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AJNR - American Journal of Neuroradiology

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MR Imaging of Human Herpesvirus-6–Associated Encephalitis in 4 Patients with Anterograde Amnesia after Allogeneic Hematopoietic Stem-Cell Transplantation

R.J.T. Gorniak^a, G.S. Young^a, D.E. Wiese^a, F.M. Marty^b,c and R.B. Schwartz^d

^a Department of Radiology, Neuroradiology Section, Brigham and Women’s Hospital, Boston, Mass
^b Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Mass
^c Dana-Farber Cancer Institute, Boston, Mass
^d Longwood MRI Specialists, Brookline, Mass

View larger version (50K): [in a new window]   Fig 1. Patient 1. Axial fluid-attenuated inversion recovery (FLAIR) imaging (A), diffusion-weighted imaging (DWI) (B), and apparent diffusion coefficient (ADC) mapping (C) performed on admission show T2 prolongation in the medial temporal lobes with reduced diffusion on the right. Follow-up FLAIR images obtained at approximately 5 weeks (D) and 8 weeks (E) after admission show persistent T2 prolongation in the medial temporal lobes and mild volume loss more pronounced in the medial temporal lobes.

View larger version (58K): [in a new window]   Fig 2. Patient 2. Axial T2-weighted image (A), diffusion-weighted imaging (DWI) (B), apparent diffusion coefficient (ADC) mapping (C), and coronal postcontrast T1-weighted (E) image obtained on admission show left medial temporal T2 prolongation on fast spin-echo T2-weighted image and DWI ("T2 shine-through" effect) as confirmed by ADC map demonstrating normal diffusivity. Axial T2-weighted and coronal T1 postcontrast images at the same level performed 3 months later (D) show resolution of abnormal T2 signal intensity with interval mild volume loss, most apparent in the medial temporal lobes (F).

View larger version (42K): [in a new window]   Fig 3. Patient 3. Axial diffusion-weighted imaging (DWI) (A) and FLAIR imaging of the temporal lobes performed 2 days (B), 3 weeks (C), and 4 months (D) after admission demonstrate initial T2 prolongation in the medial temporal lobes with subsequent gradual normalization of signal intensity abnormality culminating in complete resolution by 4 months.

View larger version (52K): [in a new window]   Fig 4. Patient 4. Axial FLAIR image (A) and diffusion-weighted imaging (DWI) (B) through the temporal lobes obtained on admission show no medial temporal lobe abnormality. Axial FLAIR image (C), DWI (D), and apparent diffusion coefficient (ADC) mapping (E) obtained 5 days later revealed new medial temporal T2 prolongation both on FLAIR and diffusion-weighted images. ADC map demonstrates normal diffusivity.