Childhood acute disseminated encephalomyelitis: the role of brain and spinal cord MRI.
BACKGROUND
It is recognised that the clinical and radiological spectrum of childhood acute disseminated encephalomyelitis (ADEM) is wide.


OBJECTIVE
To determine whether initial MRI features are predictive of clinical outcome and to determine the role of MRI in the management of ADEM.


METHODS
The MRI scans of ten consecutive children (eight boys, two girls), clinically and radiologically diagnosed to have ADEM, were retrospectively reviewed. Follow-up MRI was available for eight patients.


RESULTS
Lesions ranged from small and punctate (<1 cm) to moderate sized and confluent (4-5 cm) to diffuse and extensive. Spinal cord lesions, seen in five of seven children, were contiguous or segmental. Seven children (70%) made good clinical recovery while three children (30%) remained severely handicapped. There was no correlation between the site, extent and pattern of involvement and clinical outcome. However, the evolution of MRI findings on follow-up correlated well with the subsequent clinical course and outcome.


CONCLUSIONS
Although the extent and site of lesions on initial MRI scans are not predictive of clinical outcome, early MRI of the brain and spine is useful in aiding clinical diagnosis, and subsequent follow-up MRI is helpful in monitoring disease progression.
Khong
Pek-Lan
PL
Department of Diagnostic Radiology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong. plkhong@hkucc.hku.hk
Ho
Hok-Kung
HK
Cheng
Pui-Wai
PW
Wong
Virginia C N
VC
Goh
Winnie
W
Chan
Fu-Luk
FL
D000293:Adolescent; D001921:Brain / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004673:Encephalomyelitis, Acute Disseminated / Q000473:pathology*; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology*