title: Comparative analysis of MR sequences to detect structural brain lesions in tuberous sclerosis.
abstract: BACKGROUND
  Tuberous sclerosis (TS) is a neurocutaneous genetically inherited disease with variable penetrance characterized by dysplasias and hamartomas affecting multiple organs. MR is the imaging method of choice to demonstrate structural brain lesions in TS.
  
  
  OBJECTIVE
  To compare MR sequences and determine which is most useful for the demonstration of each type of brain lesion in TS patients.
  
  
  METHODS
  We reviewed MR scans of 18 TS patients for the presence of cortical tubers, white matter lesions (radial bands), subependymal nodules, and subependymal giant cell astrocytoma (SGCA) on the following sequences: (1) T1-weighted spin-echo (T1 SE) images before and after gadolinium (Gd) injection; (2) nonenhanced T1 SE sequence with an additional magnetization transfer contrast medium pulse on resonance (T1 SE/MTC); and (3) fluid-attenuated inversion recovery (FLAIR) sequence.
  
  
  RESULTS
  Cortical tubers were found in significantly (P<0.05) larger numbers and more conspicuously in FLAIR and T1 SE/MTC sequences. The T1 SE/MTC sequence was far superior to other methods in detecting white matter lesions (P<0.01). There was no significant difference between the T1 SE/MTC and T1 SE (before and after Gd injection) sequences in the detection of subependymal nodules; FLAIR sequence showed less sensitivity than the others in identifying the nodules. T1 SE sequences after Gd injection demonstrated better the limits of the SGCA.
  
  
  CONCLUSIONS
  We demonstrated the importance of appropriate MRI sequences for diagnosis of the most frequent brain lesions in TS. Our study reinforces the fact that each sequence has a particular application according to the type of TS lesion. Gd injection might be useful in detecting SGCA; however, the parameters of size and location are also important for a presumptive diagnosis of these tumors.
authors.affiliation: Section of Radiology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
authors.forename: Hugo Pereira
authors.initials: HP
authors.lastname: Pinto Gama
authors.forename: Antônio José
authors.initials: AJ
authors.lastname: da Rocha
authors.forename: Flávio Túlio
authors.initials: FT
authors.lastname: Braga
authors.forename: Carlos Jorge
authors.initials: CJ
authors.lastname: da Silva
authors.forename: Antonio Carlos Martins
authors.initials: AC
authors.lastname: Maia
authors.forename: Rogério Gonçalves
authors.initials: RG
authors.lastname: de Campos Meirelles
authors.forename: José Iram
authors.initials: JI
authors.lastname: Mendonça do Rego
authors.forename: Henrique Manoel
authors.initials: HM
authors.lastname: Lederman
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology*; D002540:Cerebral Cortex / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014402:Tuberous Sclerosis / Q000175:diagnosis*