Article Figures & Data
Figures
- Fig 1.
Flow chart showing the selection of the final study population. A total of 40 patients who underwent both conventional MR imaging and 3D-pCASL were clinically suspected of having encephalitis. Finally, 17 cases with HSE were included in this study.
- Fig 2.
Case 11, a 20-year-old female patient at the acute stage (5 days after the onset of symptoms). A, Axial T2 FLAIR shows multiple lesions located in right frontal and bilateral insular lobes, as well as the bilateral temporal lobes. B, 3D-pCASL demonstrates increased CBF, consistent with involved regions on axial T2 FLAIR (black arrows). C, Other lesions also show hyperperfusion in different affected areas. D, ROI site selection for bilateral cerebellum CBF on the pCASL CBF color map.
- Fig 3.
Case 12, a 47 -year-old female patient at the subacute stage (15 days after the onset of symptoms). A, Axial T2WI shows hyperintensities in bilateral frontal, temporal, and insular lobes and the cingulate gyrus. B, Axial T1WI demonstrates slight hypointensities. C, Slight hyperintensities are observed on coronal T2 FLAIR. D, 3D-pCASL shows high perfusion (black arrows) in the corresponding involved areas.
- Fig 4.
Case 1, a 17-year-old male patient. Serial T2WI (A, E, and I), T1WI (B, F, and J), and coronal T2 FLAIR (C, G, and K) demonstrate abnormal signals on the left temporal lobe and hippocampus. Serial follow-up 3D-pCASL perfusion imaging was performed, which reveals dynamic changes in the involved area on the 11th (D), 24th (H), and 30th day (L), respectively (black arrows). Meanwhile, the patient's condition markedly improved with effective therapeutic intervention.
- Fig 5.
A, The boxplot of nCBF values in acute-, subacute-, and chronic-stage lesions and the control group, respectively. B, Time course of mean CBF changes for lesions at different time points in 4 follow-up HSE cases. The mean CBF value of the lesions gradually decreased after treatment in 4 case series.
Tables
- Table 1:
Summary of the demographic and clinical features of consecutive patients with HSE
Case No. Age (yr) Sex Clinical Presentation Time (Days)a 1 17 M Headache, fever, sudden unconscious attack, seizure 11/24/30 2 58 M Headache, left lower extremity weakness and involuntary movement 4/14/20 3 35 M Headache, nausea, vomiting, and memory deterioration 6/42 4 49 F Headache and fever with irrelevant answer 2/17/29 5 21 F Headache, fever, slow response, and memory deterioration 14 6 27 M Persistent vertigo with sudden onset of left lower extremity weakness 26 7 32 M Headache, fever, and seizure 7 8 28 M Headache, dizziness, and memory deterioration 2 9 44 F Memory deterioration, slow response 7 10 50 M Headache, fever, dizziness, paroxysmal loss of consciousness, seizure 3 11 20 F Fever, disturbance of consciousness with limb seizure 5 12 47 F Headache, fever, behavioral and psychological disorder 15 13 47 M Headache, fever, dizziness 20 14 26 M Headache and fever with paroxysmal limb seizure 15 15 25 M Recurrent fever, paraphasia, memory deterioration, and limb seizure 85 16 46 M Headache, fever, convulsion with psychological and behavioral disorder 60 17 64 M Headache, dizziness, memory deterioration, paroxysmal loss of consciousness, and seizure 6 ↵a The time from symptom onset to 3D-pCASL evaluation.
- Table 2:
Initial conventional MR imaging and ASL findings after admission in patients with HSE
Case No. Lesion Locationa T2WI T1WI CE Perfusionb 1 L. T Slight hyper/hypo Slight hypo/hyper NA Obvious hyper 2 L. T, I Slight hyper Slight hypo/hyper Gyriform enhancement Obvious hyper 3 L. T, I Slight hyper Slight hypo/hyper Patchy enhancement Obvious hyper 4 R. F, T Slight hyper Slight hypo None Obvious hyper 5 L. F, I, and Bil. T Slight hyper/hyper Slight hypo/hyper Gyriform enhancement Obvious hyper 6 Bil. T, and R. P Slight hyper/hyper Slight hypo/hyper None Slight hypo 7 L. F, P, O, and Bil. I, T Slight hyper Iso Patchy enhancement Slight hyper/hyper 8 Bil. T, and L. I Slight hyper Slight hypo None Obvious hyper 9 Bil. F, T, I Slight hyper Slight hypo None Obvious hyper 10 Bil. F and cingulate gyrus Slight hyper Iso None Obvious hyper 11 R. F, and Bil. T, I Slight hyper Iso None Obvious hyper (multiple lesions) 12 Bil. F, T, I, and cingulate gyrus Slight hyper Slight hypo Patchy enhancement Obvious hyper 13 R. T, and Bil. I Slight hyper Slight hypo Slight meningeal enhancement Regional hyper 14 L. T, I Slight hypo/hyper Slight hypo/hyper Gyriform enhancement Regional hyper 15 L. T, I Slight hyper/hyper Slight hypo/hypo Slight gyriform enhancement Obvious hypo 16 R. T, I Slight hyper/hyper Slight hypo/hypo Slight enhancement Obvious hypo 17 R. T, I Slight hyper Slight hypo None Obvious hyper Note:— R indicates right; L, left; Bil., bilateral; F, frontal lobe; T, temporal lobe; P, parietal lobe; O, occipital lobe; I, insular lobe; hyper, hyperintensity or hyperperfusion; hypo, hypointensity or hyperperfusion; Iso, isointensity; CE, contrast enhancement; NA, not applicable.
↵a Abnormal signals on T2 FLAIR.
↵b Perfusion performance on the first ASL examination.
- Table 3:
Mean CBF and mean nCBF values in the lesions at different stages and control group findings
Stage (Days) No. of Cases Range of CBF Values (mL/100g/min) Mean CBF Values (mL/100g/min) Mean nCBF Values Acute stage (≤14) 11 59.5–162.3 121.5 ± 33.8 2.68 ± 0.54 Subacute stage (15–25) 6 66.1–126.5 98.3 ± 22.8 2.42 ± 0.52 Chronic stage (≥26) 6 23.0–63.1 33.9 ± 15.0 0.87 ± 0.30 Control groupa 15 47.9–71.9 58.8 ± 7.0 1.33 ± 0.08 ↵a The temporal cortex perfusion as a control reference.
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