MRI in seven cases of tacrolimus (FK-506) encephalopathy: utility of FLAIR and diffusion-weighted imaging.
We assessed the utility of fluid-attenuated inversion-recovery (FLAIR) and diffusion-weighted (DWI) images in investigation of tacrolimus (FK-506) encephalopathy, and to see whether we could predict its cause from clinical and imaging data. In seven patients with presumed FK-506 toxicity the areas involved on MRI were similar to those in cyclosporin A (CsA) toxicity. The abnormal signal was most evident on FLAIR in all cases. In three of four patients who underwent DWI, no diffusion abnormalities were detected; in the remaining patient, increased diffusion was seen in the deep white matter bilaterally on the apparent diffusion coefficient map, consistent with the findings on T2-weighted spin-echo and FLAIR images. Five of the six patients for whom we had clinical data showed sudden changes in electrolyte or fluid equilibrium due to diarrhoea, a polyuria or oliguria one day before or on the day of onset of the central nervous system disturbances. We speculate that FK-506 encephalopathy is triggered by the disturbance of the electrolyte and/or fluid equilibrium, given a certain serum level of FK-506.
Furukawa
M
M
Department of Radiology, Yamaguchi University School of Medicine, Ube, Japan.
Terae
S
S
Chu
B C
BC
Kaneko
K
K
Kamada
H
H
Miyasaka
K
K
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D016026:Bone Marrow Transplantation; D001921:Brain / Q000473:pathology; D002490:Central Nervous System / Q000187:drug effects; D002648:Child; D004058:Diffusion; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000097:blood; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000175:diagnosis* / Q000209:etiology*; D016559:Tacrolimus / Q000009:adverse effects* / Q000097:blood
D007166:Immunosuppressive Agents; D016559:Tacrolimus