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Mertiri L, Boltshauser E, Kralik SF, Desai NK, Lequin MH, Huisman TAGM. Incidence and Characteristics of Cerebellar Atrophy/Volume Loss in Children with Confirmed Diagnosis of Tuberous Sclerosis Complex. CHILDREN (BASEL, SWITZERLAND) 2024; 11:627. [PMID: 38929207 PMCID: PMC11201845 DOI: 10.3390/children11060627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/14/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024]
Abstract
Objectives: The goal of our study was to determine the incidence of cerebellar atrophy, assess the imaging findings in the posterior fossa and determine the incidence of hippocampal sclerosis in a cohort of pediatric patients with confirmed tuberous sclerosis complex (TSC). Material and methods: MRI studies of 98 TSC pediatric patients (mean age 7.67 years) were evaluated for cerebellar atrophy, cerebral/cerebellar tubers, white matter lesions, subependymal nodules, subependymal giant cell astrocytomas, ventriculomegaly, and hippocampal sclerosis. Clinical charts were revisited for clinical symptoms suggesting cerebellar involvement, for seizures and treatment for seizures, behavioral disorders and autism. Results: Cerebral tubers were present in 97/98 cases. In total, 97/98 had subependymal nodules, 15/98 had SEGA, 8/98 had ventriculomegaly and 4/98 had hippocampal sclerosis. Cerebellar tubers were found in 8/98 patients (8.2%), whereas cerebellar atrophy was described in 38/98 cases (38.8%). In 37/38 patients, cerebellar volume loss was mild and diffuse, and only one case presented with left hemi-atrophy. Briefly, 32/38 presented with seizures and were treated with anti-seizure drugs. In total, 8/38 (21%) presented with behavioral disorders, 10/38 had autism and 2/38 presented with seizures and behavioral disorders and autism. Conclusions: Several studies have demonstrated cerebellar involvement in patients with TSC. Cerebellar tubers differ in shape compared with cerebral tubers and are associated with cerebellar volume loss. Cerebellar atrophy may be focal and diffuse and one of the primary cerebellar manifestations of TSC, especially if a TSC2 mutation is present. Cerebellar degeneration may, however, also be secondary/acquired due to cellular damage resulting from seizure activity, the effects of anti-seizure drugs and anoxic-ischemic injury from severe seizure activity/status epilepticus. Further, prospective studies are required to identify and establish the pathogenic mechanism of cerebellar atrophy in patients with TSC.
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Affiliation(s)
- Livja Mertiri
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA; (S.F.K.); (N.K.D.); (M.H.L.); (T.A.G.M.H.)
| | - Eugen Boltshauser
- Division of Pediatric Neurology, University Children’s Hospital Zurich, 8032 Zurich, Switzerland;
| | - Stephen F. Kralik
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA; (S.F.K.); (N.K.D.); (M.H.L.); (T.A.G.M.H.)
| | - Nilesh K. Desai
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA; (S.F.K.); (N.K.D.); (M.H.L.); (T.A.G.M.H.)
| | - Maarten H. Lequin
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA; (S.F.K.); (N.K.D.); (M.H.L.); (T.A.G.M.H.)
| | - Thierry A. G. M. Huisman
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA; (S.F.K.); (N.K.D.); (M.H.L.); (T.A.G.M.H.)
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Pedersen C, Aboian M, Messina SA, Daldrup-Link H, Franceschi AM. PET/MRI Applications in Pediatric Epilepsy. World J Nucl Med 2023; 22:78-86. [PMID: 37223623 PMCID: PMC10202574 DOI: 10.1055/s-0043-1764303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Epilepsy neuroimaging assessment requires exceptional anatomic detail, physiologic and metabolic information. Magnetic resonance (MR) protocols are often time-consuming necessitating sedation and positron emission tomography (PET)/computed tomography (CT) comes with a significant radiation dose. Hybrid PET/MRI protocols allow for exquisite assessment of brain anatomy and structural abnormalities, in addition to metabolic information in a single, convenient imaging session, which limits radiation dose, sedation time, and sedation events. Brain PET/MRI has proven especially useful for accurate localization of epileptogenic zones in pediatric seizure cases, providing critical additional information and guiding surgical decision making in medically refractory cases. Accurate localization of seizure focus is necessary to limit the extent of the surgical resection, preserve healthy brain tissue, and achieve seizure control. This review provides a systematic overview with illustrative examples demonstrating the applications and diagnostic utility of PET/MRI in pediatric epilepsy.
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Affiliation(s)
- Christian Pedersen
- Department of Radiology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Mariam Aboian
- Department of Radiology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Steven A. Messina
- Neuroradiology Division, Department of Radiology, Mayo Clinic Radiology, Rochester, Minnesota, United States
| | - Heike Daldrup-Link
- Department of Radiology and Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Ana M. Franceschi
- Neuroradiology Division, Department of Radiology, Northwell Health/Donald and Barbara Zucker School of Medicine, Lenox Hill Hospital, New York, New York, United States
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Bychkova E, Dorofeeva M, Levov A, Kislyakov A, Karandasheva K, Strelnikov V, Anoshkin K. Specific Features of Focal Cortical Dysplasia in Tuberous Sclerosis Complex. Curr Issues Mol Biol 2023; 45:3977-3996. [PMID: 37232723 DOI: 10.3390/cimb45050254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
Patients with tuberous sclerosis complex present with cognitive, behavioral, and psychiatric impairments, such as intellectual disabilities, autism spectrum disorders, and drug-resistant epilepsy. It has been shown that these disorders are associated with the presence of cortical tubers. Tuberous sclerosis complex results from inactivating mutations in the TSC1 or TSC2 genes, resulting in hyperactivation of the mTOR signaling pathway, which regulates cell growth, proliferation, survival, and autophagy. TSC1 and TSC2 are classified as tumor suppressor genes and function according to Knudson's two-hit hypothesis, which requires both alleles to be damaged for tumor formation. However, a second-hit mutation is a rare event in cortical tubers. This suggests that the molecular mechanism of cortical tuber formation may be more complicated and requires further research. This review highlights the issues of molecular genetics and genotype-phenotype correlations, considers histopathological characteristics and the mechanism of morphogenesis of cortical tubers, and also presents data on the relationship between these formations and the development of neurological manifestations, as well as treatment options.
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Affiliation(s)
- Ekaterina Bychkova
- Research Centre for Medical Genetics, Moskvorechye Street 1, 115522 Moscow, Russia
- Faculty of Biomedicine, Pirogov Russian National Research Medical University, Ostrovityanova Street 1, 117997 Moscow, Russia
| | - Marina Dorofeeva
- Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery, Pirogov Russian National Research Medical University, Taldomskaya 2, 125412 Moscow, Russia
| | - Aleksandr Levov
- Morozov Children's City Clinical Hospital, 4th Dobryninsky Lane, 1/9, 119049 Moscow, Russia
| | - Alexey Kislyakov
- Morozov Children's City Clinical Hospital, 4th Dobryninsky Lane, 1/9, 119049 Moscow, Russia
| | | | - Vladimir Strelnikov
- Research Centre for Medical Genetics, Moskvorechye Street 1, 115522 Moscow, Russia
| | - Kirill Anoshkin
- Research Centre for Medical Genetics, Moskvorechye Street 1, 115522 Moscow, Russia
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4
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Fujii H, Sato N, Kimura Y, Mizutani M, Kusama M, Sumitomo N, Chiba E, Shigemoto Y, Takao M, Takayama Y, Iwasaki M, Nakagawa E, Mori H. MR Imaging Detection of CNS Lesions in Tuberous Sclerosis Complex: The Usefulness of T1WI with Chemical Shift Selective Images. AJNR Am J Neuroradiol 2022; 43:1202-1209. [PMID: 35835590 PMCID: PMC9575409 DOI: 10.3174/ajnr.a7573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/24/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CNS lesions of tuberous sclerosis complex are diagnosed mainly by T2WI, FLAIR, and sometimes T1WI with magnetization transfer contrast. The usefulness of T1WI with chemical shift selective images was recently reported in focal cortical dysplasia type IIb, which has histopathologic and imaging features similar to those of tuberous sclerosis complex. We investigated the usefulness of the T1WI with chemical shift selective images in detecting CNS lesions of tuberous sclerosis complex. MATERIALS AND METHODS We retrospectively reviewed 25 consecutive patients with tuberous sclerosis complex (mean age, 11.9 [SD, 8.9] years; 14 males) who underwent MR imaging including T1WI, T1WI with magnetization transfer contrast, T1WI with chemical shift selective, T2WI, and FLAIR images. Two neuroradiologists assessed the number of CNS lesions in each sequence and compared them in 2 steps: among T1WI, T1WI with magnetization transfer contrast and T1WI with chemical shift selective images, and among T2WI, FLAIR, and T1WI with chemical shift selective images. We calculated the contrast ratio of the cortical tubers and of adjacent normal-appearing gray matter and the contrast ratio of radial migration lines and adjacent normal-appearing white matter in each sequence and compared them. RESULTS T1WI with chemical shift selective images was significantly superior to T1WI with magnetization transfer contrast for the detection of radial migration lines and contrast ratio of radial migration lines. There was no significant difference between T1WI with chemical shift selective images and T1WI with magnetization transfer contrast for the detection of cortical tubers and the contrast ratio of the cortical tubers. Both T2WI and FLAIR were statistically superior to T1WI with chemical shift selective images for the detection of cortical tubers. T1WI with chemical shift selective images was significantly superior to T2WI and FLAIR for the detection of radial migration lines. CONCLUSIONS The usefulness of T1WI with chemical shift selective images in detecting radial migration lines was demonstrated. Our findings suggest that the combination of T1WI with chemical shift selective images, T2WI, and FLAIR would be useful to evaluate the CNS lesions of patients with tuberous sclerosis complex in daily clinical practice.
