Use of diffusion-weighted imaging in recurrent central nervous system Whipple's disease: a case report and review of the literature

Raheja, Amit A.; Lui, Yvonne W.; Pinzon-Ardila, Alberto; Lim, Ruth P.; Sparr, Steven A.

doi:10.1016/j.clinimag.2009.05.011

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Volume 34, Issue 2 , Pages 143-147, March 2010

Use of diffusion-weighted imaging in recurrent central nervous system Whipple's disease: a case report and review of the literature

Amit A. Raheja
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
Yvonne W. Lui
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Corresponding author. Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467-2401, USA. Tel.: +1 718 920 4030.
Alberto Pinzon-Ardila
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
Ruth P. Lim
- Department of Radiology, NYU Medical Center, New York, NY, USA
Steven A. Sparr
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

Received 10 March 2009; accepted 5 May 2009. published online 17 September 2009.

Abstract

A case of Whipple's disease with development of antibiotic resistance is reported. The patient's symptomatology correlated with evolution of diffusion abnormality rather than with lesion enhancement. The lesion demonstrated no hyperperfusion, moderately elevated choline, and decreased N-acetylaspartate.

Conventional magnetic resonance (MR) imaging findings of central nervous system Whipple's disease are nonspecific and may mimic neoplasm. MR perfusion and spectroscopy findings are reported, which may assist in diagnosis. Change in diffusion restriction appears to be a potential imaging indicator of clinical progression and response to therapy.

Keywords: Diffusion, Whipple's disease, Magnetic resonance imaging, Central nervous system, Infection