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FIG 4. Images from the case of an 8-year-old female patient with complex I mitochondrial disease, which was diagnosed when the patient was older than 3 years. MR image shows extensive T1-hypointense and T2-hyperintense signal abnormalities in the periventricular regions, particularly in the frontal white matter, in addition to T2 hyperintensity involving the genu of the corpus callosum. MR spectroscopic images show a large lactate peak in the CSF (left lateral ventricle, area 2). A small lactate peak may occur in the frontal white matter lesion (area 1), although spectra are also partially contaminated by lipids (*).W. M., white matter; Lac, lactate; Cho, choline; Cr, creatine; NAA, N-acetylaspartate; G. M., gray matter; T1 MRI, T1-weighted MR image; FLAIR, fluid-attenuated inversion recovery.
