TABLE 1:

Scheme for the evaluation of cranial MR images in patients with LCH

Anatomic StructureChanges
Craniofacial bones and skull baseBone destruction, tumorous infiltration, intracranial extension
Paranasal sinuses
 EthmoidalBone destruction
 MaxillarOpacification (fluid intense, tissue intense)
 SphenoidalEnhancement
Intracranial and extra-axial
 Meninges
  EpiduralWith or without bone destruction
  SubduralInfiltration, enhancement, symmetry
 Circumventricular organs*Enlargement, cystic formation, enhancement, symmetry
  Hypothalamic-pituitary region
   Anterior pituitarySize (empty sella, atrophy, normal, enlarged), symmetry, enhancement
   Posterior pituitarySize, T1WI hyperintensity present or absent
   InfundibulumSize (measured in at least 2 planes) normal, thickened >2.6 mm, cranial-caudal different, threadlike <1 mm
   HypothalamusMass lesions, enhancement
Intracranial and intra-axial, parenchymal
 WM
  Vascular patternSymmetry
  VRSs on T2WI†Enhancement, space-occupying effect, edema
  Perivascular spacesVisibility on T2WI
  Brainstem, ponsLeukoencephalopathy-like pattern
  Cerebellar WM enhancementT2WI hyperintensity, T1WI isointensity or hypointensity, not space-occupying
 GM
  Basal gangliaT1WI hyperintensity or hypointensity
  Cerebellar dentate nucleiT2WI isointensity, hypointensity, or hyperintensity
AtrophyLocalized, diffuse

  • * Pineal gland, ependyma, choroid plexus.

  • † VRS indicates Virchow-Robin space.