Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Carl-Neuberg-Straße 1, D-30625, Hannover, Germany.
Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Eur J Pediatr. 2023 Oct;182(10):4663-4672. doi: 10.1007/s00431-023-05130-w. Epub 2023 Aug 10.
To evaluate microstructural cerebral changes in children suffering from typical hemolytic uremic syndrome (HUS) based on apparent diffusion coefficient (ADC) maps. For 12 pediatric HUS patients (0.8 - 14.6 years of age) conventional magnetic resonance imaging (cMRI) at 1.5 T was retrospectively analyzed. ADC values were measured in 35 different brain regions and compared with age-related, previously published ADC reference values from a healthy pediatric control group. The HUS cohort was divided into 2 subgroups depending on clinical outcome. Subgroup A showed poor neurological outcome whereas subgroup B demonstrated improvement without lasting neurological deficits. Qualitative analysis revealed lesions by diffusion-weighted imaging (DWI) with hypointense correlate on the ADC map in basal ganglia and/or thalami and corresponding T2 hyperintensities in the majority of patients in Subgroup A (80%). Those in Subgroup B did not show qualitative DWI alterations with ADC correlate even when T2 hyperintense lesions were detected in basal ganglia and/or thalami. Quantitative analysis demonstrated abnormal ADC values in all HUS patients with a trend to a greater number of affected regions in Subgroup A compared to Subgroup B (16 versus 11 median number of regions respectively, p = 0.56). Conclusion: Using DWI qualitative and quantitative differences were found between HUS patients showing poor neurological outcome and those without neurological deficits at discharge. While ADC values indicated more extensive cerebral changes than conventional qualitative findings, both may provide early prognostic indicators for neurological outcome in pediatric HUS patients. What is Known: • In patients with STEC-HUS and neurological symptoms, MRI may show hyperintense signals on T2 and altered diffusivity mostly affecting basal ganglia, thalami and periventricular white matter. What is New: • In such patients, early MRI including quantitative ADC measurements over different brain regions may allow for detection of signal alterations possibly reflecting microstructural changes in such patients.
基于表观扩散系数（ADC）图评估典型溶血尿毒症综合征（HUS）患儿的脑微观结构变化。对 12 例儿科 HUS 患者（0.8-14.6 岁）的 1.5T 常规磁共振成像（cMRI）进行回顾性分析。在 35 个不同脑区测量 ADC 值，并与健康儿科对照组年龄相关的先前发表的 ADC 参考值进行比较。根据临床转归，HUS 队列分为 2 个亚组。A 亚组表现为不良神经预后，而 B 亚组表现为改善，无持续神经功能缺损。弥散加权成像（DWI）的定性分析显示，基底节和/或丘脑存在病变，ADC 图上呈低信号，在大多数 A 亚组患者（80%）中存在相应的 T2 高信号。B 亚组患者即使在基底节和/或丘脑发现 T2 高信号病变时，也没有 DWI 定性改变与 ADC 相关。定量分析显示所有 HUS 患者的 ADC 值异常，与 B 亚组相比，A 亚组病变部位更多（分别为 16 个和 11 个中位数，p=0.56）。结论：使用 DWI 定性和定量分析发现，预后不良的 HUS 患者与出院时无神经功能缺损的患者之间存在差异。虽然 ADC 值提示脑区改变比常规定性发现更广泛，但两者均可为儿科 HUS 患者的神经预后提供早期预测指标。已知情况：•在感染性 STEC-HUS 且有神经症状的患者中，MRI 可能显示 T2 高信号和弥散改变，主要影响基底节、丘脑和脑室周围白质。新发现：•在这些患者中，早期 MRI 包括对不同脑区的定量 ADC 测量，可能有助于检测信号改变，这些改变可能反映了此类患者的微观结构变化。
