.

H, Final proton spectrum obtained 90 days after symptom onset. Symptomatic lesion shows reduced NAA signal, increased Cho signal, and absence of lactate.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X