American Journal of Neuroradiology 27:1230-1233, June-July 2006
© 2006 American Society of Neuroradiology
BRAIN
Brain MRI in Neurodegeneration with Brain Iron Accumulation with and without PANK2 Mutations
a Departments of Molecular and Medical Genetics, School of Medicine, Oregon Health & Science University, Portland, Ore
b Pediatrics and Neurology, School of Medicine, Oregon Health & Science University, Portland, Ore
c Departments of Radiology, University of Wisconsin, Madison, Wis
d Neurology, University of Wisconsin, Madison, Wis
e Howard Hughes Medical Institute and Departments of Medicine and Pediatrics, University of California, San Francisco, Calif
Address correspondence and reprint requests to Dr. S. Hayflick, Department of Molecular and Medical Genetics, L-103a, Portland, OR 97239
BACKGROUND AND OBJECTIVE: Patients with a clinical diagnosis of neurodegeneration with brain iron accumulation (NBIA, formerly called Hallervorden-Spatz syndrome) often have mutations in PANK2, the gene encoding pantothenate kinase 2. We investigated correlations between brain MR imaging changes, mutation status, and clinical disease features.
METHODS: Brain MRIs from patients with NBIA were reviewed by 2 neuroradiologists for technical factors, including signal intensity abnormalities in specific brain regions, presence and location of atrophy, presence of white matter abnormality, contrast enhancement, and other comments. PANK2 genotyping was performed by polymerase chain reaction amplification of patient genomic DNA followed by automated nucleotide sequencing.
RESULTS: Sixty-six MR imaging examinations from 49 NBIA patients were analyzed, including those from 29 patients with mutations in PANK2. All patients with mutations had the specific pattern of globus pallidus central hyperintensity with surrounding hypointensity on T2-weighted images, known as the eye-of-the-tiger sign. This sign was not seen in any studies from patients without mutations. Even before the globus pallidus hypointensity developed, patients with mutations could be distinguished by the presence of isolated globus pallidus hyperintensity on T2-weighted images. Radiographic evidence for iron deposition in the substantia nigra was absent early in disease associated with PANK2 mutations. MR imaging abnormalities outside the globus pallidus, including cerebral or cerebellar atrophy, were more common and more severe in mutation-negative patients. No specific MR imaging changes could be distinguished among the mutation-negative patients.
CONCLUSION: MR imaging signal intensity abnormalities in the globus pallidus can distinguish patients with mutations in PANK2 from those lacking a mutation, even in the early stages of disease.
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