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AJNR - American Journal of Neuroradiology

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Brain Apparent Diffusion Coefficient Decrease During Correction of Severe Hypernatremic Dehydration

Andrea Righini^a, Luca Ramenghi^b, Salvatore Zirpoli^a, Fabio Mosca^b and Fabio Triulzi^a

^a Departments of Radiology and Neuroradiology, Istituti Clinici di Perfezionamento, Milan, Italy
^b Department of Neonatology, Istituti Clinici di Perfezionamento, Milan, Italy

View larger version (13K): [in a new window]   FIG 1. Time course of sodium and chlorum serum concentrations during the neonatal intensive care unit stay. I MRI indicates the first imaging study.

View larger version (99K): [in a new window]   FIG 2. Two T2-weighted fast spin-echo (A, D), diffusion-weighted (B, E), and trace apparent diffusion coefficient–calculated (C) f-axial sections from the first (time course, 0 hours) MR imaging study are reported. Ventricular and cortical cerebrospinal fluid spaces are clearly reduced. The black arrowhead shows clear swelling of the corpus callosum (especially if compared with Fig 4). The white arrow shows the thickened posterior limb of the internal capsula, and the black arrow shows increased diffusion-weighted signal intensity within the myelinated white matter at the same location. Moderate T2-weighted signal intensity increase is visible within the posterior thalamus bilaterally. The white arrowhead indicates the swollen cortical rim. Circular regions of interest for frontal and occipital unmyelinated white matter are shown for one hemisphere on T2-weighted section (D). Regions of interest for basal ganglia, frontal and occipital unmyelinated white matter, and myelinated white matter of the internal capsula are depicted on apparent diffusion coefficient maps (C and F). These regions of interest were transferred from T2 b = 0 corresponding sections. Cortical gray matter regions of interest could not be traced because of partial volume effect.

View larger version (18K): [in a new window]   FIG 3. A, Graph shows plot of the average apparent diffusion coefficient value (with standard deviation of unmyelinated white matter [UMWM]), myelinated white matter (MWM), and basal ganglia (BG) regions of interest in the first (I MRI) and second (II MRI) MR imaging study. B, Graph shows plot of the average value (with standard deviation) of the ratio between T2-weighted signal intensity of frontal-occipital unmyelinated white matter and of cerebrospinal fluid in the first and second MR imaging studies and in normal controls (n = 5).

View larger version (112K): [in a new window]   FIG 4. Two T2-weighted (A, D), diffusion-weighted (B, E), and trace apparent diffusion coefficient–calculated (C) f-axial sections from the second (at 200 hours) MR imaging study, obtained at a location similar to that of Fig 2, are reported. Cerebrospinal fluid spaces and brain parenchyma signal intensity are normal. The cortical rim and corpus callosum are no longer swollen. The regions of interest are the same ones as depicted in Fig 2.