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Fig. 1 | Egyptian Journal of Radiology and Nuclear Medicine

Fig. 1

From: Multi-parametric magnetic resonance imaging in acute necrotizing encephalopathy of children: validity and prognostic value

Fig. 1

Multi-parametric MRI dynamic changes of the brain of a 1-year-old patient who was left with marked sequelae. He presented with behavior changes, abnormal movement, and agitation and was diagnosed with ANEC. At the onset of the disease, a, b, and c axial T1 WI, d coronal T2 WI show lesions on bilateral thalamic, basal ganglia (caudate nucleus), WM cerebral parenchyma (corona radiata), and WM cerebellar parenchyma being low signal in T1WI with small focus in the center of the thalamic lesions, high signal in T2WI. e and f Axial ADC shows typical tricolor pattern of thalamic lesions being high signal at the center, low surrounding signal, and bright peripheral signal; these also seen at cerebellar WM lesion. g Single-voxel MR spectrogram (TE, 115) of cerebellar WM lesion shows increased glutamate/glutamine complex peak intensities at 2.3 ppm and lipid/lactate complex peak intensities at 1.2 ppm, with reduced NNA peak at 2 ppm. Follow-up after 4 weeks, h and i axial T2 WI, j and k FLAIR images, and reveal disappearance of WM cerebral lesions, generalized atrophy of the cerebral hemispheres, with widened ventricular size, impressive regression of the thalamic and cerebellum lesions being replaced by encephalomalacia surrounded by gliosis. l and m SWI shows hemosiderin deposition in the bilateral thalami and the cerebella (red arrow). n MRS shows dramatic reduction of the lactate peak (arrow) and the NAA peak returns within the normal range

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