Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
권호 표지

Transient Splenial Lesions in the Splenium of Corpus Callosum in Seven Patients: MR Findings and Clinical Correlations

뇌량 팽대의 일과성 병변: 7명의 환자에서의 자기공명 영상소견과 임상 양상의 연관성

  • Park, Ju Young (Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Lee, In Ho (Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Song, Chang June (Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Hwang, Hee Youn (Department of Anesthesiology and Pain Medicine, Bestian Daejeon Hospital)
  • 박주영 (충남대학교병원 영상의학과) ;
  • 이인호 (충남대학교병원 영상의학과) ;
  • 송창준 (충남대학교병원 영상의학과) ;
  • 황희윤 (베스티안 우송병원 마취통증의학과)
  • Received : 2012.02.28
  • Accepted : 2012.11.26
  • Published : 2013.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : The purpose of this study is to correlate the imaging findings and the clinical findings in patients with transient splenial lesions (TSL). Materials and Methods: Total of 7 patients (M: F = 4: 3; age range 11 - 38 years, mean age 25.5 years) were studied between November 2006 and April 2011. The MRI findings and clinical findings in all patients were retrospectively reviewed. The location, MR signal intensity, restricted diffusion, enhancement pattern and reversibility from the follow up images were reviewed. Clinical features were reviewed with respect to the presented symptoms, signs, treatment and outcome. Results: The lesions were located in the splenium of corpus callosum in all patients. All lesions showed high signal intensity on diffusion weighted imaging (DWI), and six patients showed restricted diffusion on the apparent diffusion coefficient (ADC) map. ADC map was not available in one patient. All lesions (n = 7) showed high signal intensity on the T2 weighted image (T2WI). Five of the patients (71.4%) with follow up images (range 7 - 34 days) showed complete resolution of focal high signal intensity on DWI, with recovery of ADC values as well as T2WI. After contrast media administration, none of the lesions showed any enhancements. All lesions with various etiologies including TB medication were developed in younger age patients and showed reversibility after the acceptable period of minimum 7 days with conservative treatment. Conclusion: All TSL showed nonspecific imaging findings, including restricted diffusion on DWI and ADC map on the initial images. However, reversibility of the lesions and the young age preference can be a characteristic finding of TSL with acceptable period of minimum 7 days. In addition, to keep it in mind that various etiologies including TB medication may cause TSL, is important for radiologists as well as clinicians.

목적: 이 연구의 목적은 뇌량 팽대에 일과성 병변을 보이는 환자의 영상 소견과 임상 양상의 연관성을 연구하는 데 있다. 대상과 방법: 2006년 11월부터 2011년 4월까지 일과성 뇌량 팽대 병변을 보인 총 7명의 환자 (남성: 여성 = 4:3, 연령 11-38세, 평균연령 25.5세)를 대상으로 하였다. 모든 환자의 자기 공명 영상 소견과 임상 소견을 후향적으로 검토하였다. 자기 공명 영상에서는 병변의 위치, 신호 강도, 확산 제한, 조영 증강과 추적 검사에서의 병변의 가역성에 대하여 평가하였다. 증상과 증후, 치료 및 결과에 대한 임상 소견도 후향적으로 검토하였다. 결과: 모든 환자에서 병변은 뇌량 팽대에 국한되었다. 모든 병변은 확산 강조 영상에서 고신호 강도를 보였으며 6명의 환자는 겉보기 확산 계수 영상에서 확산 제한을 보였다. 한 명의 환자에서는 겉보기 확산 계수 영상을 얻지 못하였다. 모든 환자(7명)는 T2 강조 영상에서 고신호 강도를 보였다. 5명 (71.4%)의 환자는 추적 검사 영상 (범위 7-34일) 중 확산 강조 영상과 겉보기 확산 계수 영상에서 고신호 강도와 확산 제한의 완전한 회복이 있었으며 T2 강조 영상에서도 완전한 회복을 보였다. 모든 병변에서 조영제 주입 후 조영 증강은 보이지 않았다. 모든 병변은 항결핵제를 포함한 다양한 원인으로 젊은 환자에서 발생하였고 보존적 치료로 7일 이상의 시간 뒤에는 회복되었다. 결론: 모든 일과성 뇌량 팽대 병변은 최초 확산 강조 영상과 겉보기 확산 계수 영상에서 확산 제한과 같은 비특이적 영상 소견을 보였다. 그렇지만 젊은 환자에서 호발한 점과 7일 이상의 시간 뒤에 가역적인 변화를 보인다는 것은 일과성 뇌량 팽대 병변의 특징이 될 수 있다. 또한, 영상의학과 의사뿐 아니라 임상의사는 항결핵제를 포함한 다양한 원인이 이러한 병변을 일으킬 수 있다는 것을 명심해야 한다.

