Acute Acquired Metabolic Encephalopathy Based on Diffusion MRI

Abstract

Metabolic encephalopathy is a critical condition that can be challenging to diagnose. Imaging provides early clues to confirm clinical suspicions and plays an important role in the diagnosis, assessment of the response to therapy, and prognosis prediction. Diffusion-weighted imaging is a sensitive technique used to evaluate metabolic encephalopathy at an early stage. Metabolic encephalopathies often involve the deep regions of the gray matter because they have high energy requirements and are susceptible to metabolic disturbances. Understanding the imaging patterns of various metabolic encephalopathies can help narrow the differential diagnosis and improve the prognosis of patients by initiating proper treatment regimen early.

Acute Diffusion MRI Findings in Metabolic Encephalopathies are Diverse

“…We read with interest the excellent review article by Jeon et al [ 1 ] about the multimodal diffusion-weighted brain magnetic resonance imaging (MRI) findings of acute cerebral lesions in metabolic encephalopathies. Metabolic encephalopathies included hyper- and hypoglycemia, hyper- and hyponatremia, uremia, hyperammonemia, and vitamin B1 deficiency [ 1 ].…”

“…We read with interest the excellent review article by Jeon et al [ 1 ] about the multimodal diffusion-weighted brain magnetic resonance imaging (MRI) findings of acute cerebral lesions in metabolic encephalopathies. Metabolic encephalopathies included hyper- and hypoglycemia, hyper- and hyponatremia, uremia, hyperammonemia, and vitamin B1 deficiency [ 1 ]. Acute metabolic encephalopathies were usually found to share bilaterally symmetrical imaging abnormalities and manifest as vasogenic or cytotoxic edema, both of which can be reversible [ 1 ].…”

“…Metabolic encephalopathies included hyper- and hypoglycemia, hyper- and hyponatremia, uremia, hyperammonemia, and vitamin B1 deficiency [ 1 ]. Acute metabolic encephalopathies were usually found to share bilaterally symmetrical imaging abnormalities and manifest as vasogenic or cytotoxic edema, both of which can be reversible [ 1 ]. The study is appealing but raises the following questions and concerns.…”

Acute Acquired Metabolic Encephalopathy Based on Diffusion MRI: Note of an Error

“…I read with interest the review article titled “Acute Acquired Metabolic Encephalopathy Based on Diffusion MRI” by Jeon et al [ 1 ] in the December 2021 issue of the Korean Journal of Radiology . The authors supplied detailed information about the imaging features of acute acquired metabolic encephalopathies, and I obtained quite useful information from this article.…”

“…MRI may show abnormalities in the cortex, white matter, basal ganglia, and hippocampus. As described in the article, MRI findings in uremic encephalopathy are classified into three patterns: 1) cortical type, 2) basal ganglia type, and 3) diffuse white matter type [ 1 2 ]. The cortical type is the most common and is a part of the posterior reversible encephalopathy syndrome.…”