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MR imaging of periventricular leukomalacia in childhood
1Department of Radiology, University of British Columbia Children's Hospital, Vancouver, Canada.
Abstract:
Eight children with clinical and radiologic abnormalities consistent with periventricular leukomalacia were investigated with MR imaging of the brain that employed both inversion-recovery and T2-weighted spin-echo imaging sequences. The more precise delineation of white and gray matter on inversion-recovery images as compared with CT allows a detailed demonstration of the anatomic features of periventricular leukomalacia; specifically, a reduced quantity of white matter in the periventricular region and centrum semiovale and, in more severe cases, cavitated infarcts that replace the immediate periventricular white matter. The T2-weighted spin-echo and short inversion time inversion-recovery images demonstrated abnormally increased signal in white matter that appeared normal on CT scans and only minimally abnormal on conventional inversion-recovery images. These abnormalities most probably represent white matter gliosis that extends beyond the immediate periventricular regions. MR recognition of cerebral white matter abnormalities associated with periventricular leukomalacia may confirm the clinical suspicion of this diagnosis in children with spastic diplegia or quadriplegia.
Insights
Magnetic resonance imaging (MRI) precisely visualizes white matter abnormalities in children with periventricular leukomalacia. This advanced imaging confirms suspected cases, even when CT scans appear normal.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Neuroimaging
Background:
- Periventricular leukomalacia (PVL) is a significant cause of neurological deficits in children, particularly spastic diplegia and quadriplegia.
- Conventional Computed Tomography (CT) has limitations in detecting subtle white matter changes associated with PVL.
Purpose of the Study:
- To evaluate the utility of Magnetic Resonance (MR) imaging, specifically inversion-recovery (IR) and T2-weighted spin-echo sequences, in diagnosing periventricular leukomalacia in children.
- To compare the sensitivity of MR imaging with CT in delineating white matter abnormalities in suspected PVL cases.
Main Methods:
- Brain MR imaging was performed on eight children with clinical and radiological findings suggestive of PVL.
- Utilized both inversion-recovery (IR) and T2-weighted spin-echo (T2-SE) imaging sequences.
- Compared MR findings with CT scans for detailed anatomical assessment of white matter.
Main Results:
- IR sequences provided superior delineation of white and gray matter compared to CT, revealing reduced white matter volume and cavitated infarcts in severe PVL.
- T2-SE and short inversion time IR images identified increased white matter signal abnormalities not apparent on CT or conventional IR images.
- These MR-detected abnormalities likely represent gliosis extending beyond the immediate periventricular regions.
Conclusions:
- MR imaging, particularly with advanced sequences, is highly effective in detecting and characterizing cerebral white matter abnormalities in periventricular leukomalacia.
- MR imaging can confirm clinical suspicion of PVL in children, especially those presenting with spastic diplegia or quadriplegia, by revealing subtle or extensive white matter damage.
- The findings highlight MR's crucial role in the diagnosis and management of pediatric white matter disorders.