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Affiliation(s)
- H Fujii
- From the Departments of Radiology (H.F., N.Sato, Y.K., M.K., E.C., Y.S.).,Department of Radiology (H.F., H.M.), Jichi Medical University, School of Medicine, Shimotsuke, Tochigi, Japan
| | - N Sato
- From the Departments of Radiology (H.F., N.Sato, Y.K., M.K., E.C., Y.S.)
| | - Y Kimura
- From the Departments of Radiology (H.F., N.Sato, Y.K., M.K., E.C., Y.S.)
| | - M Mizutani
- Pathology and Laboratory Medicine (M.M., M.T.)
| | - M Kusama
- From the Departments of Radiology (H.F., N.Sato, Y.K., M.K., E.C., Y.S.)
| | | | - E Chiba
- From the Departments of Radiology (H.F., N.Sato, Y.K., M.K., E.C., Y.S.)
| | - Y Shigemoto
- From the Departments of Radiology (H.F., N.Sato, Y.K., M.K., E.C., Y.S.)
| | - M Takao
- Pathology and Laboratory Medicine (M.M., M.T.)
| | - Y Takayama
- Neurosurgery (Y.T., M.I.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - M Iwasaki
- Neurosurgery (Y.T., M.I.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | | | - H Mori
- Department of Radiology (H.F., H.M.), Jichi Medical University, School of Medicine, Shimotsuke, Tochigi, Japan
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Gomes I, Jesus Ribeiro J, Palavra F. Monitoring and Managing Patients with Tuberous Sclerosis Complex: Current State of Knowledge. J Multidiscip Healthc 2022; 15:1469-1480. [PMID: 35860622 PMCID: PMC9292455 DOI: 10.2147/jmdh.s266990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/29/2022] [Indexed: 12/05/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare genetic disease of autosomal dominant transmission that, in most cases, results from the presence of pathogenic variants of the TSC1 or TSC2 genes, encoding hamartin and tuberin, respectively. It is a multisystemic disease, affecting most frequently the brain, skin, kidney, and heart. The wide variety of possible clinical manifestations, given this multisystem dimension, makes the follow-up of patients with TSC an exercise of multidisciplinarity. In fact, these patients may require the intervention of various medical specialties, which thus have to combine their efforts to practice a medicine that is truly holistic. The past few years have witnessed a dramatic leap not only in the diagnosis and management of TSC patients, with standard monitoring recommendations, but also in the therapeutic field, with the use of mTORC1 inhibitors. In this article, we review the clinical manifestations associated with TSC, as well as the treatment and follow-up strategies that should be implemented, from a multidisciplinary perspective.
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Affiliation(s)
- Inês Gomes
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Filipe Palavra
- Center for Child Development - Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Laboratory of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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6
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Coban G, Gumeler E, Parlak S, Konuskan B, Karakaya J, Yalnizoglu D, Anlar B, Oguz KK. Synthetic MRI in children with tuberous sclerosis complex. Insights Imaging 2022; 13:115. [PMID: 35796889 PMCID: PMC9263007 DOI: 10.1186/s13244-022-01219-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
Objective The generation of numerous sequences and quantitative data in a short scanning time is the most potential advantage of Synthetic MRI (SyMRI). We aimed to test detection of the tubers and to determine underlying tissue characteristics, and morphometric alterations in the brain of pediatric tuberous sclerosis complex (TSC) patients, using SyMRI. Methods Conventional brain MRI (cMRI) and SyMRI were prospectively obtained from 10 TSC patients and 18 healthy control subjects (HCs). Two neuroradiologists independently evaluated tubers on both scans. Additionally, automatically segmented volume calculation and myelin quantification, including the subcortical part of the tubers and normal-appearing brain parenchyma (NABP) of patients, were carried out using SyMRI. Results The cMRI and SyMRI comparison showed a very good correlation on the detection of the tubers (k = 0.82–0.94). Automatic segmentation of Non-gray matter/white matter/cerebrospinal fluid (Non), %Non/brain parenchymal volume, and %Non/intracranial volume was significantly higher; however, %Myelin/intracranial volume and %Myelin/brain parenchymal volume were significantly lower in the TSC patients (p < 0.05). The proton density values were significantly increased, and myelin fraction volume and myelin-correlated compound values were significantly decreased in the NABP in TSC patients on myelin maps (p < 0.05). The white-matter volume, myelin and white-matter fractional volume, longitudinal relaxation rate, transverse relaxation rate, and myelin-correlated compound values were significantly decreased in the subcortical part of tubers on quantification maps (p < 0.001) in TSC patients. Conclusion SyMRI enables the detection of cortical tubers and is a developing tool in the quantification of morphometric and tissue alterations in pediatric TSC patients with a rational scanning time. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01219-2.
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Affiliation(s)
- Gokcen Coban
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey.
| | - Ekim Gumeler
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Safak Parlak
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Bahadir Konuskan
- Department of Pediatric Neurology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Dilek Yalnizoglu
- Department of Pediatric Neurology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Banu Anlar
- Department of Pediatric Neurology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Kader K Oguz
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
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7
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Robinson J, Uzun O, Loh NR, Harris IR, Woolley TE, Harwood AJ, Gardner JF, Syed YA. The association of neurodevelopmental abnormalities, congenital heart and renal defects in a tuberous sclerosis complex patient cohort. BMC Med 2022; 20:123. [PMID: 35440050 PMCID: PMC9019964 DOI: 10.1186/s12916-022-02325-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/07/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is a rare multi-system genetic disorder characterised by the presence of benign tumours throughout multiple organs including the brain, kidneys, heart, liver, eyes, lungs and skin, in addition to neurological and neuropsychiatric complications. Intracardiac tumour (rhabdomyoma), neurodevelopmental disorders (NDDs) and kidney disorders (KD) are common manifestations of TSC and have been linked with TSC1 and TSC2 loss-of-function mutations independently, but the dynamic relationship between these organ manifestations remains unexplored. Therefore, this study aims to characterise the nature of the relationship specifically between these three organs' manifestations in TSC1 and TSC2 mutation patients. METHODS Clinical data gathered from TSC patients across South Wales registered with Cardiff and Vale University Health Board (CAV UHB) between 1990 and 2020 were analysed retrospectively to evaluate abnormalities in the heart, brain and kidney development. TSC-related abnormalities such as tumour prevalence, location and size were analysed for each organ in addition to neuropsychiatric involvement and were compared between TSC1 and TSC2 mutant genotypes. Lastly, statistical co-occurrence between organ manifestations co-morbidity was quantified, and trajectories of disease progression throughout organs were modelled. RESULTS This study found a significantly greater mutational frequency at the TSC2 locus in the cohort in comparison to TSC1. An equal proportion of male and female patients were observed in this group and by meta-analysis of previous studies. No significant difference in characterisation of heart involvement was observed between TSC1 and TSC2 patients. Brain involvement was seen with increased severity in TSC2 patients, characterised by a greater prevalence of cortical tubers and communication disorders. Renal pathology was further enhanced in TSC2 patients, marked by increased bilateral angiomyolipoma prevalence. Furthermore, co-occurrence of NDDs and KDs was the most positively correlated out of investigated manifestations, regardless of genotype. Analysis of disease trajectories revealed a more diverse clinical outcome for TSC2 patients: however, a chronological association of rhabdomyoma, NDD and KD was most frequently observed for TSC1 patients. CONCLUSIONS This study marks the first empirical investigation of the co-morbidity between congenital heart defects (CHD), NDDs, and KDs in TSC1 and TSC2 patients. This remains a unique first step towards the characterisation of the dynamic role between genetics, heart function, brain function and kidney function during the early development in the context of TSC.
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Affiliation(s)
- Jessica Robinson
- Neuroscience and Mental Health Research Institute, Hadyn Ellis Building, Cardiff, CF24 4HQ, UK.,School of Bioscience, The Sir Martin Evans Building, Museum Ave, Cardiff, CF10 3AX, UK
| | - Orhan Uzun
- University Hospital of Wales, Heath Park, Cardiff, CF10 3AX, UK.
| | - Ne Ron Loh
- University Hospital of Wales, Heath Park, Cardiff, CF10 3AX, UK.,Royal United Hospitals Bath NHS Foundation Trust, Bath, BA1 3NG, UK
| | - Isabelle Rose Harris
- Neuroscience and Mental Health Research Institute, Hadyn Ellis Building, Cardiff, CF24 4HQ, UK.,School of Bioscience, The Sir Martin Evans Building, Museum Ave, Cardiff, CF10 3AX, UK
| | - Thomas E Woolley
- School of Mathematics, Cardiff University, Cardiff, CF24 4AG, UK
| | - Adrian J Harwood
- Neuroscience and Mental Health Research Institute, Hadyn Ellis Building, Cardiff, CF24 4HQ, UK.,School of Bioscience, The Sir Martin Evans Building, Museum Ave, Cardiff, CF10 3AX, UK
| | | | - Yasir Ahmed Syed
- Neuroscience and Mental Health Research Institute, Hadyn Ellis Building, Cardiff, CF24 4HQ, UK. .,School of Bioscience, The Sir Martin Evans Building, Museum Ave, Cardiff, CF10 3AX, UK.
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Tsai JD, Ho MC, Shen CY, Weng JC. Assessment of disrupted brain functional connectome in tuberous sclerosis complex using resting-state fMRI. Medicine (Baltimore) 2022; 101:e29024. [PMID: 35356911 PMCID: PMC10684191 DOI: 10.1097/md.0000000000029024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/16/2022] [Indexed: 12/31/2022] Open
Abstract
ABSTRACT Tuberous sclerosis complex (TSC) is a rare genetic disorder with multisystem involvement. TSC is characterized by benign hamartomas in multiple organs, including the brain, and its clinical phenotypes may be associated with abnormal functional connections. We aimed to use resting-state functional connectivity to provide findings of disrupted functional brain networks in TSC patients using graph theoretical analysis (GTA) and network-based statistic (NBS) analysis.Forty TSC patients (age = 24.11+/-11.44 years old) and 18 age-matched (25.13+/- 10.01 years old) healthy controls were recruited; they underwent resting-state functional magnetic resonance imaging using a 3T magnetic resonance imaging scanner. After image preprocessing and removing physiological noises, GTA was used to calculate the topological parameters of the brain network. NBS analysis was then used to determine the differences in cerebrum functional connectivity between the 2 groups.In GTA, several topological parameters, including the clustering coefficient, local efficiency, transitivity, and modularity, were better in controls than in TSC patients (P < .05). In NBS analysis, the edges of the brain networks between the groups were compared. One subnetwork showed more edges in controls than in TSC patients (P < .05), including the connections from the frontal lobe to the temporal and parietal lobe.The study results provide the findings on disrupted functional connectivity and organization in TSC patients compared with controls. The findings may help better understand the underlying physiological mechanisms of brain connection in TSC.
