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Brain MRI features and scoring of leukodystrophy in adult-onset Krabbe disease
Louis Cousyn1, Bruno Law-Ye2, Nadya Pyatigorskaya2
1From the Department of Neurology, Reference Center for Lysosomal Diseases, UF Neuro-Genetics and Metabolism (L.C., R.D., Y.N.), and Department of Neuroradiology (B.L.-Y., N.P., D.L.), Pitié-Salpêtrière Hospital, Paris; Service de Biochimie et Biologie Moléculaire Grand Est (R.F., M.P.), Unité Médicale Pathologies Métaboliques, Erythrocytaires et Dépistage Périnatal, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Bron; UMR 5305 CNRS/UCBL (R.F.), Lyon, France; Department of Medicine, Surgery and Neurosciences (A.F., S.S.), Unit of Neurology and Neurometabolic Diseases, Medical School, University of Siena; Neuroradiology Unit (A.C.), Azienda Ospedaliera Universitaria Senese, Siena, Italy; Department of Neurology (M.C.M., J.D.), Coimbra Hospital and University Centre, Portugal; Department of Neurology (S.H.K.), College of Medicine, Hanyang University, Seoul, Korea; Division of Neurology (H.A.), Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan; Department of Neurology (B.A.), La Timone Hospital; Aix-Marseille University (B.A.), CNRS, CRMBM UMR, Marseille; Department of Neurology (X.A.), Montpellier University Hospital, France; Department of Neurology (Y.D.), Xuan Wu Hospital, Capital Medical University, Beijing, China; Department of Neurology (R.H.), Royal Brisbane Hospital, Brisbane, Australia; Laboratory of Neurogenetics of Motion and Department of Neuroradiology (R.L.P.), Montréal Neurological Institute and Hospital, McGill University, Montréal; Department of Radiology (C.L.), Department of Pathology and Laboratory Medicine (C.L.), International Collaboration on Repair Discoveries (ICORD) (C.L.), Department of Physics and Astronomy (C.L.), and Division of Endocrinology, Department of Medicine (S.M.S.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.N.), Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan; Department of Radiology (R.R.), Uppsala University, Sweden; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Eberhard-Karls-University; German Center of Neurodegenerative Diseases (DZNE) (L.S.), Tübingen, Germany; Department of Neurology (F.V.), Caen-Normandie University Hospital, Caen; Inserm U1077 (F.V.), EPHE, Caen-Normandie University, Caen, France; and Department of Neurology and Stroke (K.J.), Medical University of Lodz, Poland. louis.cousyn@gmail.com.
Objective:
To perform a systematic analysis and scoring of brain MRI white matter hyperintensities (WMH) in adult-onset Krabbe disease.
Methods:
We retrospectively collected basic clinical data and the first available brain MRI from patients with confirmed Krabbe disease with first clinical manifestations beyond 10 years of age. Data were obtained from our reference center for lysosomal diseases (n = 6) and from contacted authors of published articles describing patients with adult-onset Krabbe disease (n = 15). T2-weighted fluid-attenuated inversion recovery images of each patient were analyzed and scored using a radiologic score of WMH in a single center.
Results:
The corticospinal tract was always affected by WMH (100% of patients), however, with some distinctions along the tract: the precentral gyrus (100%), corona radiata (95%), and posterior internal capsule (81%) were highly abnormal, whereas the mesencephalon (57%), pons (52%), and medulla oblongata (5%) were less affected. WMH were also frequently present in the posterior lateral periventricular white matter (95%), optic radiations (86%), postcentral gyrus (71%), medial lemniscus (62%), and corpus callosum, especially in the isthmus (71%), whereas the genu was always normal. A few patients did not have the classical MRI pattern but extensive hyperintensities (n = 3), or patchy distribution of hyperintensities mimicking an acquired etiology (n = 2), or very subtle hyperintensities of the corticospinal tract (n = 1).
Conclusions:
We specified the main locations of WMH, which were observed in the earliest stages of the disease and were also present in patients with atypical MRI pattern, highlighting the importance of radiologic features to guide the diagnosis.
Insights
Brain MRI white matter hyperintensities (WMH) in adult-onset Krabbe disease show specific patterns. The corticospinal tract is consistently affected, aiding diagnosis even with atypical MRI findings.
Area of Science:
- Neurology
- Radiology
- Genetics
Background:
- Krabbe disease is a rare lysosomal storage disorder.
- Adult-onset Krabbe disease presents with neurological symptoms.
- White matter hyperintensities (WMH) on MRI are a key imaging finding.
Purpose of the Study:
- To systematically analyze and score brain MRI white matter hyperintensities (WMH) in adult-onset Krabbe disease.
- To identify characteristic WMH patterns in adult-onset Krabbe disease.
- To evaluate the diagnostic utility of WMH in this patient population.
Main Methods:
- Retrospective collection of clinical data and brain MRIs from adult-onset Krabbe disease patients.
- Analysis of T2-weighted fluid-attenuated inversion recovery MRI sequences.
- Scoring of WMH using a standardized radiologic score.
Main Results:
- The corticospinal tract was universally affected by WMH (100%).
- Specific areas like the precentral gyrus (100%) and corona radiata (95%) showed high abnormality.
- WMH were also frequent in periventricular white matter (95%) and optic radiations (86%).
- Some patients presented atypical WMH patterns, including extensive or patchy distributions.
Conclusions:
- Specific WMH locations are characteristic of adult-onset Krabbe disease, even in early stages.
- Radiologic features, including WMH patterns, are crucial for guiding the diagnosis of Krabbe disease.
- Understanding WMH distribution aids in differentiating Krabbe disease from acquired etiologies.
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