title: Brain MRI diffusion-weighted imaging in patients with classical phenylketonuria.
abstract: BACKGROUND
  The aim of this study was to grade magnetic resonance white matter abnormalities (WMAs) of classical phenylketonuria (cPKU) patients treated from birth and to compare sensitivity and specificity of T2-weighted and diffusion-weighted images (DWI).
  
  
  METHODS
  Twenty early-treated cPKU patients still on a low-phenylalanine diet (12 males; mean age 21.2 years) and 26 normal subjects (ten males; mean age 25.1 years) were enrolled. Typical T2- and diffusion-weighted WMAs were semiquantitatively graded according to Thompson score (TS). Besides, a regional magnetic resonance imaging (MRI) score (mTS) was developed according to extension and intensity of WMAs. Phenylalanine and tyrosine plasma concentrations before performing MRI and the amino acid mean levels collected the year before MRI (Tyr(year) and Phe(year)) were measured.
  
  
  RESULTS
  No patient with Phe(year) concentration below 460 mumol/L showed WMAs. In cPKU patients, TS and mTS were significantly higher on DWI than on T2 images (3.50 vs 2.65 and 23.65 vs 15.85, respectively, p < 0.002, Wilcoxon test). All controls were scored 0 on DWI, while in T2 images, TS and mTS were 0.19 and 1.70. DWI evaluated by mTS disclosed a frontotemporal, occipital, and parietal WM progressive involvement. TS and mTS, both on T2 images and on DWI, showed no correlation with tyrosine while they proved to have a strong correlation with phenylalaninemia and an excellent one with Phe(year) levels.
  
  
  CONCLUSIONS
  Among the different MR sequences, DWI seems to be the most sensitive and reliable in detecting and grading the typical WMAs of cPKU patients.
authors: Neuroradiologic Unit, University Hospital of Padua, Padua, Italy.
authors: Renzo
authors: R
authors: Manara
authors: Alessandro P
authors: AP
authors: Burlina
authors: Valentina
authors: V
authors: Citton
authors: Mario
authors: M
authors: Ermani
authors: Francesco
authors: F
authors: Vespignani
authors: Carla
authors: C
authors: Carollo
authors: Alberto B
authors: AB
authors: Burlina
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology*; D002648:Child; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D010661:Phenylketonurias / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult