title: MRI signal intensity differentiation of brainstem encephalitis induced by Enterovirus 71: a classification approach for acute and convalescence stages.
abstract: BACKGROUND
  The objective of this study is to assess standardized histograms of signal intensities of T1 signal and T2 signal on sagittal view without enhancement during (1) acute stage, and (2) convalescence stage of pediatric patients with Enterovirus 71 related brainstem encephalitis (BE), and with respect to (3) healthy normal.
  
  
  METHODS
  Our subjects were hospitalized between March 2010 and October 2012, and underwent pre- and post-contrast MRI studies. The research question to be answered is whether the comparison of the MRI image intensity histograms and relevant statistical quantification can add new knowledge to the diagnosis of BE patients. So, both 25 cases in acute stage with prolonged T1 and T2 signal, without enhancement, and 13 cases in convalescence stage were introduced. In additional, a healthy group with 25 cases was recruited for comparison.
  
  
  RESULTS
  MRI signal intensity histogram changes of the lesions were compared at the acute and convalescence stages of the disease. Our preliminary results suggest that standardized histograms of signal intensities and their statistical properties are able to provide diagnostic information for the clinical assessment of the disease. Different stages pertaining to the histogram plots comparison showed that overall T1 signal intensity values increase as we traverse from the acute stage to the convalescence stage. And then for the healthy subjects, the T2 signal intensity values changed their magnitudes in a reverse direction. However, exceptions of this can happen in four cases where the primary lesions occurred in the brainstem that developed encephalomalacia resulting in a lower signal in T1WI and higher signal in T2WI. Statistical analysis revealed there was significant difference of T1 signal intensity among the three groups; and also, the T2 signal intensity was lower than other two groups.
  
  
  CONCLUSIONS
  Standardized histogram of T1 and T2 intensity provide valuable and useful information for disease diagnosis and evaluation, which can potentially help medical doctors to save the lives of children.
authors.affiliation: School of Medicine, Southern Medical University, Zhongshan Er Road No. 106, 510080, Guangzhou City, Guangdong Province, People's Republic of China. homerzeng@126.com.|Department of Radiology, Guangdong General Hospital, Guangdong, People's Republic of China. homerzeng@126.com.|Radiology, Neurology and Pediatric Intensive Care Unit Department, Shenzhen Children's Hospital, Guangdong, People's Republic of China. homerzeng@126.com.
authors.forename: Hongwu
authors.initials: H
authors.lastname: Zeng
authors.affiliation: Radiology, Neurology and Pediatric Intensive Care Unit Department, Shenzhen Children's Hospital, Guangdong, People's Republic of China. huangwenxian6@126.com.
authors.forename: Wenxian
authors.initials: W
authors.lastname: Huang
authors.affiliation: Radiology, Neurology and Pediatric Intensive Care Unit Department, Shenzhen Children's Hospital, Guangdong, People's Republic of China. fwen62@126.com.
authors.forename: Feiqiu
authors.initials: F
authors.lastname: Wen
authors.affiliation: Department of Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA. yonkerwang@gmail.com.
authors.forename: Yonker
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Radiology, Neurology and Pediatric Intensive Care Unit Department, Shenzhen Children's Hospital, Guangdong, People's Republic of China. gdszgyg-1@126.com.
authors.forename: Yungen
authors.initials: Y
authors.lastname: Gan
authors.affiliation: Radiology, Neurology and Pediatric Intensive Care Unit Department, Shenzhen Children's Hospital, Guangdong, People's Republic of China. weibin84@126.com.
authors.forename: Weibin
authors.initials: W
authors.lastname: Zeng
authors.affiliation: Radiology, Neurology and Pediatric Intensive Care Unit Department, Shenzhen Children's Hospital, Guangdong, People's Republic of China. ranranchen1989@126.com.
authors.forename: Ranran
authors.initials: R
authors.lastname: Chen
authors.affiliation: Radiology, Neurology and Pediatric Intensive Care Unit Department, Shenzhen Children's Hospital, Guangdong, People's Republic of China. yanxiahe1119@163.com.
authors.forename: Yanxia
authors.initials: Y
authors.lastname: He
authors.affiliation: Department of Radiology, Guangdong General Hospital, Guangdong, People's Republic of China. zyliu@163.com.
authors.forename: Zaiyi
authors.initials: Z
authors.lastname: Liu
authors.affiliation: School of Medicine, Southern Medical University, Zhongshan Er Road No. 106, 510080, Guangzhou City, Guangdong Province, People's Republic of China. cjr.lchh@vip.163.com.|Department of Radiology, Guangdong General Hospital, Guangdong, People's Republic of China. cjr.lchh@vip.163.com.
authors.forename: Changhong
authors.initials: C
authors.lastname: Liang
authors.affiliation: School of Medicine, Western Sydney University, Locked Bag 1797 Penrith, Campbelltown, NSW, 2751, Australia. Kelvin.Wong@westernsydney.edu.au.
authors.forename: Kelvin K L
authors.initials: KK
authors.lastname: Wong
mesh_terms: D000208:Acute Disease; D001933:Brain Stem / Q000821:virology*; D016022:Case-Control Studies; D002648:Child; D003289:Convalescence; D018792:Encephalitis, Viral / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D029821:Enterovirus A, Human / Q000502:physiology*; D004769:Enterovirus Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006232:Hand, Foot and Mouth Disease / Q000150:complications; D006760:Hospitalization; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D012189:Retrospective Studies