Keywords

References

  1. Takanashi J, Barkovich AJ, Yamaguchi K, Kohno Y. Influenzaassociated encephalitis/encephalopathy with a reversible lesion in the splenium of the corpus callosum: a case report and literature review. AJNR Am J Neuroradiol 2004;25:798-802
  2. Takanashi J, Barkovich AJ, Shiihara T, et al. Widening spectrum of a reversible splenial lesion with transiently reduced diffusion. AJNR Am J Neuroradiol 2006;27:836-838
  3. Kim SS, Chang KH, Kim ST, et al. Focal lesion in the splenium of the corpus callosum in epileptic patients: antiepileptic drug toxicity? AJNR Am J Neuroradiol 1999;20:125-129
  4. Maeda M, Shiroyama T, Tsukahara H, Shimono T, Aoki S, Takeda K. Transient splenial lesion of the corpus callosum associated with antiepileptic drugs: evaluation by diffusionweighted MR imaging. Eur Radiol 2003;13:1902-1906 https://doi.org/10.1007/s00330-002-1679-5
  5. Polster T, Hoppe M, Ebner A. Transient lesion in the splenium of the corpus callosum: three further cases in epileptic patients and a pathophysiological hypothesis. J Neurol Neurosurg Psychiatry 2001;70:459-463 https://doi.org/10.1136/jnnp.70.4.459
  6. Oster J, Doherty C, Grant PE, Simon M, Cole AJ. Diffusionweighted imaging abnormalities in the splenium after seizures. Epilepsia 2003;44:852-854 https://doi.org/10.1046/j.1528-1157.2003.40902.x
  7. Mirsattari SM, Lee DH, Jones MW, Blume WT. Transient lesion in the splenium of the corpus callosum in an epileptic patient. Neurology 2003;60:1838-1841 https://doi.org/10.1212/01.WNL.0000058754.99940.11
  8. Honda K, Nishimiya J, Sato H, et al. Transient splenial lesion of the corpus callosum after acute withdrawal of antiepileptic drug: a case report. Magn Reson Med Sci 2006;5:211-215 https://doi.org/10.2463/mrms.5.211
  9. Bulakbasi N, Kocaoglu M, Tayfun C, Ucoz T. Transient splenial lesion of the corpus callosum in clinically mild influenza-associ- ated encephalitis/encephalopathy. AJNR Am J Neuroradiol 2006;27:1983-1986
  10. Tada H, Takanashi J, Barkovich AJ, et al. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion. Neurology 2004;63:1854-1858 https://doi.org/10.1212/01.WNL.0000144274.12174.CB
  11. Gallucci M, Limbucci N, Paonessa A, Caranci F. Reversible focal splenial lesions. Neuroradiology 2007;49:541-544 https://doi.org/10.1007/s00234-007-0235-z
  12. Hagemann G, Mentzel HJ, Weisser H, Kunze A, Terborg C. Multiple reversible MR signal changes caused by Epstein-Barr virus encephalitis. AJNR Am J Neuroradiol 2006;27:1447-1449
  13. Takanashi J, Miyamoto T, Ando N, et al. Clinical and radiological features of rotavirus cerebellitis. AJNR Am J Neuroradiol 2010;31:1591-1595 https://doi.org/10.3174/ajnr.A2131
  14. Oztoprak I, Engin A, Gumus C, Egilmez H, Oztoprak B. Transient splenial lesions of the corpus callosum in different stages of evolution. Clin Radiol 2007;62:907-913 https://doi.org/10.1016/j.crad.2007.04.012
  15. Kobata R, Tsukahara H, Nakai A, et al. Transient MR signal changes in the splenium of the corpus callosum in rotavirus encephalopathy: value of diffusion-weighted imaging. J Comput Assist Tomogr 2002;26:825-828 https://doi.org/10.1097/00004728-200209000-00028