title: Susceptibility-weighted imaging helps to discriminate pediatric multiple sclerosis from acute disseminated encephalomyelitis.
abstract: BACKGROUND
  Susceptibility-weighted imaging is a relatively new magnetic resonance imaging sequence that can identify lesions of multiple sclerosis in adults. This study was designed to determine if susceptibility-weighted imaging is a useful discriminator between children who develop multiple sclerosis and children with monophasic acute disseminated encephalomyelitis.
  
  
  METHODS
  Eighteen children who presented with acute central nervous system demyelination and had a brain magnetic resonance imaging study including susceptibility-weighted imaging within 6 months of the first clinical attack were studied. Final diagnosis was based on international consensus definitions. Brain lesions detected on the fluid-attenuated inversion recovery sequence were assessed for abnormal signal on susceptibility-weighted imaging. The burden of susceptibility abnormalities was then analyzed for differences between the multiple sclerosis and acute disseminated encephalomyelitis groups.
  
  
  RESULTS
  Eight patients had a final diagnosis of acute disseminated encephalomyelitis and ten had multiple sclerosis. Twenty-two percent of fluid-attenuated inversion recovery lesions were identified on susceptibility-weighted imaging. The percentage of fluid-attenuated inversion recovery lesions identified on susceptibility-weighted imaging differed between the multiple sclerosis and acute disseminated encephalomyelitis groups (P = 0.04). The median percentage (minimum-maximum) of lesions identified on susceptibility-weighted imaging in the multiple sclerosis group was 0.22 (0-0.68) and in the acute disseminated encephalomyelitis group was 0.0 (0-0.17).
  
  
  CONCLUSIONS
  Susceptibility-weighted imaging may be a useful technique in differentiating acute disseminated encephalomyelitis from multiple sclerosis at initial presentation.
authors.affiliation: Department of Radiology, Washington University School of Medicine, St. Louis, Missouri. Electronic address: kellyj@mir.wustl.edu.
authors.forename: James E
authors.initials: JE
authors.lastname: Kelly
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Soe
authors.initials: S
authors.lastname: Mar
authors.affiliation: Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Gina
authors.initials: G
authors.lastname: D'Angelo
authors.affiliation: Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Gongfu
authors.initials: G
authors.lastname: Zhou
authors.affiliation: Department of Pediatric Radiology, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Dhanashree
authors.initials: D
authors.lastname: Rajderkar
authors.affiliation: Department of Radiology, Washington University School of Medicine, St. Louis, Missouri; Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Tammie L S
authors.initials: TL
authors.lastname: Benzinger
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004673:Encephalomyelitis, Acute Disseminated / Q000175:diagnosis* / Q000473:pathology*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000473:pathology*; D011446:Prospective Studies
keywords: ADEM; acute disseminated encephalomyelitis; multiple sclerosis; pediatric demyelination; susceptibility-weighted imaging