DWI scoring system for prognosis of acute encephalopathy with biphasic seizures and late reduced diffusion
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ORIGINAL ARTICLE
DWI scoring system for prognosis of acute encephalopathy with biphasic seizures and late reduced diffusion Hirotaka Takita1,2 · Taro Shimono1 · Takao Manabe2 · Ichiro Kuki3 · Kiyoko Amo4 · Masao Togawa4 · Yukio Miki1 Received: 18 January 2020 / Accepted: 26 April 2020 © Japan Radiological Society 2020
Abstract Purpose The aim of this study was to predict neurological outcomes for acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) using diffusion-weighted imaging (DWI), and assess relationships between anatomical sites of lesions and their outcomes. Materials and methods We assessed DWI abnormalities and neurological outcomes in 30 patients with AESD, and classified patients into severe and non-severe groups according to their neurological outcomes. We also established a DWI scoring system as follows: zero for normal, and one for lesion at each location. Differences between the severe and non-severe groups were examined, and receiver operating characteristic (ROC) curve analysis was performed. Results Nine (30%) patients were classified into the severe group. On DWI, patients in the severe group were more likely to have temporal lobe (P = 0.014), perirolandic (P = 0.008), and corpus callosum (P = 0.0008) lesions than those in the non-severe group. The total DWI scores were significantly higher in the severe group than those in the non-severe group (P = 0.0002). ROC curve showed an area under the curve of 0.929, with a cutoff value of five, sensitivity of 88.9%, and specificity of 81.0%. Conclusion Patients with severe AESD had more extensive DWI abnormalities than those with non-severe AESD. Our DWI scoring system may be useful for the prediction of outcomes of AESD. Widespread lesions seemed to have stronger influence on outcomes than each lesion location.
Introduction Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is the most common subtype of infectious pediatric encephalopathy in Japan [1]. AESD is characterized by a febrile seizure on day 1, with secondary seizures on days 4–6. During the first 2 days, there are no abnormal findings on magnetic resonance (MR) imaging. However, over days 3–9, diffusion-weighted imaging * Hirotaka Takita [email protected] 1
Departments of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1‑4‑3 Asahi‑cho, Abeno‑ku, Osaka, Japan
2
Department of Diagnostic Radiology, Osaka City General Hospital, Osaka, Japan
3
Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan
4
Department of Pediatric Emergency Medicine, Osaka City General Hospital, Osaka, Japan
(DWI) and apparent diffusion coefficient (ADC) maps show restricted diffusion in the subcortical white matter [2, 3]. AESD is also characterized by low mortality and a high incidence of neurological sequelae, which can vary from mild to severe [1–3]. An autopsy case of AESD showed evidence of loss of myelinated axons and gemistocytic astrocytes in the subcortical white m
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