Cortical Laminar Necrosis Caused by Immunosuppressive Therapy and Chemotherapy
Nuria Bargalló
,a,
Marta Burrela,
Joan Berenguera,
Federico Cofana,
Laura Buñescha and
Josep M. Mercadera
a From the Department of Radiology (N.B., M.B., J.B., L.B., J.M.M.) and the Renal Transplant Unit (F.C.), Hospital Clínic Provincial de Barcelona, Spain.
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FIG 1. Case 1: 54-year-old woman who underwent renal transplantation and immunosuppressive therapy with FK 506.
A, Contrast-enhanced axial CT scan obtained at the onset of symptoms shows subcortical bilateral parietal hypodensities (arrows).
B and C, Axial T2-weighted MR images 12 hours later show diffuse cortical and white matter hyperintensities involving the bilateral frontal and parietal lobes (B). Involvement of right thalamus (black arrow), white matter, and both occipital lobes is also observed (white arrows) (C).
D and E, Follow-up MR studies 3 weeks later show complete resolution of the initial lesions. Axial T2-weighted image at the same position as B (D) shows no abnormalities. Axial T1-weighted unenhanced image (E) shows curvilinear areas of hyperintensity of superficial cortical layers in the parietal region (arrows).
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FIG 2. Case 2: 28-year-old man who underwent bone marrow transplantation and immunosuppressive therapy with CsA.
A and B, Axial CT scans obtained at the onset of right arm paresis, mutism, and mydriatic pupils show confluent hypodensity in the right frontal white matter (black arrows) and patchy areas of hypodensity in the left prerolandic area (white arrows) (A). After contrast injection (B), there is marked hypodensity of the left hippocampus and slight hypodensity in the right hippocampus (arrows).
C–E, MR studies 20 days later. Axial T2-weighted image at the level of the midbrain (C) shows partial resolution of the left hippocampal lesion with remaining bilateral hippocampal hyperintensities (arrows). Axial noncontrast T1-weighted image in the frontoparietal region (D) shows a subtle hyperintensity in the right frontal cortex (arrows). T1-weighted image after contrast administration (E) shows gyral enhancement in both frontal and parietal lobes (arrowheads).
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FIG 3. Case 3: 18-year-old woman treated for acute lymphoid T leukemia with polychemotherapy, including vincristine and methotrexate.
A, Axial contrast-enhanced CT scan obtained at the onset of neurologic symptoms shows right parietal white matter hypodensity (black arrows) and subtle patchy hypodensities in the frontal white matter (white arrows).
B and C, MR study performed the same day. Axial T2-weighted image in the posterior fossa (B) shows diffuse bilateral cerebellar lesions. Axial T2-weighted image in the frontoparietal lobes (C) shows thickened cortex of both frontal and parietal lobes with parietal white matter involvement.
D and E, MR study 11 days later. T2-weighted image in the frontoparietal region (D) shows complete resolution of the initial lesions. Corresponding axial noncontrast T1-weighted image (E) shows laminar hyperintensities in the bilateral frontal cortex (arrows).
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AJNR - American Journal of Neuroradiology