Leslie Dervan1, Andrew Poliakov2, Seth D Friedman2, Dennis Shaw3, Catherine Pihoker4, Joan S Roberts5, Todd Richards6, Kenneth Marro6, Monica S Vavilala7. 1. Department of Pediatrics, University of Washington, Seattle, Washington. 2. 1] Department of Radiology, Seattle Children's Hospital, Seattle, Washington [2] Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington. 3. 1] Department of Radiology, Seattle Children's Hospital, Seattle, Washington [2] Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington [3] Department of Radiology, University of Washington, Seattle, Washington. 4. 1] Department of Pediatrics, University of Washington, Seattle, Washington [2] Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington [3] Division of Endocrinology and Diabetes, Seattle Children's Hospital, Seattle, Washington. 5. 1] Department of Pediatrics, University of Washington, Seattle, Washington [2] Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington. 6. Department of Radiology, University of Washington, Seattle, Washington. 7. 1] Department of Pediatrics, University of Washington, Seattle, Washington [2] Department of Radiology, Seattle Children's Hospital, Seattle, Washington [3] Department of Anesthesiology, University of Washington, Seattle, Washington.
Abstract
BACKGROUND: The pathophysiology resulting in cerebral edema in pediatric diabetic ketoacidosis (DKA) is unknown. To investigate the changes in white matter microstructure in this disease, we measured diffusion tensor imaging (DTI) parameters, including apparent diffusion coefficient (ADC), fractional anisotropy (FA), and radial and axial diffusivity in children with DKA at two time points during treatment. METHODS: A prospective observational study was conducted at Seattle Children's Hospital, Seattle, WA. Thirty-two children admitted with DKA (pH < 7.3, bicarbonate < 15 mEq/l, glucose > 300 mg/dl, and ketosis; 11.9 ± 3.2 y; and 47% male) were enrolled and underwent two serial paired diffusion magnetic resonance imaging (MRI) scans following hospital admission. Seventeen of the 32 participants had diffusion tensor images of adequate quality for tract-based spatial statistics (TBSS) analysis. RESULTS: TBSS mapping demonstrated main white matter tract areas with a significant increase in FA and areas with a significant decrease in ADC, from the first to the second MRI. Both radial and axial diffusivity terms showed change, with a diffuse pattern of involvement. CONCLUSION: Consistent DTI changes occurred during DKA treatment over a short time frame. These findings describe widespread water diffusion abnormalities in DKA, supporting an association between clinical illness and DTI markers of microstructural change in white matter.
BACKGROUND: The pathophysiology resulting in cerebral edema in pediatric diabetic ketoacidosis (DKA) is unknown. To investigate the changes in white matter microstructure in this disease, we measured diffusion tensor imaging (DTI) parameters, including apparent diffusion coefficient (ADC), fractional anisotropy (FA), and radial and axial diffusivity in children with DKA at two time points during treatment. METHODS: A prospective observational study was conducted at Seattle Children's Hospital, Seattle, WA. Thirty-two children admitted with DKA (pH < 7.3, bicarbonate < 15 mEq/l, glucose > 300 mg/dl, and ketosis; 11.9 ± 3.2 y; and 47% male) were enrolled and underwent two serial paired diffusion magnetic resonance imaging (MRI) scans following hospital admission. Seventeen of the 32 participants had diffusion tensor images of adequate quality for tract-based spatial statistics (TBSS) analysis. RESULTS:TBSS mapping demonstrated main white matter tract areas with a significant increase in FA and areas with a significant decrease in ADC, from the first to the second MRI. Both radial and axial diffusivity terms showed change, with a diffuse pattern of involvement. CONCLUSION: Consistent DTI changes occurred during DKA treatment over a short time frame. These findings describe widespread water diffusion abnormalities in DKA, supporting an association between clinical illness and DTI markers of microstructural change in white matter.
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