title: Patterns in early diffusion-weighted MRI in children with haemolytic uraemic syndrome and CNS involvement.
abstract: OBJECTIVE
  Diffusion-weighted imaging (DWI) in children with diarrhoea associated haemolytic uraemic syndrome (D+HUS) and cerebral involvement was evaluated retrospectively.
  
  
  METHODS
  DWI within 24 h of onset of neurological symptoms. The apparent diffusion coefficient (ADC) was measured in grey/white matter and correlated with clinical and laboratory findings.
  
  
  RESULTS
  DWI was abnormal in all. Abnormal ADC was detected in the supratentorial white matter (6/12) and cortex (1/12), the basal ganglia (5/12), the thalami (4/12), and the cerebellum (1/12). ADC was reduced in 5/12, increased in 4/12, and both in 3/12. Mean serum sodium was lower in patients with DWI abnormalities affecting the white matter (6/12), than in those with basal ganglia/thalamic involvement (6/12). Neurological outcome was normal in 4/11 and abnormal in 7/11, and 1 patient died, outcome did not correlate to either localisation or type of DWI abnormality.
  
  
  CONCLUSIONS
  In D+HUS with neurological symptoms, early DWI may reveal abnormal ADC not only in the basal ganglia/thalami, but also in the white matter/cortex. Besides thrombotic microangiopathy, toxic effects of shiga toxin, azotaemia and hyponatraemia / hypoosmolality may be involved in cerebral involvement in children with D+HUS. Findings on early MRI seem not to predict clinical course or outcome.
  
  
  CONCLUSIONS
  • DWI MR imaging may detect early CNS involvement in haemolytic uraemic syndrome • Different pathogenetical mechanisms may contribute to the CNS disease in HUS • Early MRI findings do not seem to allow prediction of clinical outcome.
authors: Institute of Diagnostic and Therapeutic Neuroradiology, Hannover Medical School, 30623 Hannover, Germany. donnerstag.frank@mh-hannover.de
authors: Frank
authors: F
authors: Donnerstag
authors: Xiaoqi
authors: X
authors: Ding
authors: Lars
authors: L
authors: Pape
authors: Eva
authors: E
authors: Bültmann
authors: Thomas
authors: T
authors: Lücke
authors: Jan
authors: J
authors: Zajaczek
authors: Ludwig
authors: L
authors: Hoy
authors: Anibh Martin
authors: AM
authors: Das
authors: Heinrich
authors: H
authors: Lanfermann
authors: Jochen
authors: J
authors: Ehrich
authors: Hans
authors: H
authors: Hartmann
mesh_terms: D001927:Brain Diseases / Q000175:diagnosis* / Q000209:etiology*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000209:etiology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies