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RT Journal Article
SR Electronic
T1 Diffusion-Weighted Imaging of Acute Corticospinal Tract Injury Preceding Wallerian Degeneration in the Maturing Human Brain
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1057
OP 1066
VO 24
IS 6
A1 Mazumdar, Avi
A1 Mukherjee, Pratik
A1 Miller, Jeffrey H.
A1 Malde, Hiten
A1 McKinstry, Robert C.
YR 2003
UL http://www.ajnr.org/content/24/6/1057.abstract
AB BACKGROUND AND PURPOSE: Wallerian degeneration, the secondary degeneration of axons from cortical and subcortical injury, is associated with poor neurologic outcome. Since diffusion-weighted (DW) imaging is sensitive to early changes of cytotoxic edema, DW imaging may depict the acute injury to descending white matter tracts that precedes Wallerian degeneration; this injury is not visible on conventional CT or MR images in the maturing human brain.METHODS: Two neuroradiologists retrospectively analyzed clinical MR images in six children (aged 3 days to 5 months) with DW findings consistent with acute injury of the descending white matter tract due to territorial anterior or middle cerebral artery infarction. In five patients, images were obtained as a part of routine clinical evaluation. The remaining patient was a part of a prospective study of brain injury. Imaging findings were correlated with clinical outcomes.RESULTS: In all six patients, DW imaging performed 2–8 days after the onset of ischemia depicted injury to the descending white matter tract ipsilateral to the territorial infarct. Conventional MR images of the ipsilateral descending white matter tracts were abnormal in three patients. In all five patients for which follow-up results were available, the presence of DW changes was correlated with persistent neurologic disability.CONCLUSION: As shown in this retrospective analysis, DW imaging can depict acute injury to the descending white matter tract in neonates and infants, when conventional MR imaging may show normal findings. These DW findings likely precede the development of Wallerian degeneration, and they may portend a poor clinical outcome.