Comparative analysis of MR sequences to detect structural brain lesions in tuberous sclerosis.
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.
Pinto Gama
Hugo Pereira
HP
Section of Radiology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
da Rocha
Antônio José
AJ
Braga
Flávio Túlio
FT
da Silva
Carlos Jorge
CJ
Maia
Antonio Carlos Martins
AC
de Campos Meirelles
Rogério Gonçalves
RG
Mendonça do Rego
José Iram
JI
Lederman
Henrique Manoel
HM
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*