Distribution and conspicuity of intracranial abnormalities on MR imaging in adults with tuberous sclerosis complex: A comparison of sequences including ultrafast T2-weighted images.
OBJECTIVE
Tuberous sclerosis complex produces a wide range of intracranial pathologies, the most common being cortical tubers and subependymal nodules. This study evaluates which magnetic resonance (MR) sequences show the pathology best and to see if "ultrafast" sequences can show the pathology robustly.


METHODS
MR imaging was performed on 29 adults with tuberous sclerosis complex. Anatomically matched 5-mm-thick sections were taken in the axial plane using four different sequences, including single shot fast spin echo as the ultrafast method. The ability of those sequences to show cortical tubers and subependymal nodules was assessed by reporting each sequence independently and comparing with the reference standard report based on all of the sequences together.


RESULTS
A total of 219 cortical tubers were shown in the 29 people; three did not have cortical tubers. Cortical tubers were best delineated on fluid-attenuated inversion recovery (FLAIR) images (false-negative rate <0.5%) followed by the T(2)-weighted images (false-negative rate 21%). The single-shot fast spin echo and gradient echo T(2)* sequences both failed to show more than 50% of cortical tubers. Subependymal nodules were shown in 24 of 29 people and the gradient echo T(2)* sequence showed that pathology best in all 24 cases.


CONCLUSIONS
Our study shows that single-shot fast spin echo sequences do not sufficiently show the expected intracranial complications of tuberous sclerosis complex and should not be considered as an alternative to standard sequences in this group. Cortical tubers are shown exceptionally well on FLAIR images, whereas subependymal nodules (and calcified tubers) are best shown on gradient echo T(2)* images.
Griffiths
Paul D
PD
Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom. p.griffiths@sheffield.ac.uk
Hoggard
Nigel
N
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D001921:Brain / Q000473:pathology*; D002114:Calcinosis / Q000175:diagnosis / Q000473:pathology; D002540:Cerebral Cortex / Q000473:pathology; D017352:Echo-Planar Imaging / Q000379:methods / Q000706:statistics & numerical data; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012015:Reference Standards; D014402:Tuberous Sclerosis / Q000175:diagnosis / Q000473:pathology*