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Affiliation(s)
| | | | | | - Jun-Cheng Weng
- Correspondence: Jun-Cheng Weng, Department of Medical Imaging and Radiological Sciences, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist.,Taoyuan City 33302, Taiwan (e-mail: mail: ).
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Hulshof HM, Kuijf HJ, Kotulska K, Curatolo P, Weschke B, Riney K, Krsek P, Feucht M, Nabbout R, Lagae L, Jansen A, Otte WM, Lequin MH, Sijko K, Benvenuto A, Hertzberg C, Benova B, Scholl T, De Ridder J, Aronica EA, Kwiatkowski DJ, Jozwiak S, Jurkiewicz E, Braun K, Jansen FE. Association of Early MRI Characteristics With Subsequent Epilepsy and Neurodevelopmental Outcomes in Children With Tuberous Sclerosis Complex. Neurology 2022; 98:e1216-e1225. [PMID: 35101906 DOI: 10.1212/wnl.0000000000200027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Multiple factors have been found to contribute to the high risk of epilepsy in infants with Tuberous Sclerosis Complex (TSC), including evolution of EEG abnormalities, TSC gene mutation and MRI characteristics. The aim of the present prospective multi-center study was to: 1) identify early MRI biomarkers of epilepsy in infants with TSC aged < 6 months and before seizure onset, and 2) associate these MRI biomarkers with neurodevelopmental outcomes at 2 years of age. The study was part of the EPISTOP project. METHODS We evaluated brain MRIs performed in infants with TSC younger than 6 months of age. We used harmonized MRI-protocols across centers and children were monitored closely with neuropsychological evaluation, and serial video EEG. MRI characteristics defined as tubers, radial migration lines, white matter abnormalities, cysts, calcifications, subependymal nodules (SEN) and subependymal giant cell astrocytoma (SEGA) were visually evaluated and lesions were detected semi-automatically. Lesion to brain volume ratios were calculated and associated with epilepsy and neurodevelopmental outcomes at two years. RESULTS Lesions were assessed on MRIs from 77 TSC infants, 62 MRIs were sufficient for volume analysis. The presence of tubers and higher tuber-brain ratios were associated with the development of clinical seizures, independently of TSC gene mutation and preventive treatment. Furthermore, higher tuber-brain ratios were associated with lower cognitive and motor development quotients at two years, independently of TSC gene mutation and presence of epilepsy. DISCUSSION In infants with TSC, there is a significant association between characteristic TSC lesions detected on early brain MRI and development of clinical seizures, as well as neurodevelopmental outcomes in the first two years of life. According to our results, early brain MRI findings may guide clinical care for young children with TSC. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that in infants with TSC, there is a significant association between characteristic TSC lesions on early brain MRI and the development of clinical seizures and neurodevelopmental outcomes in the first two years of life.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Wim M Otte
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Maarten H Lequin
- Department of Radiology, University Medical Center, Utrecht, the Netherlands
| | - Kamil Sijko
- Instytut Pomnik-Centrum Zdrowia Dziecka, The Children's Memorial Health Institute, Warsaw, Poland, Member of the European Reference Network EpiCARE
| | | | | | | | | | | | - EleonoraM A Aronica
- Stichting Epilepsie Instellingen Nederland (SEIN), Hoofddorp, the Netherlands
| | | | - Sergiusz Jozwiak
- Department of Child Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Elzbieta Jurkiewicz
- Instytut Pomnik-Centrum Zdrowia Dziecka, The Children's Memorial Health Institute, Warsaw, Poland, Member of the European Reference Network EpiCARE
| | - Kees Braun
- Department of Pediatric Neurology, Brain Center UMC Utrecht, The Netherlands, Member of the European Reference Network EpiCARE
| | - Floor E Jansen
- Department of Pediatric Neurology, Brain Center UMC Utrecht, The Netherlands, Member of the European Reference Network EpiCARE
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10
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Imaging in the study of macrocephaly: Why?, when?, how? RADIOLOGIA 2022; 64:26-40. [DOI: 10.1016/j.rxeng.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022]
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11
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Schonstedt Geldres V, Stecher Guzmán X, Manterola Mordojovich C, Rovira À. Radiología en el estudio de la macrocefalia. ¿Por qué?, ¿cuándo?, ¿cómo? RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Iyer RR, Strahle JM, Groves ML. Neurosurgical Considerations of Neurocutaneous Syndromes. Neurosurg Clin N Am 2021; 33:81-89. [PMID: 34801145 DOI: 10.1016/j.nec.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The phakomatoses are a group of genetic and acquired disorders characterized by neurologic, cutaneous, and often ocular manifestations, thus commonly referred to as neurocutaneous syndromes. In several of these conditions the underlying genetic pathophysiology has been elucidated, which will continue to play an important role in advancing therapeutic techniques. This article focuses on several examples of such neurocutaneous syndromes, with special attention to the relevant neurosurgical considerations of these patients.
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Affiliation(s)
- Rajiv R Iyer
- Department of Neurosurgery/Division of Pediatric Neurosurgery, University of Utah/Primary Children's Hospital, 100 N. Mario Capecchi Drive Suite 3850, Salt Lake City, UT 84113, USA.
| | - Jennifer M Strahle
- Pediatric Neuro Spine Program, Pediatric Cerebrovascular Surgery, Division of Pediatric Neurosurgery, Department of Neurosurgery, Washington University School of Medicine, 1 Childrens Pl Suite 4S20, St. Louis, MO 63110, USA
| | - Mari L Groves
- Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N. Wolfe Street Phipps 554, Baltimore, MD 21287, USA
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Updated International Tuberous Sclerosis Complex Diagnostic Criteria and Surveillance and Management Recommendations. Pediatr Neurol 2021; 123:50-66. [PMID: 34399110 DOI: 10.1016/j.pediatrneurol.2021.07.011] [Citation(s) in RCA: 245] [Impact Index Per Article: 81.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disease affecting multiple body systems with wide variability in presentation. In 2013, Pediatric Neurology published articles outlining updated diagnostic criteria and recommendations for surveillance and management of disease manifestations. Advances in knowledge and approvals of new therapies necessitated a revision of those criteria and recommendations. METHODS Chairs and working group cochairs from the 2012 International TSC Consensus Group were invited to meet face-to-face over two days at the 2018 World TSC Conference on July 25 and 26 in Dallas, TX, USA. Before the meeting, working group cochairs worked with group members via e-mail and telephone to (1) review TSC literature since the 2013 publication, (2) confirm or amend prior recommendations, and (3) provide new recommendations as required. RESULTS Only two changes were made to clinical diagnostic criteria reported in 2013: "multiple cortical tubers and/or radial migration lines" replaced the more general term "cortical dysplasias," and sclerotic bone lesions were reinstated as a minor criterion. Genetic diagnostic criteria were reaffirmed, including highlighting recent findings that some individuals with TSC are genetically mosaic for variants in TSC1 or TSC2. Changes to surveillance and management criteria largely reflected increased emphasis on early screening for electroencephalographic abnormalities, enhanced surveillance and management of TSC-associated neuropsychiatric disorders, and new medication approvals. CONCLUSIONS Updated TSC diagnostic criteria and surveillance and management recommendations presented here should provide an improved framework for optimal care of those living with TSC and their families.
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Hulshof HM, Benova B, Krsek P, Kyncl M, Lequin MH, Belohlavkova A, Jezdik P, Braun KPJ, Jansen FE. The epileptogenic zone in children with tuberous sclerosis complex is characterized by prominent features of focal cortical dysplasia. Epilepsia Open 2021; 6:663-671. [PMID: 34328682 PMCID: PMC8633464 DOI: 10.1002/epi4.12529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Patients with tuberous sclerosis complex (TSC) present with drug-resistant epilepsy in about 60% of cases, and evaluation for epilepsy surgery may be warranted. Correct delineation of the epileptogenic zone (EZ) among multiple dysplastic lesions on MRI represents a challenging step in pre-surgical evaluation. METHODS Two experienced neuroradiologists evaluated pre- and post-surgical MRIs of 28 epilepsy surgery patients with TSC, assessing characteristics of tubers, cysts, calcifications, and focal cortical dysplasia (FCD)-resembling lesions. Utilizing multiple metrics, we compared MRI features of the EZ-defined as the resected area in TSC patients who achieved seizure-freedom 2 years after epilepsy surgery-with features of other brain areas. Using combinatorial analysis, we identified combinations of dysplastic features that are most frequently observed in the epileptogenic zone in TSC patients. RESULTS All TSC-associated dysplastic features were more frequently observed in the EZ than in other brain areas (increased cortical thickness, gray-white matter blurring, transmantle sign, calcifications, and tubers; Kendal's tau 0.35, 0.25, 0.27, 0.26, and 0.23, respectively; P value <.001 in all). No single feature could reliably and independently indicate the EZ in all patients. Conversely, the EZ was indicated by the presence of the combination of three of the following features: tubers, transmantle sign, increased cortical thickness, calcifications, and the largest FCD-affected area. Out of these, the largest FCD-affected area emerged as the most reliable indicator of the EZ, combined either with calcifications or tubers. SIGNIFICANCE The epileptogenic zone in TSC patients harbors multiple dysplastic features, consistent with focal cortical dysplasia. A specific combination of these features can indicate the EZ and aid in pre-surgical MRI evaluation in epilepsy surgery candidates with TSC.
