Neuro-Behcet's disease: Diffusion MR imaging and proton MR spectroscopy

We herein report the case of a 53-year-old woman with Behcet's disease and an acute T2-hyperintense lesion in left side of the pons. Echo-planar "trace" diffusion MR imaging revealed high signal intensity changes at the lesion site on b = 1000 s/mm(2) images, initially suggesting restricted diffusion. On corresponding apparent diffusion coefficient maps, however, the lesion had high signal intensity and high apparent diffusion coefficient values (1.22 x 10(-3) mm(2)/s), compared with the contralateral normal side of the pons (0.86 x 10(-3) mm(2)/s) and compared with the normal temporal white matter (0.80 x 10(-3) mm(2)/s). This was consistent with the presence of increased diffusion, hence vasogenic edema. Proton MR spectroscopy excluded acute infarction. This particular pattern (high signal intensity on b = 1000 s/mm(2) images in association with high apparent diffusion coefficient values) likely represented the acute inflammatory process associated with disrupted brain-blood barrier in the fulminant form of neuro-Behcet's disease. Follow-up examinations less than or equal to2 years later revealed a remaining gliotic lesion.