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. 2016 Feb 25:15:25.
doi: 10.1186/s12938-016-0136-7.

MRI signal intensity differentiation of brainstem encephalitis induced by Enterovirus 71: a classification approach for acute and convalescence stages

Hongwu Zeng  1   2   3 , Wenxian Huang  4 , Feiqiu Wen  5 , Yonker Wang  6 , Yungen Gan  7 , Weibin Zeng  8 , Ranran Chen  9 , Yanxia He  10 , Zaiyi Liu  11 , Changhong Liang  12   13 , Kelvin K L Wong  14
Affiliations

MRI signal intensity differentiation of brainstem encephalitis induced by Enterovirus 71: a classification approach for acute and convalescence stages

Hongwu Zeng et al. Biomed Eng Online. .

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.

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Figures

Fig. 1
Fig. 1
Schematic diagram depicting the location of primary lesion of brainstem encephalitis. The primary lesion is located at the posterior junction region of the pons and medulla oblongata. It is usually presented as an oval shaped fleck, which varies from 1 to 2.5 cm in length
Fig. 2
Fig. 2
T1WI and T2WI MRI scans of diseased and healthy subjects. a. Acute stage: Sagittal MR images revealed a longitudinal lesion at the posterior junction region of the pons and medulla oblongata, with prolonged T1 (a, white arrow) and prolonged T2 (b, black arrow) signal. b Convalescence stage: MR images showed there was a longitudinal malacia cavity at the posterior junction region of the pons and medulla, with prolonged T1 (a, white arrow) and prolonged T1 (b, black arrow) signal. c) Healthy controls: plain MRI scan show there is no abnormality
Fig. 3
Fig. 3
Simultaneous T1WI and T2WI histogram plots comparison based on different stages individually. a Histograms for T1 and T2 signal intensity at acute stage. b Histograms for T1 and T2 signal intensity at convalescence stage. Standardized histogram showed a lower T1 signal intensity (with the mean value of intensities at 47.81) at acute stage while compared with convalescence stage (with the mean value of intensities at 55.65). Also standardized histogram showed a higher T2 signal intensity (with the mean value of intensities at 106.62) at acute stage in comparison with convalescence stage (with the mean value of intensities at 70.72)
Fig. 4
Fig. 4
Different stages histogram plots comparison for T1WI and T2WI individually. a Histograms for T1 signal intensity of three groups. b Histograms for T2 signal intensity of three groups. In practice, the overall T1 signal intensity values increase as we traverse from the acute to the convalescence stages, and then to the healthy subjects. However, exceptions of this can happen in 4 of the cases where the condition deteriorate, the primary lesion in the brainstem that developed in conjunction to encephalomalacia resulting in a lower signal in T1WI and higher signal in T2WI. This produces an outlier represented by an extra secondary peak on the left side of the histogram (lower signal intensity values) in the T1WI, and on right side of the histogram (higher signal intensity values) in the T2WI
Fig. 5
Fig. 5
Comparison of means of T1WI and T2WI distributions for different stages of the disease for patients, and for healthy subjects. Statistical analysis revealed that there was significant difference of T1 signal intensity among the three groups; and also T2 signal intensity was much lower for the healthy subjects in comparison with the other two groups
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References

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