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Fig 4. Patient 178. Evolution of T1, diffusivity, and metabolites over 3 scans during 8 days. A–C were performed at day 1 (16 hours), D–F were performed at 4 days (84 hours), and G–I were performed at 8 days (178 hours).
A, Axial T1-weighted image at age 16 hours is normal.
B, Axial Dav map at age 16 hours shows a small amount of reduced diffusivity on the ventrolateral thalami (arrows). Measurements showed a reduction in Dav of about 10%.
C, Proton MR spectroscopy from the right thalamus at age 16 hours shows minimal elevation of lactate (Lac), but is otherwise normal.
D, Axial T1-weighted image at 84 hours shows that the normal hyperintensity in the posterior limb of the internal capsule is no longer seen. Abnormal hyperintensity is seen in the ventrolateral thalami and posterior putamina.
E, Axial Dav map at 84 hours shows that reduced diffusivity is now present in the posterior putamina (arrows). Measurements of Dav showed significant reduction since day 1, with values now 50%–60% or normal (40%–50% reduced) in the thalami and putamina, and dorsal brain stem. Lesser reductions of about 25% were found in the cerebral hemispheric white matter.
F, Proton MR spectroscopy from the right thalamus at 84 hours shows an increase in lactate (Lac) and relative reduction of choline and NAA compared with the first study.
G, Axial T1-weighted image at 8 days shows that the T1 shortening is becoming less diffuse and more globular (arrows), with the globular regions being located in the globi pallidi, ventrolateral thalami, and at the junction of the anterior globi pallidi and putamina.
H, Axial Dav map at 84 hours shows that reduced diffusivity is now almost exclusively seen in the posterior putamina (arrows) with the thalamic abnormality nearly completely gone. Measurements showed that the Dav values of the putamina were still about 30% below normal, but those in the thalami had normalized.
I, Proton MR spectroscopy from the right thalamus at 8 days shows that the lactate peak has gotten significantly smaller. Note that the NAA and choline peaks have continued to decrease in size compared with the creatine peak.
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