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Affiliation(s)
- Hanna M Hulshof
- Department of Pediatric Neurology, Brain Center University Medical Center Utrecht, Utrecht, The Netherlands
| | - Barbora Benova
- Department of Pediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Pavel Krsek
- Department of Pediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Martin Kyncl
- Department of Radiology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Maarten H Lequin
- Department of Radiology, Brain Center University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anezka Belohlavkova
- Department of Pediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Petr Jezdik
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University, Prague, Czech Republic
| | - Kees P J Braun
- Department of Pediatric Neurology, Brain Center University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floor E Jansen
- Department of Pediatric Neurology, Brain Center University Medical Center Utrecht, Utrecht, The Netherlands
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15
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Kútna V, O'Leary VB, Newman E, Hoschl C, Ovsepian SV. Revisiting Brain Tuberous Sclerosis Complex in Rat and Human: Shared Molecular and Cellular Pathology Leads to Distinct Neurophysiological and Behavioral Phenotypes. Neurotherapeutics 2021; 18:845-858. [PMID: 33398801 PMCID: PMC8423952 DOI: 10.1007/s13311-020-01000-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/27/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a dominant autosomal genetic disorder caused by loss-of-function mutations in TSC1 and TSC2, which lead to constitutive activation of the mammalian target of rapamycin C1 (mTORC1) with its decoupling from regulatory inputs. Because mTORC1 integrates an array of molecular signals controlling protein synthesis and energy metabolism, its unrestrained activation inflates cell growth and division, resulting in the development of benign tumors in the brain and other organs. In humans, brain malformations typically manifest through a range of neuropsychiatric symptoms, among which mental retardation, intellectual disabilities with signs of autism, and refractory seizures, which are the most prominent. TSC in the rat brain presents the first-rate approximation of cellular and molecular pathology of the human brain, showing many instructive characteristics. Nevertheless, the developmental profile and distribution of lesions in the rat brain, with neurophysiological and behavioral manifestation, deviate considerably from humans, raising numerous research and translational questions. In this study, we revisit brain TSC in human and Eker rats to relate their histopathological, electrophysiological, and neurobehavioral characteristics. We discuss shared and distinct aspects of the pathology and consider factors contributing to phenotypic discrepancies. Given the shared genetic cause and molecular pathology, phenotypic deviations suggest an incomplete understanding of the disease. Narrowing the knowledge gap in the future should not only improve the characterization of the TSC rat model but also explain considerable variability in the clinical manifestation of the disease in humans.
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Affiliation(s)
- Viera Kútna
- Department of Experimental Neurobiology, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.
| | - Valerie B O'Leary
- Department of Medical Genetics, Third Faculty of Medicine of Charles University, Ruská 87, 100 00, Prague, Czech Republic
| | - Ehren Newman
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Cyril Hoschl
- Department of Experimental Neurobiology, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
- Department of Psychiatry and Medical Psychology, Third Faculty of Medicine of Charles University, Ruská 87, 100 00, Prague, Czech Republic
| | - Saak V Ovsepian
- Department of Experimental Neurobiology, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.
- Department of Psychiatry and Medical Psychology, Third Faculty of Medicine of Charles University, Ruská 87, 100 00, Prague, Czech Republic.
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16
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Enhancing cyst-like lesions of the white matter in tuberous sclerosis complex: a novel neuroradiological finding. Neuroradiology 2021; 63:971-974. [PMID: 33481070 DOI: 10.1007/s00234-021-02647-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant condition clinically presenting with heterogenous clinical features. Multiple neuroradiological manifestations have been associated with TSC, such as tubers, radial migration lines, subependymal nodules, subependymal giant cell astrocytomas, and cyst-like lesions of the white matter (CLLWMs). The latter have been described as non-enhancing well-defined cysts whose pathogenesis is still unknown. We describe 2 TSC patients with CLLWM showing contrast enhancement after Gadolinium injection, a previously unreported entity.
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17
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Weerasinghe S, Sato TS. All tubers are not created equal: Cerebellar tubers in a pediatric patient with tuberous sclerosis. Radiol Case Rep 2020; 16:497-499. [PMID: 33363690 PMCID: PMC7753220 DOI: 10.1016/j.radcr.2020.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/11/2020] [Indexed: 11/18/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare autosomal dominant disease characterized by multiple tumors throughout the body. Supratentorial hamartomas (or tubers), are a very common CNS feature of TSC. Cerebellar tubers are much less common in TSC. We present an interesting case of cerebellar tuber in a 14-year-old patient with TSC, highlighting clinical and diagnostic criteria for TSC and review the unique features of cerebellar tubers, differentiating these lesions from their more common supratentorial counterparts. This case serves as an educational tool to improve awareness of cerebellar tubers in patients with tuberous sclerosis.
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Affiliation(s)
| | - Takashi S Sato
- Department of Radiology, Stead Family Children's Hospital, University of Iowa, 200 Hawkins Dr. 3889 JPP, Iowa City, IA 52242 USA
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18
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Hastings B, Mortele K, Lee EY. Genetic Syndromes Affecting Both Children and Adults: A Practical Guide to Imaging-based Diagnosis, Management, and Screening Recommendations for General Radiologists. Radiol Clin North Am 2020; 58:619-638. [PMID: 32276707 DOI: 10.1016/j.rcl.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Genetic syndromes are an infrequently encountered but challenging group of conditions for both pediatric and adult radiologists given the multitude of possible findings and important complications associated with these syndromes. This article reviews characteristic syndromic imaging features, as well as discussing important complications and screening recommendations for a selected group of clinically relevant genetic syndromes affecting both pediatric and adult populations.
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Affiliation(s)
- Bradford Hastings
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | | | - Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Taschner CA, Erny D, Schnell O, Urbach H, Duman IE, Prinz M. Freiburg Neuropathology Case Conference : Intraventricular Mass Lesion in a Child. Clin Neuroradiol 2020; 30:189-195. [PMID: 32103286 PMCID: PMC7082370 DOI: 10.1007/s00062-020-00885-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.
| | - D Erny
- Department of Neuropathology, Medical Center - University of Freiburg, Freiburg, Germany
| | - O Schnell
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - I E Duman
- Department of Neuroradiology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, Medical Center - University of Freiburg, Freiburg, Germany
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20
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Liu S, Cai Y, Rong R, Hu P, Chen S, Wang X, Shi H. Tuberous sclerosis complex (TSC) with epilepsy on 18F-FDG simultaneous PET/MR. Eur J Nucl Med Mol Imaging 2020; 47:2471-2472. [PMID: 31953673 DOI: 10.1007/s00259-019-04539-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/13/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Siwei Liu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Cai
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rong Rong
- United Imaging Healthcare of American, Houston, TX, USA
| | - Pengcheng Hu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuguang Chen
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
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21
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Park BS, Yoo MJ, Kim IH, Park JH, Park SH, Lee YJ, Park KM. Alterations of gray matter volumes and connectivity in patients with tuberous sclerosis complex. J Clin Neurosci 2019; 72:360-364. [PMID: 31892496 DOI: 10.1016/j.jocn.2019.12.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/20/2019] [Indexed: 11/16/2022]
Abstract
Tuberous sclerosis complex (TSC) is an inherited genetic disorder caused by mutations in the TSC1 or TSC2 genes, encoding hamartin and tuberin. We aimed to evaluate structural volumes and connectivity of patients with TSC compared to those of healthy subjects. We consecutively enrolled 13 patients with a diagnosis of TSC and 15 age- and sex-matched healthy control subjects. Subjects underwent three-dimensional volumetric T1-weighted imaging, suitable for a quantitative analysis. Structural volumes were investigated using FreeSurfer image analysis software, and structural connectivity was calculated from a connectivity matrix, which was estimated from the correlation analysis of structural volumes using the Brain Analysis using Graph Theory software package. Differences in structural volumes and connectivity were analyzed between patients with TSC and healthy subjects. There were no differences of cortical volumes between the patients with TSC and healthy controls. However, we found decreased gray matter volumes in several subcortical regions in the patients with TSC compared to those in healthy controls, specifically in the putamen (0.3212 vs. 0.3841%, p = 0.001), even after multiple corrections. Regarding global structural connectivity, the small-worldness index was significantly decreased in patients with TSC compared to that in healthy controls (0.907 vs. 0.977, p = 0.049). This study revealed structural volumes and connectivity in patients with TSC that are significantly different from those in healthy controls. These alterations have implications for the pathogenesis of TSC.
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Affiliation(s)
- Bong Soo Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Mi Jung Yoo
- Department of Internal Medicine, Dongkang Hospital, Ulsan, South Korea
| | - Il Hwan Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jin Han Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Si Hyung Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
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22
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Hill BJ, Gadde JA, Palasis S. Subependymal Giant Cell Astrocytoma Size Measurement in Tuberous Sclerosis Complex: Noncontrast vs Contrast-Enhanced 3-Dimensional T1-Weighted Magnetic Resonance Imaging (MRI). J Child Neurol 2019; 34:922-927. [PMID: 31424303 DOI: 10.1177/0883073819867541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Tuberous sclerosis complex is a multisystem genetic disorder characterized by multiorgan hamartomas, seizures, and developmental delay. Current consensus recommendations for tuberous sclerosis complex include brain magnetic resonance imaging (MRI) without and with contrast every 1 to 3 years until age 25 years for subependymal giant cell astrocytoma screening, and more often in patients with known subependymal giant cell astrocytoma. Recent reports in the literature regarding gadolinium deposition have prompted us to investigate the added value of intravenous contrast in this setting. MATERIALS AND METHODS Thirty-nine MRI examinations from 12 tuberous sclerosis complex patients with known subependymal giant cell astrocytoma were retrospectively reviewed for all caudothalamic groove lesions larger than 1 cm. Lesions were measured in 2 planes on both noncontrast and contrast-enhanced axial 3-dimensional (3D) T1-weighted imaging in a randomized fashion by 2 attending pediatric neuroradiologists. Differences in lesion measurements were compared to zero using a 1-sample t test. RESULTS On average, radiologist A measured lesions 1.1 mm larger in long-axis diameter without contrast (P = .0003), whereas radiologist B measured lesions 0.1 mm larger without contrast (not significant). Differences in lesion measurement were smaller when comparing noncontrast to contrast-enhanced 3D T1-weighted imaging than when comparing radiologist A to radiologist B. CONCLUSIONS Noncontrast axial 3D T1-weighted imaging is similar to contrast-enhanced axial 3D T1-weighted imaging for subependymal giant cell astrocytoma size measurement. It has high accuracy and may be a safer and more efficient imaging method for tuberous sclerosis complex patients who commonly undergo numerous MRI examinations throughout their lifetime. Further studies may be appropriate to determine whether contrast material could be beneficial in certain situations.
