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Comparative analysis of MR sequences to detect structural brain lesions in tuberous sclerosis

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Abstract

Background: Tuberous sclerosis (TS) is a neurocutaneous genetically inherited disease with variable penetrance characterized by dysplasias and hamartomas affecting multiple organs. MR is the imaging method of choice to demonstrate structural brain lesions in TS. Objective: To compare MR sequences and determine which is most useful for the demonstration of each type of brain lesion in TS patients. Materials and methods: We reviewed MR scans of 18 TS patients for the presence of cortical tubers, white matter lesions (radial bands), subependymal nodules, and subependymal giant cell astrocytoma (SGCA) on the following sequences: (1) T1-weighted spin-echo (T1 SE) images before and after gadolinium (Gd) injection; (2) nonenhanced T1 SE sequence with an additional magnetization transfer contrast medium pulse on resonance (T1 SE/MTC); and (3) fluid-attenuated inversion recovery (FLAIR) sequence. Results: Cortical tubers were found in significantly (P<0.05) larger numbers and more conspicuously in FLAIR and T1 SE/MTC sequences. The T1 SE/MTC sequence was far superior to other methods in detecting white matter lesions (P<0.01). There was no significant difference between the T1 SE/MTC and T1 SE (before and after Gd injection) sequences in the detection of subependymal nodules; FLAIR sequence showed less sensitivity than the others in identifying the nodules. T1 SE sequences after Gd injection demonstrated better the limits of the SGCA. Conclusion: We demonstrated the importance of appropriate MRI sequences for diagnosis of the most frequent brain lesions in TS. Our study reinforces the fact that each sequence has a particular application according to the type of TS lesion. Gd injection might be useful in detecting SGCA; however, the parameters of size and location are also important for a presumptive diagnosis of these tumors.

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Authors and Affiliations

  1. Section of Radiology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil

    Hugo Pereira Pinto Gama, Rogério Gonçalves de Campos Meirelles & José Iram Mendonça do Rego

  2. Section of Radiology, Centro de Medicina Diagnóstica Fleury, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil

    Antônio José da Rocha & Carlos Jorge da Silva

  3. Section of Radiology, Centro de Medicina Diagnóstica Fleury, Santa Casa de Misericórdia de São Paulo, Department of Diagnostic Imaging, Federal University of São Paulo, Escola Paulista de Medicina, São Paulo, Brazil

    Flávio Túlio Braga

  4. Section of Radiology, Centro de Medicina Diagnóstica Fleury, Department of Neurology, Federal University of São Paulo, Escola Paulista de Medicina, São Paulo, Brazil

    Antonio Carlos Martins Maia Jr.

  5. Division of Diagnostic Imaging in Pediatrics, Department of Diagnostic Imaging, Federal University of São Paulo, Escola Paulista de Medicina, São Paulo, Brazil

    Henrique Manoel Lederman

  6. Rua José Maria Lisboa 480, Ap. 171, São Paulo, 01423-908, Brazil

    Henrique Manoel Lederman

Authors
  1. Hugo Pereira Pinto Gama
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  2. Antônio José da Rocha
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  3. Flávio Túlio Braga
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  4. Carlos Jorge da Silva
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  5. Antonio Carlos Martins Maia Jr.
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  6. Rogério Gonçalves de Campos Meirelles
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  7. José Iram Mendonça do Rego
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  8. Henrique Manoel Lederman
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Correspondence to Henrique Manoel Lederman.

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Pinto Gama, H.P., da Rocha, A.J., Braga, F.T. et al. Comparative analysis of MR sequences to detect structural brain lesions in tuberous sclerosis. Pediatr Radiol 36, 119–125 (2006). https://doi.org/10.1007/s00247-005-0033-x

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  • DOI: https://doi.org/10.1007/s00247-005-0033-x

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