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MRI with diffusion-weighted imaging in children and young adults with simultaneous supra- and infratentorial manifestations of Sturge-Weber syndrome - 08/03/10

Doi : 10.1016/j.neurad.2009.05.001 
S. Arulrajah a, G. Ertan a, A. M. Comi b, A. Tekes a, D. L. Lin c, T. A.G.M. Huisman a,
a Divisions of Pediatric Radiology, Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 North Wolfe Street, Nelson Basement, 173, Baltimore, MD 21287-0842, United States 
b Division of Neurology and Developmental Medicine, Kennedy Krieger Institute, Departments of Neurology and Pediatrics, Johns Hopkins School of Medicine, Baltimore, United States 
c Divisions of Pediatric Radiology and Neuroradiology, Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, United States 

Corresponding author.

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Summary

Background and purpose

Patients with Sturge-Weber syndrome (SWS) may present with neurological symptoms or neurocognitive deficits that cannot always be explained by the supratentorial findings seen on conventional MRI. Purpose of our study was to determine (a) what percentage of children with SWS have simultaneous supra- and infratentorial involvement and (b) what kind of infratentorial lesions are seen. In addition, we used DWI data to measure the ADC-values of normal appearing white matter (NAWM) to rule out impaired or delayed white matter maturation.

Material and methods

Fifteen SWS patients who underwent MRI/DWI between January 2000 and August 2008 were studied. Images were retrospectively reviewed by two experienced pediatric neuroradiologists. ADC measurements of the NAWM were performed at multiple locations within the brain. ADC-values were compared with normative data and with 18 matched normal controls from our hospital.

Results

Infratentorial involvement was seen in six out of 15 patients (40%). Cerebellar lesions included leptomeningeal enhancement, atrophy and developmental venous anomaly. ADC-values were increased in the NAWM of the frontal, parietal and occipital lobes of both hemispheres and in the pons. The ADC-values of the cerebellar white matter were increased in six out of eight affected cerebellar lobes.

Conclusion

Infratentorial involvement of SWS is more frequently than previously thought. ADC analysis of the NAWM reveals impaired/altered white matter maturation distant from the area of leptomeningeal angiomatosis. This may explain neurocognitive deficits. ADC analysis of the NAWM may serve as biomarker of tissue injury and therefore guide treatment options.

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Keywords : Surge-Weber, Myelination, Cerebellum, Diffusion-weighted imaging, Children


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© 2009  Elsevier Masson SAS. Reservados todos los derechos.
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