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Affiliation(s)
- Brook J Hill
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Judith A Gadde
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Susan Palasis
- Lurie Children's Hospital of Chicago, Chicago, IL, USA
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23
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Lu DS, Karas PJ, Krueger DA, Weiner HL. Central nervous system manifestations of tuberous sclerosis complex. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2018; 178:291-298. [PMID: 30230171 DOI: 10.1002/ajmg.c.31647] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/28/2018] [Accepted: 06/30/2018] [Indexed: 01/21/2023]
Abstract
Tuberous sclerosis complex (TSC) is a neurocutaneous autosomal-dominant genetic syndrome marked by development of hamartomatous lesions arising from dysfunction of the mammalian target of rapamycin (mTOR) pathway. Although TSC remains a heterogeneous clinical entity, the recent inclusion of genetic diagnostic criteria reflects advancement in our understanding of its underlying etiopathogenesis. Abnormal cellular growth, differentiation, and migration result in multisystem sequelae, with neurologic manifestations of TSC representing the primary cause of morbidity and mortality for the majority of individuals. Modern imaging techniques aid in the diagnosis of TSC and guide treatment strategies by revealing central nervous system findings. Cortical tubers are the namesake lesion of the disorder and occur in up to 90% of cases, often exerting significant epileptogenic potential. Subependymal nodules are found in 80% of patients as calcified tumors lining the ependyma of the lateral ventricles. In some cases, these nodules are thought to progress to subependymal giant cell astrocytomas and may present with obstructive hydrocephalus. Retinal astrocytic hamartomas are also common, present in 50% of patients. Surgery remains the treatment of choice for large or symptomatic lesions, though clinical trials have highlighted a potential role for mTOR pathway antagonism. A multidisciplinary approach is necessary for achieving optimal patient outcomes.
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Affiliation(s)
- Derek S Lu
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Patrick J Karas
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Darcy A Krueger
- Division of Child Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Howard L Weiner
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.,Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
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24
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Grilli G, Moffa AP, Perfetto F, Specchiulli LP, Vinci R, Macarini L, Zizzo L. Neuroimaging Features of Tuberous Sclerosis Complex and Chiari Type I Malformation: A Rare Association. J Pediatr Neurosci 2018; 13:224-228. [PMID: 30090143 PMCID: PMC6057178 DOI: 10.4103/jpn.jpn_76_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An 8-year-old girl was admitted during the night in our emergency department for an acute episode of seizures. The patient underwent computed-tomography (CT) brain scan (Toshiba ® Aquilion 64-TSX-101A/HC) and magnetic resonance imaging (MRI) brain scan (Philips® Achieva 1.5T). CT scan showed left frontal calcified nodules and calcified periventricular subependymal nodules. Subsequently, MRI evaluation revealed cortical and subcortical nodules that showed low signal with respect to the white matter on T1-weighted imaging sequences and high signal both in T2-weighted imaging sequences and in fluid-attenuated inversion recovery sequences. We also showed a herniation of cerebellar tonsils through the foramen magnum (Chiari malformation Type I [CMI]) with the associated hydrosyringomyelic cavity. Our report showed a rare association between tuberous sclerosis complex and CMI.
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Affiliation(s)
| | | | | | | | - Roberta Vinci
- Department of Radiology, University of Foggia, Italy
| | - Luca Macarini
- Department of Radiology, University of Foggia, Italy
| | - Luciano Zizzo
- Department of Child Neuropsychiatry, Riuniti Hospital of Foggia, Italy
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25
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Dillman JR, Trout AT, Smith EA, Towbin AJ. Hereditary Renal Cystic Disorders: Imaging of the Kidneys and Beyond. Radiographics 2017; 37:924-946. [PMID: 28493804 DOI: 10.1148/rg.2017160148] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The purpose of this article is to review the hereditary renal cystic diseases that can manifest in children and adults, with specific attention to pathogenesis and imaging features. Various common and uncommon hereditary renal cystic diseases are reviewed in terms of their underlying etiology, including the involved genetic mutations and the affected proteins and cellular structures. Focus is placed on the morphologic findings in each condition and the features that distinguish one disorder from another. The two most common categories of hereditary renal cystic disease are (a) the ciliopathic disorders, which are related to mutations affecting the primary cilia (called "ciliopathies"), and (b) the phakomatoses. Autosomal dominant polycystic kidney disease, autosomal recessive polycystic kidney disease, and the "medullary cystic disease complex" are all ciliopathies but have different phenotypes. Tuberous sclerosis complex and the associated "contiguous gene syndrome," as well as von Hippel-Lindau syndrome, are phakomatoses that can manifest with cystic renal lesions but have uniquely different extrarenal manifestations. Finally, DICER1 mutations can manifest with renal cystic lesions (typically, cystic nephromas) in patients predisposed to other malignancies in the chest, ovaries, and thyroid. Although some overlap exists in the appearance of the renal cysts associated with each of these diseases, there are clear morphologic differences (eg, cyst size, location, and complexity) that are emphasized in this review. To improve patient outcomes, it is important for the radiologist to recognize the various hereditary renal cystic diseases so that a correct diagnosis is assigned and so that the patient is adequately evaluated and followed up. ©RSNA, 2017.
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Affiliation(s)
- Jonathan R Dillman
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 (J.R.D., A.T.T., A.J.T.); and the Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.S.)
| | - Andrew T Trout
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 (J.R.D., A.T.T., A.J.T.); and the Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.S.)
| | - Ethan A Smith
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 (J.R.D., A.T.T., A.J.T.); and the Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.S.)
| | - Alexander J Towbin
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 (J.R.D., A.T.T., A.J.T.); and the Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.S.)
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MARTÍN-PÉREZ MÁ, MARÍN-BALBÍN JM, BLANCO-HERNÁNDEZ R, MARTÍN-GARCÍA I, TABERNERO-RICO R, GONZALO-DOMÍNGUEZ M. Resonancia magnética en hipoacusia y vértigo. REVISTA ORL 2017. [DOI: 10.14201/orl201781.14832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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von Ranke FM, Faria IM, Zanetti G, Hochhegger B, Souza AS, Marchiori E. Imaging of tuberous sclerosis complex: a pictorial review. Radiol Bras 2017; 50:48-54. [PMID: 28298732 PMCID: PMC5347503 DOI: 10.1590/0100-3984.2016.0020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Tuberous sclerosis complex (TSC) is a genetically determined hamartomatous
neurocutaneous disease with high phenotypic variability. TSC is characterized by
widespread hamartomas and benign, or rarely malignant, neoplasms distributed in
several organs throughout the body, especially in the brain, skin, retina,
kidney, heart, and lung. Common manifestations include cortical tubers,
subependymal nodules, white matter abnormalities, retinal abnormalities, cardiac
rhabdomyoma, lymphangioleiomyomatosis, renal angiomyolipoma, and skin lesions.
The wide range of organs affected by the disease implies that TSC1 and TSC2
genes play important roles in the regulation of cell proliferation and
differentiation. Although recent advances in treatment have improved morbidity,
the prognosis remains quite poor and nearly 40% of patients die by the age of 35
years. Imaging is important in the evaluation of TSC because of its role not
only in presumptive diagnosis, but also in defining the full extent of
involvement. This information allows a better understanding of the behavioural
phenotype, as related to lesion location. Imaging also contributes to treatment
planning. This pictorial review describes common and uncommon imaging
manifestations of TSC.
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Affiliation(s)
| | - Igor Murad Faria
- MD, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Gláucia Zanetti
- MD, PhD, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Arthur Soares Souza
- MD, PhD, Faculdade de Medicina de São José do Rio Preto (Famerp) and Ultra X, São José do Rio Preto, SP, Brazil
| | - Edson Marchiori
- MD, PhD, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Hu S, Hu DY, Zhu WZ, Wang L, Wang Z. Tuberous sclerosis complex: Imaging characteristics in 11 cases and review of the literature. ACTA ACUST UNITED AC 2016; 36:601-606. [PMID: 27465340 DOI: 10.1007/s11596-016-1632-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/12/2016] [Indexed: 11/30/2022]
Abstract
Tuberous sclerosis complex (TSC) is an uncommon multiorgan disorder that may present many and different manifestations on imaging. Radiology plays an important role in diagnosis and management, and can substantially improve the clinical outcome of TSC. Therefore, a comprehensive understanding of this disease is essential for the radiologist. The manifestations of TSC on computer tomography (CT) and magnetic resonance (MR) images were analyzed. Eleven patients with a clinical diagnosis of TSC were retrospectively reviewed. Central nervous system lesions included subependymal nodules (SENs) (11/11), subependymal giant cell astrocytomas (SEGAs) (2/11), cortical and subcortical tuber lesions (5/11), and white matter lesions (4/11). Of the 6 patients with abdominal scans, there were 6 cases of renal angiomyolipomas (AMLs), and one case of hepatic AMLs. Of the 4 patients undergoing chest CT, lung lymhangioleiomyomatosis (LAM) (2/4), and multiple small sclerotic bone lesions (2/4) were observed. Different modalities show different sensitivity to the lesion. Analysis of images should be integrated with patients' history in order to diagnose TSC.
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Affiliation(s)
- Shan Hu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Dao-Yu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Wen-Zhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Liang Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zi Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
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Ellingson BM, Hirata Y, Yogi A, Karavaeva E, Leu K, Woodworth DC, Harris RJ, Enzmann DR, Wu JY, Mathern GW, Salamon N. Topographical Distribution of Epileptogenic Tubers in Patients With Tuberous Sclerosis Complex. J Child Neurol 2016; 31:636-45. [PMID: 26472749 DOI: 10.1177/0883073815609151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/22/2015] [Indexed: 11/16/2022]
Abstract
Tuberous sclerosis complex is a multisystem genetic syndrome often affecting the central nervous system. The purpose of the current study was to identify topographical patterns in the distribution specific to epileptogenic (n = 37) and nonepileptogenic (n = 544) tubers throughout the brain for a cohort of 23 tuberous sclerosis complex patients with a history of seizures. Tubers localized to the inferior parietal lobes, middle frontal lobes, middle temporal lobes, or central sulcus regions were associated with a high frequency of epileptogenic tubers. Epileptogenic tubers occurred statistically more frequently within the inferior parietal lobe and within the central sulcus region in children younger than 1 or between 1 and 3 years old, respectively. Results imply seizure activity in tuberous sclerosis complex patients can be associated with the location of cortical tubers.
