PMC8484865_01
Overview of the axial T2-weighed images (T2WI) on day 13 after the onset of Kawasaki disease. (A,B) T2WI showing scattered high-intensity lesions mainly affecting the subcortical white matter. (C) An enlarged image showing the periventricular space revealing a radial pattern of hyperintensity along the deep cerebral veins (blue arrows). (D-F) White matter lesions observed bilaterally in the subcortical white matter, thalamus, and external capsule, and sparse in the internal capsule and corpus callosum.
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T2-weighted images (T2WI) showed bilateral symmetrical hyperintensities in the cerebral white matter and thalamus. The white matter lesions were observed predominantly in the subcortical white matter and sparsely in the internal capsule and corpus callosum (Figure 1). Linear radial hyperintensities parallel to the cerebral vessels of the periventricular space were also observed (Figure 1C).
Neuroimaging findings on days 13-14. (A-E) Several sequences of the head MRI on day 13. (A) Isointense white matter lesions on a T1-weighted image (T1WI). (B) Fluid-attenuated inversion recovery image showing a high intensity in the subcortical white matter and external capsule. (C) Post-gadolinium T1WI showing no enhancement in the white matter or perivascular lesions. (D) Diffusion-weighted imaging showing isointense signals in the white matter lesions. (E) An apparent diffusion coefficient map showing diffuse hyperintensity in the white matter. (F) Brain computed tomography (CT) performed 8 h after the MRI demonstrating cerebral and cerebellar edema with sulcal and cisternal effacement.
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T1-weighted image (T1WI), and there were hyperintense signals on fluid-attenuated inversion recovery (Figures 2A,B). The lesions showed no gadolinium enhancement (Figure 2C). The cerebral white matter displayed iso-intensity on diffusion-weighted images (Figure 2D), with high intensity on the apparent diffusion coefficient map (Figure 2E). These findings suggested vasogenic edema. Head CT demonstrated diffuse swelling of the cerebrum, cerebellum, and brainstem, with sulcal and cisternal effacement, suggesting brain herniation (Figure 2F).