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AJNR - American Journal of Neuroradiology

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MR Features of Diseases Involving Bilateral Middle Cerebellar Peduncles

Kouichirou Okamoto^a, Susumu Tokiguchi^a, Tetsuya Furusawa^a, Kazuhiro Ishikawa^a, Akther F. Quardery^a, Satoru Shinbo^a and Keisuke Sasai^a

^a From the Department of Radiology, Niigata University Faculty of Medicine, Niigata City, Japan, Department of Neurology, Ojiya General Hospital, Ojiya City, Japan, and Department of Neurology, Kawase Neurology Clinic, Sanjo City, Japan

View larger version (68K): [in a new window]   FIG 1. A 48-year-old woman with spinocerebellar ataxia (SCA6). T2-weighted fast spin-echo (FSE) MR image (3,600/102/2) shows bilateral symmetrical hyperintensity of atrophic MCPs. The pons with the "cross sign" and cerebellum are also atrophic. These MR findings are identical to that of sOPCA.

View larger version (68K): [in a new window]   FIG 2. A 38-year-old man with ALD. T2-weighted FSE MR image (3,600/102/2) shows bilateral symmetrical hyperintensity of both MCPs, pyramidal tracts in the pons, and cerebellar white matter. The cerebellum is atrophic, and the fourth ventricle is slightly dilated.

View larger version (68K): [in a new window]   FIG 3. A 34-year-old woman with Wilson disease. T2-weighted FSE MR image (3,600/102/2) shows symmetrical bilateral hyperintensity in both MCPs. There are several small hyperintensities in the pons. Mild atrophy of the cerebellum is seen.

View larger version (83K): [in a new window]   FIG 4. A 60-year-old woman with hypoglycemic coma. A, T2-weighted FSE MR image (3,600/102/2) on admission shows subtle symmetrical hyperintensity in both MCPs. B, Isotropic diffusion-weighted MR image (b = 1,000 s/mm2) obtained at the same time shows markedly hyperintense signal intensity in both MCPs. In addition, small symmetrical hyperintensities along the pyramidal tracts are demonstrated (arrows). These hyperintensities disappeared completely on repeated MR imaging performed the next day (not shown).

View larger version (92K): [in a new window]   FIG 5. A 57-year-old man with bilateral MCP infarction. T2-weighted FSE MR image (3,600/102/2) shows bilateral hyperintensity in both MCPs. Also demonstrated are additional cerebellar infarction in the left AICA distribution and lacunar infarctions in the pons.

View larger version (92K): [in a new window]   FIG 6. A 55-year-old woman with diffuse infiltrating B-cell malignant lymphoma. T2-weighted SE image (3,000/90/1) shows a heterogeneous hyperintensity extending from the pons into the cerebellar white matter through the MCPs. The hyperintensity is asymmetrical. Enlargement of the pons and right MCP is demonstrated.

View larger version (72K): [in a new window]   FIG 7. A 77-year-old woman with meningeal carcinomatosis. A, Postcontrast T1-weighted SE midsagittal image (600/15/1) shows enhancement in the cerebellar fissures and cortical sulci as well as the anterior margin of the midbrain and upper pons. B, T2-weighted FSE MR image (3,600/102/2) shows symmetrical hyperintensities of MCPs, upper cerebellar peduncles, lateral and dorsal pons. C, T2-weighted FSE MR image (3,600/102/2) obtained 5 months earlier showed no hyperintensities at the same level of that shown in B.