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Affiliation(s)
- Benjamin M Ellingson
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yoko Hirata
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA Department of Neurosurgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Akira Yogi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nakagami-gun, Okinawa, Japan
| | - Elena Karavaeva
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kevin Leu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, CA, USA
| | - Davis C Woodworth
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA Department of Biomedical Physics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Robert J Harris
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA Department of Biomedical Physics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dieter R Enzmann
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Joyce Y Wu
- Department of Pediatrics, Division of Pediatric Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Gary W Mathern
- Departments of Neurosurgery and Psychiatry and Biobehavioral Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Raus I, Coroiu RE, Capusan CS. Neuroimaging in pediatric phakomatoses. An educational review. Med Pharm Rep 2016; 89:56-64. [PMID: 27004026 PMCID: PMC4777470 DOI: 10.15386/cjmed-417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/25/2015] [Accepted: 07/06/2015] [Indexed: 12/30/2022] Open
Abstract
Phakomatoses are a group of more than 30 entities with an inheritance pattern that primarily affects the central nervous system, skin, viscera and connective tissue. The aim of this paper is to make an educational review of the most common radiological findings on phakomatoses through the iconography of the cases collected in our magnetic resonance imaging (MRI) and computer tomography (CT) units over the last ten years. Also, we describe and illustrate by these techniques the main features of the most common entities within the wide spectrum of diseases. As highly variable and age dependent, imaging techniques have an important role in the diagnosis and follow-up of these patients. Increased awareness for the need to implement and conduct screening programs could be considered as a solution to prevent late diagnosis and to treat the patients in early stages of disease.
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Affiliation(s)
- Iulian Raus
- Radiology Department, Dr. Constantin Papilian Military and Emergency Hospital of Cluj-Napoca, Romania
| | - Roxana Elena Coroiu
- Radiology Department, Iuliu Hatieganu University of Medicine and Pharmacy of Cluj-Napoca, Romania
| | - Cosmin Serban Capusan
- Radiology Department, Dr. Constantin Papilian Military and Emergency Hospital of Cluj-Napoca, Romania
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31
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Krishnan A, Kaza RK, Vummidi DR. Cross-sectional Imaging Review of Tuberous Sclerosis. Radiol Clin North Am 2016; 54:423-40. [PMID: 27153781 DOI: 10.1016/j.rcl.2015.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Tuberous sclerosis complex (TSC) is a multisystem, genetic disorder characterized by development of hamartomas in the brain, abdomen, and thorax. It results from a mutation in one of 2 tumor suppressor genes that activates the mammalian target of rapamycin pathway. This article discusses the origins of the disorder, the recently updated criteria for the diagnosis of TSC, and the cross-sectional imaging findings and recommendations for surveillance. Familiarity with the diverse radiological features facilitates diagnosis and helps in treatment planning and monitoring response to treatment of this multisystem disorder.
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Affiliation(s)
- Anant Krishnan
- Department of Diagnostic Radiology, The Oakland University William Beaumont School of Medicine and Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Ravi K Kaza
- Department of Radiology, University of Michigan Hospitals, 1500 East Medical Center Drive, UH B1 502 E, Ann Arbor, MI 48109, USA
| | - Dharshan R Vummidi
- Department of Radiology, University of Michigan Hospitals, 1500 East Medical Center Drive, CVC5581, Ann Arbor, MI 48109, USA
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32
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Dogan M, Gumus K, Koc G, Doganay S, Per H, Gorkem S, Canpolat M, Bayram A, Coskun A. Brain diffusion tensor imaging in children with tuberous sclerosis. Diagn Interv Imaging 2016; 97:171-6. [DOI: 10.1016/j.diii.2015.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/15/2015] [Accepted: 04/02/2015] [Indexed: 11/25/2022]
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Abstract
Pediatric neurology relies on ultrasound, computed tomography (CT), and magnetic resonance (MR) imaging. CT prevails in acute neurologic presentations, including traumatic brain injury (TBI), nontraumatic coma, stroke, and status epilepticus, because of easy availability, with images of diagnostic quality, e.g., to exclude hemorrhage, usually completed quickly enough to avoid sedation. Concerns over the risks of ionizing radiation mean re-imaging and higher-dose procedures, e.g., arteriography and venography, require justification. T1/T2-weighted imaging (T1/T2-WI) MR with additional sequences (arteriography, venography, T2*, spectroscopy, diffusion tensor, perfusion, diffusion- (DWI) and susceptibility-weighted imaging (SWI)) often clarifies the diagnosis, which may alter management in acute settings, as well as chronic conditions, e.g., epilepsy. Clinical acumen remains essential to avoid imaging, e.g., in genetic epilepsies or migrainous headaches responding to treatment, or to target sequences to specific diagnosis, e.g., T1/T2-WI for shunt dysfunction (with SWI for TBI); DWI, arteriography including neck vessels, and venography for acute hemiplegia or coma; coronal temporal cuts for partial epilepsy; or muscle imaging for motor delay. The risk of general anesthesia is low; "head-only" scanners may allow rapid MRI without sedation. Timely and accurate reporting, with discrepancy discussion between expert neuroradiologists, is important for management of the child and the family's expectations.
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Mistry KA, Sood D, Bhoil R, Chadha V, Ahluwalia AK, Sood S, Suthar PP. A Classic Case of Tuberous Sclerosis with Multisystem Involvement Including Giant Bilateral Renal Angiomyolipomas Presenting as Massive Hematuria. Pol J Radiol 2015; 80:435-41. [PMID: 26491490 PMCID: PMC4588676 DOI: 10.12659/pjr.894741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 06/19/2015] [Indexed: 12/19/2022] Open
Abstract
Background Tuberous Sclerosis (TSC) also known as Bourneville disease is a neurocutaneous syndrome having an autosomal dominant inheritance pattern, though the condition has a high rate of spontaneous mutation. It is the second most common neurocutaneous syndrome after neurofibromatosis. This disease demonstrates a widespread potential for hamartomatous growths in multiple organ systems. Case Report We report a case of a 36-year-old female with TSC presenting as massive hematuria with underlying giant bilateral renal angiomyolipomas (AML) with estimated total tumor burden of more than 8 kg which is to the best of our knowledge the highest ever reported. The patient also had lymphangioleiomyomatosis and lesions in the brain, skin, teeth and bones. Conclusions TSC has a wide variety of clinical and radiologic manifestations. It should be suspected when some of the common radiological manifestations are found, including CNS involvement, renal and hepatic AMLs and LAM, even if clinical signs are not obvious. Renal AMLs in setting of TSC may reach giant proportions and may present with massive hematuria.
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Affiliation(s)
- Kewal A Mistry
- Department of Radiology, Dr. Rajendra Prasad Government Medical College, Kangra, India
| | - Dinesh Sood
- Department of Radiology, Dr. Rajendra Prasad Government Medical College, Kangra, India
| | - Rohit Bhoil
- Department of Radiology, Indira Gandhi Medical College, Shimla, India
| | - Veenal Chadha
- Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, India
| | - Ajay K Ahluwalia
- Department of Radiology, Dr. Rajendra Prasad Government Medical College, Kangra, India
| | - Saurabh Sood
- Department of Radiology, Dr. Rajendra Prasad Government Medical College, Kangra, India
| | - Pokhraj P Suthar
- Department of Radiology, Baroda Medical College, Vadodara, India
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Abstract
Tuberous sclerosis complex is an autosomal dominant disorder with variable affection of the central nervous system (CNS) and many other organ systems. Radiological features include various lesions of the brain as well as lesions of the lungs, kidneys and the heart. Imaging is important for the early detection of complications. This article provides an overview of the clinical features and therapy as well as the specific imaging of tuberous sclerosis complex.
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Affiliation(s)
- U Yilmaz
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg/Saar, Deutschland,
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36
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Rovira À, Ruiz-Falcó ML, García-Esparza E, López-Laso E, Macaya A, Málaga I, Vázquez É, Vicente J. Recommendations for the radiological diagnosis and follow-up of neuropathological abnormalities associated with tuberous sclerosis complex. J Neurooncol 2014; 118:205-223. [PMID: 24771286 DOI: 10.1007/s11060-014-1429-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/28/2014] [Indexed: 01/25/2023]
Abstract
Tuberous sclerosis complex (TSC) is a genetic condition with multisystem involvement, characterized by the development of tumors and other abnormalities in organs such as the brain, retina, skin, heart, kidneys, and lungs. Most patients have neuropathological abnormalities such as cortical tubers, white matter radial migration lines, subependymal nodules, and subependymal giant cell astrocytomas (SEGAs). These lesions are associated with different neurological manifestations that are frequently associated with TSC. These manifestations consist of epilepsy, intellectual disability, and neurobehavioral and psychiatric problems, including autism spectrum disorder. Hydrocephalus may also develop in patients with SEGAs due to ventricular obstruction, when this usually slow-growing tumor reaches sufficient size. Surgery has been the classical approach to treat SEGAs, although this treatment is associated with substantial morbidity and does not completely prevent tumor recurrence. Recently, the mammalian target of rapamycin (mTOR) inhibitor, everolimus, has been approved by the Food and Drug Administration and the European Medicines Agency for the treatment of patients with SEGAs associated with TSC. However, the treatment of SEGAs with these agents requires the development of guidelines that establish a differential diagnosis between SENs and SEGAs, in which neuroradiological examinations play an essential role. With the aim of improving the neuroradiological diagnosis and follow-up of the neuropathological abnormalities associated with TSC, a group of experts in this field has reviewed different aspects related to these issues and put together, a series of statements and recommendations intended to provide guidance to specialists involved in the management of TSC.
