X-linked Adrenoleukodystrophy: The Role of Contrast-enhanced MR Imaging in Predicting Disease Progression

X-linked ALD in 43-year-old man with rapidly progressive spasticity, deafness, visual deficits, and personality changes.

A, Initial contrast-enhanced axial T1-weighted MR image (550/24), obtained at the level of the lateral ventricles, shows curvilinear enhancement outlining the periphery of the zone of demyelination (arrowheads).

B, Contiguous axial proton density–weighted MR images (2500/30), obtained at the level of the centrum semiovale at the same time as the image shown in panel A, show very mild white matter abnormalities.

C, Six-month follow-up axial proton density–weighted MR images (3000/30), obtained at a level similar to that shown in panel B, show confluent and symmetrical white matter hyperintensity in both parietal lobes (arrows), confirming the progression of disease.