Study of Subclinical Cerebral Edema in Diabetic Ketoacidosis by Magnetic Resonance Imaging T2 Relaxometry and Apparent Diffusion Coefficient Maps

Abstract

Cerebral edema is the most significant complication in children with diabetic ketoacidosis (DKA). Our goal was to study whether subclinical cerebral edema was preferentially vasogenic or cytotoxic. Magnetic resonance imaging (MRI)—diffusion-weighted imaging (DWI) and T2 relaxometry (T2R)—were obtained in pediatric patients presenting with severe diabetic ketoacidosis (DKA) 6–12 hours after initial DKA treatment and stabilization and 96 hours after correction of DKA. T2 relaxometry was significantly increased during treatment in both white and gray matter, in comparison to the absolute T2R values 96 hours after correction of DKA (p = .034). Classic intracellular cytotoxic edema could not be detected, based on the lack of a statistically significant decrease in ADC values. ADC values were instead elevated, implying a large component of cell membrane water diffusion, correlating with the elevated white and gray matter T2R. We discuss the findings in relation to cerebral blood volume, cerebral vasoregulatory dysfunction, and cerebral hyperemia.