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Affiliation(s)
- Àlex Rovira
- Neuroradiology Unit (IDI), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - María Luz Ruiz-Falcó
- Neuropediatrics Department, Hospital Infantil Universitario Niño Jesús, Avenida de Menéndez Pelayo, 65, 28009, Madrid, Spain.
| | - Elena García-Esparza
- Neuroradiology Department, Hospital Infantil Universitario Niño Jesús, Avenida de Menéndez Pelayo, 65, 28009, Madrid, Spain
| | - Eduardo López-Laso
- Neuropediatrics Department, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal, s/n, 14004, Córdoba, Spain
| | - Alfons Macaya
- Neuropediatrics Department, Hospital Universitari Vall D'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Ignacio Málaga
- Child Neurology Unit, Pediatrics Department, Hospital Universitario Central de Asturias, Calle de Celestino Villamil, s/n, 33006, Oviedo, Spain
| | - Élida Vázquez
- Pediatric Radiology Department, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Josefina Vicente
- Neuroradiology Department, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal, s/n, 14004, Córdoba, Spain
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37
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Krueger DA, Northrup H. Tuberous sclerosis complex surveillance and management: recommendations of the 2012 International Tuberous Sclerosis Complex Consensus Conference. Pediatr Neurol 2013; 49:255-65. [PMID: 24053983 PMCID: PMC4058297 DOI: 10.1016/j.pediatrneurol.2013.08.002] [Citation(s) in RCA: 546] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 07/30/2013] [Accepted: 08/01/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Tuberous sclerosis complex is a genetic disorder affecting every organ system, but disease manifestations vary significantly among affected individuals. The diverse and varied presentations and progression can be life-threatening with significant impact on cost and quality of life. Current surveillance and management practices are highly variable among region and country, reflective of the fact that last consensus recommendations occurred in 1998 and an updated, comprehensive standard is lacking that incorporates the latest scientific evidence and current best clinical practices. METHODS The 2012 International Tuberous Sclerosis Complex Consensus Group, comprising 79 specialists from 14 countries, was organized into 12 separate subcommittees, each led by a clinician with advanced expertise in tuberous sclerosis complex and the relevant medical subspecialty. Each subcommittee focused on a specific disease area with important clinical management implications and was charged with formulating key clinical questions to address within its focus area, reviewing relevant literature, evaluating the strength of data, and providing a recommendation accordingly. RESULTS The updated consensus recommendations for clinical surveillance and management in tuberous sclerosis complex are summarized here. The recommendations are relevant to the entire lifespan of the patient, from infancy to adulthood, including both individuals where the diagnosis is newly made as well as individuals where the diagnosis already is established. CONCLUSIONS The 2012 International Tuberous Sclerosis Complex Consensus Recommendations provide an evidence-based, standardized approach for optimal clinical care provided for individuals with tuberous sclerosis complex.
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Affiliation(s)
- Darcy A Krueger
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Peters JM, Taquet M, Prohl AK, Scherrer B, van Eeghen AM, Prabhu SP, Sahin M, Warfield SK. Diffusion tensor imaging and related techniques in tuberous sclerosis complex: review and future directions. FUTURE NEUROLOGY 2013; 8:583-597. [PMID: 24489482 DOI: 10.2217/fnl.13.37] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this article, the authors aim to introduce the nonradiologist to diffusion tensor imaging (DTI) and its applications to both clinical and research aspects of tuberous sclerosis complex. Tuberous sclerosis complex is a genetic neurocutaneous syndrome with variable and unpredictable neurological comorbidity that includes refractory epilepsy, intellectual disability, behavioral abnormalities and autism spectrum disorder. DTI is a method for modeling water diffusion in tissue and can noninvasively characterize microstructural properties of the brain. In tuberous sclerosis complex, DTI measures reflect well-known pathological changes. Clinically, DTI can assist with detecting the epileptogenic tuber. For research, DTI has a putative role in identifying potential disease biomarkers, as DTI abnormalities of the white matter are associated with neurocognitive morbidity including autism. If indeed DTI changes parallel phenotypical changes related to the investigational treatment of epilepsy, cognition and behavior with mTOR inhibitors, it will facilitate future clinical trials.
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Affiliation(s)
- Jurriaan M Peters
- Department of Neurology & the Division of Epilepsy & Clinical Neurophysiology, Boston Children's Hospital, 300 Longwood Avenue, Fegan 9, Boston, MA 02115, USA ; Department of Radiology & the Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA 02115, USA
| | - Maxime Taquet
- Department of Radiology & the Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA 02115, USA ; ICTEAM Institute, Université catholique de Louvain, Place du Levant 2 bte L5.04.04, 1348 Louvain-La-Neuve, Belgium
| | - Anna K Prohl
- Department of Neurology & the Division of Epilepsy & Clinical Neurophysiology, Boston Children's Hospital, 300 Longwood Avenue, Fegan 9, Boston, MA 02115, USA ; Department of Radiology & the Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA 02115, USA
| | - Benoit Scherrer
- Department of Radiology & the Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA 02115, USA
| | - Agnies M van Eeghen
- Department of Neuroscience, ENCORE, Expertise Centre for Neurodevelopmental Disorders, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Sanjay P Prabhu
- Department of Radiology & the Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA 02115, USA
| | - Mustafa Sahin
- Department of Neurology & the Division of Epilepsy & Clinical Neurophysiology, Boston Children's Hospital, 300 Longwood Avenue, Fegan 9, Boston, MA 02115, USA
| | - Simon K Warfield
- Department of Radiology & the Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA 02115, USA
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Bhavsar AS, Verma S, Lamba R, Lall CG, Koenigsknecht V, Rajesh A. Abdominal manifestations of neurologic disorders. Radiographics 2013; 33:135-53. [PMID: 23322834 DOI: 10.1148/rg.331125097] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A variety of disorders-including infectious, inflammatory, hereditary, and metabolic diseases-may affect both the brain and abdominal cavity, and the findings in one region may help establish the diagnosis or limit the differential diagnosis. Establishing an accurate early diagnosis enables clinicians to adequately manage these unusual diseases and potentially avert life-threatening complications. For example, an early diagnosis of Gardner syndrome enables annual sigmoid- or colonoscopy and ultrasonography. In many conditions, abdominal manifestations precede neurologic manifestations and may have prognostic significance. Patients with celiac disease more often present with abdominal manifestations such as duodenitis, slow transit time, reversal of the jejunal-ileal fold pattern, and transient small bowel intussusception than with intracranial manifestations. In other conditions, the neurologic manifestations may be the same as the presenting symptoms. For example, patients with Gardner syndrome may initially present with multiple mandibular or sinonasal osteomas. In addition, sarcoidosis may manifest with multifocal enhancing dural masses. Abdominal and neurologic manifestations may even occur simultaneously, as in several of the phakomatoses such as neurofibromatosis type 1, tuberous sclerosis complex, and von Hippel-Lindau syndrome. Ultimately, familiarity with the appearances of these conditions allows radiologists to pinpoint a diagnosis, even when imaging findings in either location are nonspecific.
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Affiliation(s)
- Anil S Bhavsar
- Department of Radiology, University of Cincinnati Hospitals, 234 Goodman St, ML 0761, PO Box 670761, Cincinnati, OH 45267-0761, USA.
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40
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Krueger DA. Management of CNS-related Disease Manifestations in Patients With Tuberous Sclerosis Complex. Curr Treat Options Neurol 2013; 15:618-33. [DOI: 10.1007/s11940-013-0249-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Woermann FG, Vézina G. Structural imaging in children with chronic focal epilepsy: diagnostic algorithms and exploration strategies. HANDBOOK OF CLINICAL NEUROLOGY 2013; 111:747-57. [PMID: 23622222 DOI: 10.1016/b978-0-444-52891-9.00077-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Malformations of cortical development, especially focal cortical dysplasia in infants and children, and hippocampal sclerosis in adolescents with epilepsy are frequent lesions, but they are overlooked on standard MRI. In infants, errors in the interpretation of MRI in epilepsy can be attributed to MRI signal changes due to ongoing myelination. Poor technique, perceptual misses, incomplete knowledge and poor judgment are, however, other likely sources of errors when reading MRIs. This review covers MRI search strategies, i.e., how to conduct MRI examinations in epilepsy and what to expect in the structural MRI of an infant or child with focal epilepsy. Exploiting increased sensitivity, false positive results can be avoided in the light of a clinical hypothesis, possibly isolating a localized brain area by seizure semiology, EEG, and sometimes PET prior to MR reading.
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42
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Lennert B, Farrelly E, Sacco P, Pira G, Frost M. Resource utilization in children with tuberous sclerosis complex and associated seizures: a retrospective chart review study. J Child Neurol 2013; 28:461-9. [PMID: 22772159 DOI: 10.1177/0883073812448437] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Seizures are a hallmark manifestation of tuberous sclerosis complex, yet data characterizing resource utilization are lacking. This retrospective chart review was performed to assess the economic burden of tuberous sclerosis complex with neurologic manifestations. Demographic and resource utilization data were collected for 95 patients for up to 5 years after tuberous sclerosis complex diagnosis. Mean age at diagnosis was 3.1 years, with complex partial and infantile spasms as the most common seizure types. In the first 5 years post-diagnosis, 83.2% required hospitalization, 30.5% underwent surgery, and the majority of patients (90.5%) underwent ≥3 testing procedures. In 79 patients with a full 5 years of data, hospitalizations, intensive care unit stays, diagnostic testing, and rehabilitation services decreased over the 5-year period. Resource utilization is cost-intensive in children with tuberous sclerosis complex and associated seizures during the first few years following diagnosis. Improving seizure control and reducing health care costs in this population remain unmet needs.
