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Vasogenic edema characterizes pediatric acute disseminated encephalomyelitis

  • Paediatric Neuroradiology
  • Published:
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Abstract

Introduction

MR imaging criteria for diagnosing acute disseminated encephalomyelitis (ADEM) have not been clearly established. Due to the wide spectrum of differential considerations, new imaging features allowing early and accurate diagnosis for ADEM are needed. We hypothesized that ADEM lesions would be characterized by vasogenic edema due to the potential reversibility of the disease.

Methods

Sixteen patients who met the diagnostic criteria for ADEM proposed by the International Pediatric Multiple Sclerosis Study Group (IPMSSG) and had complete MR imaging studies performed at our institution during the acute phase of the disease were identified retrospectively and evaluated by experienced pediatric neuroradiologists.

Results

Vasogenic edema was demonstrated on diffusion-weighted imaging (DWI) and corresponding apparent diffusion coefficient (ADC) maps in 12 out of 16 patients; cytotoxic edema was identified in two patients while the other two patients displayed no changes on DWI/ADC. ADC values for lesions and normal-appearing brain tissue were 1.39 ± 0.45 × 10−3 and 0.81 ± 0.09 × 10−3 mm/s2, respectively (p = 0.002). When considering a cutoff of 5 days between acute and subacute disease, no difference between ADC values in acute vs. subacute phase was depicted. However, we found a significant correlation and an inverse and significant relationship between time and ADC value.

Conclusion

We propose that vasogenic edema is a reliable diagnostic sign of acute neuroinflammation in ADEM.

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Abbreviations

ADEM:

Acute disseminated encephalomyelitis

IPMSSG:

International Pediatric Multiple Sclerosis Study Group

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Ethical standards and patient consent

We declare that all human and animal studies have been approved by the University of Pittsburgh IRB and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Section of Neuroradiology, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA, 15244, USA

    Giulio Zuccoli, Ashok Panigrahy, Gayathri Sreedher, Ariel Bailey & Ernest John Laney IV

  2. Department of Diagnostic Radiology, Rush University Medical Center, Chicago, IL, USA

    Ernest John Laney IV

  3. Department of Anesthesiology, University of Parma, Parma, Italy

    Luca La Colla

  4. Department of Emergency Medicine, UPMC Shadyside Hospital, Pittsburgh, PA, USA

    Luca La Colla

  5. Department of Pediatric Neurology, Neuroimmunology Clinic, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA

    Gulay Alper

Authors
  1. Giulio Zuccoli
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  2. Ashok Panigrahy
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  3. Gayathri Sreedher
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  4. Ariel Bailey
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  5. Ernest John Laney IV
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  6. Luca La Colla
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  7. Gulay Alper
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Corresponding author

Correspondence to Giulio Zuccoli.

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Zuccoli, G., Panigrahy, A., Sreedher, G. et al. Vasogenic edema characterizes pediatric acute disseminated encephalomyelitis. Neuroradiology 56, 679–684 (2014). https://doi.org/10.1007/s00234-014-1379-2

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  • DOI: https://doi.org/10.1007/s00234-014-1379-2

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