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

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Gama, HPP
Rocha, A. J. da
Braga, F. T.
Silva, C. J. da
Maia, ACM
Meirelles, RGD
Rego, JIM do
Lederman, H. M.
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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.
Pediatric Radiology. New York: Springer, v. 36, n. 2, p. 119-125, 2006.