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Katz JS, Milla SS, Wiggins GC, Devinsky O, Weiner HL, Roth J. Intraventricular lesions in tuberous sclerosis complex: a possible association with the caudate nucleus. J Neurosurg Pediatr 2012; 9:406-13. [PMID: 22462706 DOI: 10.3171/2011.12.peds11418] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Tuberous sclerosis complex (TSC) can manifest with 3 principal intracranial pathological entities: cortical tubers, subependymal nodules (SENs), and subependymal giant cell astrocytomas (SEGAs). The authors analyzed the location and growth of intraventricular lesions in a large cohort of patients with TSC. METHODS After institutional review board protocol approval, the authors retrospectively reviewed brain MRI scans of TSC patients for whom at least 1 electronically stored cranial MRI study was available. Collected data included location, size, and growth over time of all intraventricular lesions. RESULTS The authors reviewed 560 scans in 103 patients, who harbored 496 intraventricular lesions. Of the 496 lesions, 157 lesions were located along the caudate-thalamic groove (CTG) in 88 patients. Twenty SEGAs were operated on. The remaining 339 lesions were distributed along the lateral ventricle, always in contact with the course of the caudate nucleus, and were presumed to be SENs. Twenty-two patients with more than 4 years of follow-up had 34 lesions along the CTG, of which 23 were stable in size and 11 grew. All other intraventricular lesions were stable. Seven-Tesla MRI showed the intimate association of SENs and the caudate nucleus in 1 patient. CONCLUSIONS Intraventricular lesions in TSC patients are located throughout the lateral ventricular wall. Their location exclusively follows the course of the caudate nucleus. Only lesions along the CTG showed the potential to grow, and these were then identified as SEGAs. The remaining lesions were SENs. Understanding why these lesions develop in relation to the caudate nucleus may offer insights into therapy.
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Affiliation(s)
- Joel S Katz
- Department of Neurosurgery, Division of Pediatric Neurosurgery, New York, NY, USA
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Hallett L, Foster T, Liu Z, Blieden M, Valentim J. Burden of disease and unmet needs in tuberous sclerosis complex with neurological manifestations: systematic review. Curr Med Res Opin 2011; 27:1571-83. [PMID: 21692602 DOI: 10.1185/03007995.2011.586687] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Tuberous sclerosis complex (TSC) is a progressive genetic disorder characterized by pervasive benign tumor growth. We sought to assess the current understanding of burden of TSC-related neurological manifestations. METHODS We systematically searched MEDLINE- and EMBASE-indexed, English-language literature (5/2000-5/2010) and non-indexed materials. RESULTS In total, 119 articles were included, 115 on epidemiology and treatment. Recent prevalence estimates from Ireland and Taiwan report TSC in 1:14,000-25,000 individuals, below older estimates of 1:10,000. While neurological manifestations are common, treatment is largely unaddressed by guidelines and focuses on symptoms, with resection standard for subependymal giant cell astrocytomas (SEGAs) and common practice for refractory epilepsy. Antiepileptic drugs and mammalian target of rapamycin inhibitors safely, effectively minimize the need for surgery for severe epilepsy and SEGAs. CONCLUSION Morbidity and treatment burden of prevalent neurological manifestations is significant, suggesting substantial economic and humanistic burden; however, these areas are poorly studied, indicating total disease burden is unknown. Future research should assess quality of life, caregiver burden, and costs.
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Craven I, Griffiths P, Hoggard N. Magnetic resonance imaging of epilepsy at 3 Tesla. Clin Radiol 2011; 66:278-86. [DOI: 10.1016/j.crad.2010.10.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 10/28/2010] [Accepted: 10/29/2010] [Indexed: 11/29/2022]
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Cerebellar abnormality in children and young adults with tuberous sclerosis complex: MR and diffusion weighted imaging findings. J Neuroradiol 2010; 37:231-8. [PMID: 20381146 DOI: 10.1016/j.neurad.2009.12.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 12/14/2009] [Accepted: 12/15/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The goal of our study was to: determine the incidence of cerebellar lesions in a cohort of children and young adults with TSC, and analyze the magnetic resonance imaging (MRI) findings of cerebellar TSC lesions including their contrast behavior and diffusion characteristics. MATERIAL AND METHODS MRI studies of 27 TSC patients (mean age, 10.6 years) were evaluated for: cortical/subcortical tubers, white matter lesions, subependymal nodules, and giant cell astrocytomas. Patients with cerebellar involvement were further analyzed for the imaging and diffusion characteristics. ADC measurements of the cerebellar tubers were performed and compared with the contralateral normal appearing cerebellum. The clinical charts were revisited for symptoms suggesting cerebellar involvement. RESULTS Cerebellar tubers were seen in 8/27 patients, cerebellar atrophy in 1/27 patients. Cerebellar tubers showed a pyramidal/wedge appearance with a broad base reaching the cortex. The majority of the cerebellar tubers (11/12, 92%) showed a "zebra-like" contrast enhancement. All cerebellar tubers had increased ADC values (mean ADC 1472×10(-6) mm(2)/s). None of the patients had "typical" cerebellar symptoms. CONCLUSION Thirty-three percent of TSC patients had cerebellar lesions, most of them being cerebellar tubers. Cerebellar tubers differ from supratentorial tubers both concerning shape and contrast behavior. The exact etiology of contrast enhancement remains unclear. Future studies have to determine the impact of cerebellar lesions on neurocognitive development.
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Gama HPP, da Rocha AJ, Valério RMF, da Silva CJ, Garcia LAL. Hippocampal abnormalities in an MR imaging series of patients with tuberous sclerosis. AJNR Am J Neuroradiol 2010; 31:1059-62. [PMID: 20053803 DOI: 10.3174/ajnr.a1972] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Hippocampal abnormalities are known as highly epileptogenic precursor lesions in the general population, primarily manifesting as MTS. The purpose of this study was to evaluate the occurrence of hippocampal abnormalities on MR imaging in patients with TS to explore the possible underlying mechanisms of the abnormalities and to identify the relationship between an abnormal HF and epilepsy. MATERIALS AND METHODS We studied MR images and clinical data from 31 patients with TS. The MR imaging protocol was identical for all patients and included tilted coronal images of their temporal lobes. The diagnosis of TSC was made according to established criteria. The HFs of the patients were evaluated from coronal images according to size, morphology, and signal intensity. The data were submitted to statistical analysis, and P values < or = .05 were considered significant. RESULTS We found HF abnormalities in 5 patients. Four had typical MTS, and 1 had HIMAL. We found a positive correlation between childhood febrile seizures and MTS in patients with TS. We also confirmed that patients with altered hippocampi had a tendency to exhibit more cortical tubers. CONCLUSIONS Analysis of this series of patients demonstrated the presence of HF abnormalities, mainly MTS in patients with TS. We also found that the occurrence of febrile seizures during the first year of life appears to be one of the determining factors for MTS development in these patients.
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Affiliation(s)
- H P P Gama
- Service of Radiology, Santa Casa of São Paulo, São Paulo-SP, Brazil.
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PET imaging in pediatric neuroradiology: current and future applications. Pediatr Radiol 2010; 40:82-96. [PMID: 19937235 DOI: 10.1007/s00247-009-1457-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 10/12/2009] [Accepted: 10/20/2009] [Indexed: 10/20/2022]
Abstract
Molecular imaging with positron emitting tomography (PET) is widely accepted as an essential part of the diagnosis and evaluation of neoplastic and non-neoplastic disease processes. PET has expanded its role from the research domain into clinical application for oncology, cardiology and neuropsychiatry. More recently, PET is being used as a clinical molecular imaging tool in pediatric neuroimaging. PET is considered an accurate and noninvasive method to study brain activity and to understand pediatric neurological disease processes. In this review, specific examples of the clinical use of PET are given with respect to pediatric neuroimaging. The current use of co-registration of PET with MR imaging is exemplified in regard to pediatric epilepsy. The current use of PET/CT in the evaluation of head and neck lymphoma and pediatric brain tumors is also reviewed. Emerging technologies including PET/MRI and neuroreceptor imaging are discussed.
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Lee KK, Salamon N. [18F] fluorodeoxyglucose-positron-emission tomography and MR imaging coregistration for presurgical evaluation of medically refractory epilepsy. AJNR Am J Neuroradiol 2009; 30:1811-6. [PMID: 19628624 DOI: 10.3174/ajnr.a1637] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Epilepsy is a chronic disorder affecting approximately 1% of the population of the world. Approximately one third of patients with epilepsy remain refractory to medical therapy. For these patients, surgery is a curative option. In order for surgery to be considered, precise localization of the structural abnormality is needed. When MR imaging findings are normal, more sensitive techniques such as positron-emission tomography (PET) can help find the abnormality. Combining MR imaging and PET information increases the sensitivity of the presurgical evaluation. In this review, we discuss the clinical applications of coregistration of [(18)F] fluorodeoxyglucose (FDG)-PET with MR imaging for medically refractory epilepsy. Because FDG-PET/MR imaging coregistration has been a routine component of the presurgical evaluation for patients with epilepsy at our institution since 2004, we also included cases from our data base that exemplify the utility of this technology to obtain better postsurgical outcomes.
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Affiliation(s)
- K K Lee
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Saada J, Hadj Rabia S, Fermont L, Le Bidois J, Bernardes LS, Martinovic J, Sonigo P, Dumez Y, Bonnet D, Benachi A. Prenatal diagnosis of cardiac rhabdomyomas: incidence of associated cerebral lesions of tuberous sclerosis complex. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:155-159. [PMID: 19606448 DOI: 10.1002/uog.6367] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To determine the prevalence of specific cerebral lesions of tuberous sclerosis complex (TSC) and neurological outcome in cases diagnosed prenatally with cardiac rhabdomyomas. METHODS We reviewed all fetuses diagnosed prenatally with cardiac rhabdomyomas which had undergone detailed ultrasound evaluation and cerebral magnetic resonance imaging (MRI) and which were recorded in the database of a single institution covering the period January 1992 to December 2005. RESULTS Fifty-one fetuses were included in the study. MRI was performed at a mean +/- SD gestational age of 30 +/- 3 gestational weeks and showed specific lesions of TSC in 49% of cases. Termination of pregnancy was chosen by the parents in 26 cases. Neurological development was studied in 20 cases, follow-up lasting 4.8 +/- 2.9 years. Neurodevelopmental events occurred during the follow-up period in 45% of cases. Neurological complications occurred in 67% of patients who had cerebral lesions at MRI and in 33% of patients with normal MRI results. There was no significant difference between the two groups of patients (P = 0.2). CONCLUSION In fetuses with cardiac rhabdomyomas detailed ultrasound examination and third-trimester cerebral MRI are able to diagnose most TSC cerebral lesions, but fail to determine neurological outcome.
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Affiliation(s)
- J Saada
- Maternité, Université Paris-Descartes, Faculté de Médecine, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.
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