Figueroa Ramon E, Hoffman William H, Momin Zahir, Pancholy Ajay, Passmore Gregory G, Allison Jerry
Neuroradiology Section, Department of Radiology, Medical College of Georgia, 1120 15th street, Augusta, GA 30912, USA.
Endocr Res. 2005;31(4):345-55. doi: 10.1080/07435800500451912.
Cerebral edema is the most significant complication in children with diabetic ketoacidosis (DKA). Our goal was to study whether subclinical cerebral edema was preferentially vasogenic or cytotoxic. Magnetic resonance imaging (MRI)--diffusion-weighted imaging (DWI) and T2 relaxometry (T2R)--were obtained in pediatric patients presenting with severe diabetic ketoacidosis (DKA) 6-12 hours after initial DKA treatment and stabilization and 96 hours after correction of DKA. T2 relaxometry was significantly increased during treatment in both white and gray matter, in comparison to the absolute T2R values 96 hours after correction of DKA (p = .034). Classic intracellular cytotoxic edema could not be detected, based on the lack of a statistically significant decrease in ADC values. ADC values were instead elevated, implying a large component of cell membrane water diffusion, correlating with the elevated white and gray matter T2R We discuss the findings in relation to cerebral blood volume, cerebral vasoregulatory dysfunction, and cerebral hyperemia.
脑水肿是糖尿病酮症酸中毒（DKA）患儿最严重的并发症。我们的目标是研究亚临床脑水肿主要是血管源性的还是细胞毒性的。对初次DKA治疗并稳定病情6 - 12小时以及DKA纠正96小时后的重度糖尿病酮症酸中毒（DKA）患儿进行了磁共振成像（MRI）——弥散加权成像（DWI）和T2弛豫测量（T2R）。与DKA纠正96小时后的绝对T2R值相比，治疗期间白质和灰质的T2弛豫测量值均显著升高（p = 0.034）。基于表观扩散系数（ADC）值没有统计学上的显著降低，未检测到典型的细胞内细胞毒性水肿。相反，ADC值升高，这意味着细胞膜水扩散占很大一部分，与白质和灰质升高的T2R相关。我们结合脑血容量、脑血管调节功能障碍和脑充血来讨论这些发现。
