title: Childhood encephalitis: relationship between diffusion abnormalities and clinical outcome.
abstract: BACKGROUND
  The impact of restricted diffusion on clinical outcome has not been well studied in childhood encephalitis. We hypothesized that the patients with lesions with restricted diffusion (LRD) would have worse clinical outcome.
  
  
  METHODS
  We reviewed the MR studies of 83 children with encephalitis for LRD. An MRI scoring system (0-12) based on fluid-attenuated inversion recovery (FLAIR) imaging was created to evaluate the extent of imaging abnormality. Clinical outcome was graded by using Glasgow outcome scale (GOS) (1-5) in 1st and 12th month: 1 for death and five for full recovery. With respect to diffusion, the correlation between imaging score and GOS was assessed. Logistic regression analysis was used to explore the impact of diffusion and imaging score on clinical outcome. The patients were divided into three subgroups regarding imaging score: I, 0-4; II, 5-8; and III, 9-12.
  
  
  RESULTS
  LRD was found in 28 patients. Negative significant correlation was found between imaging score and GOS in the group with LRD in both 1st month (R = -0.67, P < 0.001) and 12th month (R = -0.56, P = 0.001). Multivariate logistic regression showed that LRD (P < 0.001) and age (P = 0.026) were significant independent risk factors for unfavorable outcome in 1st month, and both LRD (P = 0.001) and imaging score (P = 0.043) were significant risk factors for unfavorable outcome in 12th month.
  
  
  CONCLUSIONS
  Patients with LRD have a worse clinical outcome than those without LRD. In patients with LRD, those with a greater extent of abnormality have a poorer outcome.
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Keelong, Linkou Medical Center and Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan, Tao Yuan, Taiwan, Republic of China, alexmcwchop@yahoo.com.
authors.forename: Alex M
authors.initials: AM
authors.lastname: Wong
authors.forename: Jainn-Jim
authors.initials: JJ
authors.lastname: Lin
authors.forename: Cheng-Hong
authors.initials: CH
authors.lastname: Toh
authors.forename: Larissa T
authors.initials: LT
authors.lastname: Bilaniuk
authors.forename: Robert A
authors.initials: RA
authors.lastname: Zimmerman
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Chang
authors.forename: Kuang-Lin
authors.initials: KL
authors.lastname: Lin
authors.forename: Huei-Shyong
authors.initials: HS
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004660:Encephalitis / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors